Metastatic leiomyosarcoma of the thoracic spine: case report

Leiomyosarcoma is a rare malignant mesenchymal tumor arising from smooth muscle cells. Metastatic spreading is possible, which even rarely metastasize to the bone being the latter localization a delayed manifestation of its natural progression. Spinal metastases represent the most common bone localizations with prevalence in the thoracic and lumbar spine.We present a 55-year-old female, operated there’s 2 years for a hysterectomy of uterine leiomyosarcoma, admitted in our department with a flaccid paraplegia. Spine magnetic resonance imaging showed an extradural mass, iso-intense on T2, enhancing after gadolinium administration; placed at T5-T6 level with a severe cord compression. The patient underwent a decompressive laminectomy T5 and a total removal of the tumor. The histological examination revealed a metastatic leiomyosarcoma.The prognosis of patients with leiomyosarcoma is variable depending on the resectability and existence of metastasis. The essential treatment is surgery but an additional therapy, such as radiotherapy and/or chemotherapy, may be required to improve local control

Rola dynamicznej tomografii komputerowej złącza szczytowo-potylicznego przy ustalaniu postępowania w przypadkach stwierdzenia os odontoideum

Abstract Os odontoideum is an uncommon abnormality of the craniovertebral junction (CVJ) that exists as a separate ossicle apart from a hypoplastic dens. Its genesis and natural history have been debated, and its proper treatment remains uncertain. A 48-year-old woman complained of persistent upper neck pain and paraesthesia of her left side. Magnetic resonance imaging of the CVJ demonstrated an os odontoideum. Dynamic computed tomography scan of the CVJ showed a reduction of the space available for the spinal cord to 50% from extended to flexed position. The patient underwent posterior spinal fusion of C1–C2 using a sublaminar titanium hook and rods fixed in moderate extension. We discuss the usefulness of the dynamic computed tomography (CT) scan in the evaluation of atlantoaxial motion and the management of this pathology.Streszczenie Os odontoideum jest rzadko spotykaną nieprawidłowością złącza szczytowo-potylicznego, w której słabo wykształcony ząb obrotnika tworzy dodatkową kość. Sposób jej powstawania i historia naturalna są przedmiotem dyskusji; istnieje również niepewność co do właściwego postępowania. Czterdziestoośmioletnia kobieta zgłosiła się z powodu utrzymującego się bólu górnej części szyi oraz lewostronnych parestezji. W badaniu złącza szczytowo-potylicznego za pomocą rezonansu magnetycznego uwidoczniono os odontoideum. Dynamiczna tomografia komputerowa tej okolicy wykazała zmniejszanie się przestrzeni dostępnej dla rdzenia kręgowego o 50% podczas zgięcia w porównaniu z prostowaniem szyi. U chorej wykonano tylne zespolenie kręgów C1–C2 za pomocą tytanowego haka i prętów, uzyskując stabilizację szyjnego odcinka kręgosłupa w umiarkowanym wyproście. Autorzy omawiają przydatność dynamicznej tomografii komputerowej (TK) w ocenie ruchomości stawu szczytowo-obrotowego i w leczeniu wspomnianej patologii

Cross-sectional study of recurrent disc herniation risk factors and predictors of outcomes after primary lumbar discectomy: A STROBE compliance

Objectives: The purpose of this study is to determine if lifting weight, smoking status, occupational work, and diabetes were predictors for recurrent lumbar disk herniation (rLDH) leading to reoperation and if the outcome can be influenced by the reoperated level and side. Methods: From June 2010 to July 2019, the 2196 consecutive patients who underwent first-time single-level lumbar discectomy at our institution were revised. Data on first lumbar spine surgery, reoperation as well as preoperative data were brought into the analysis. Multivariate Logistic Regression Analysis was performed to determine whether lifting weight, smoking status, occupational work, and diabetes were predictors for recurrent lumbar disk herniation. The outcome level was assessed by the Multivariable Cox-regression Kaplan–Meier analysis for repeated lumbar disc herniation excision at the L4L5 and L5S1 levels independently. Results: From the 101(4.59%) patients that presented with recurrent lumbar disc herniation (rLDH), 75 cases (3.41%) met the inclusion criteria. There were 54 cases of ipsilateral recurrent herniation and 21 contralateral with a male predominance of 64% (n = 48). The average age at the time of recurrence was 48 ± 9.34 years (age range 29–67 years). The group of diabetes patients who smoke is at high risk (Odds 2.77) of rapid recurrence for lumbar disc prolapse; about 3 months after the first surgery followed by the group of diabetes who lift weight (Odds 0.83), about 4 months after the first surgery. At the L4L5 level, only the group of patients operated for opposite side recurrence (Odd ratio 1.01) did well and were pain-free immediately after surgery compared to the group of patients operated for recurrence on the same side (Odd ratio 6.73). Conclusion: Coexisting diabetes and smoking status in the same patient increase the risk of rLDH and the patient’s outcome is favorable with pain-free after reoperation without the need for physiotherapy when the recurrence is on the same level and opposite side