Solitary osteochondroma of the twelfth rib with intraspinal extension and cord compression in a middle-aged patient

<p>Abstract</p> <p>Background</p> <p>Osteochondroma is a disease of growing bone and thus typically presents in younger patients. It has rarely been described in middle-aged and elderly patients. Data on the occurrence of osteochondroma show that the reported incidence of costal osteochondroma is very low. Moreover, costal osteochondroma arising at the costovertebral junction with neural foraminal extension and spinal cord compression is extremely rare.</p> <p>Case presentation</p> <p>This study reports the case of a 58-year-old patient with a solitary osteochondroma of the 12th rib with intraspinal extension and spinal cord compression. The clinical history, plain radiographs, computed tomography (CT), magnetic resonance imaging, and pathologic findings of the reported patient have been reviewed. The relevant medical literature has also been reviewed. The patient was treated with surgery for complete tumour excision to avoid tumour recurrence. After surgery, the patient's symptoms improved. An additional CT scan obtained at 1 year after surgery did not show any evidence of recurrence.</p> <p>Conclusions</p> <p>This patient is the oldest patient reported to have this rare form of costal osteochondroma. The age of the patient and the erosion of the adjacent bones raised clinical suspicion of malignancy; therefore, surgical management involved complete tumour excision with thoracolumbar fixation and fusion.</p

The Relationship between Serum Level of Osteoprotegerin and Post-laminectomy Epidural Fibrosis in Rabbit

Abstract: Background & Aims: Epidural fibrosis (EF) is part of natural physiological tissue response to laminctomy and it may be an important cause of failed back surgery syndrome (FBSS). There is still no effective medical or surgical therapy for EF. Osteoprotegerin (OPG) is a soluble member of the tumor necrosis factor receptor family that might play a role in postoperative EF. The objective of this study was to evaluate the relationship between serum OPG level and EF after laminectomy. Methods: Sixty rabbits were employed and divided randomly into two groups. Group A contained 20 rabbits as controls and group B contained 40 rabbits that underwent bilateral laminecyomy at L4 and L5 lumbar levels under an approved surgical protocol. Serum sample was obtained after 8 weeks from all rabbits and then the animals in group B were killed in accordance with the guidelines for euthanasia. The spine segment from L3 to L6 was removed en bloc. The amount of scar tissue at the laminectomy defect was scored on an ordinal score from 0 to 3 with a scoring system similar to that of He et al. According to the amount of scar the rabbits in group B, were divided into two groups: B1 with low fibrosis (grade 0, 1) and B2 with high fibrosis (grade 2, 3). The serum OPG level of groups A, B1 and B2 were determined using ELISA method. The one way ANOVA was used to assess significant difference among groups. Results: Serum OPG level ranged from 0-4 Pmol/l_with a median of 1.5 Pmol/l in group A, 0-6 Pmol/l with a median of 2.42 Pmol/l n group B1 and 0-6 Pmol/l with a median of 2.15 Pmol/l in group B2. There was not any significant difference in OPG levels among these 3 groups. Conclusion: This study showed no relation between OPG level and existence of postlaminectomy EF after 8 weeks. Keywords: Osteoprotegerin, Fibrosis, Epidural space, Laminectom

The effect of Gel Foam on post laminectomy epidural fibrosis in rabbits

&quot;nBackground: Epidural fibrosis (EF) is a part of normal physiological tissue response to laminectomy and it may be an important cause of failed back surgery syndrome (FBSS). The objective of this study was to evaluate the effect of using gel foam after laminectomy on reduction of epidural fibrosis. &quot;nMethods: In this prospective study forty five rabbits were recruited. The cases undergone bilateral laminectomy at the L4 and L5 lumbar levels under an approved surgical protocol. After eight weeks the rabbits were sacrificed and the spinal segments from L3 to L6 were removed en bloc. The amount of scar tissue at the laminectomy defect was scored. The fibroblast and inflammatory cell counts were also compared between two groups. &quot;nResults: In this study 55% of group A rabbits were placed in grade 0 or I, grade II fibrosis could be detected in the remaining 45%. In group B these amounts were 73.7% and 26.3% respectively, which no significant statistical difference could be detected between two arms (p=0.189). Comparing the quantity of fibroblasts 40% of group A rabbits were recognized as grade I and the other 60% as grade II and grade I fibrosis was discovered in 42.1% of group B rabbits, while other 57.9% suffered from grade II fibrosis, again no significant statistical difference could be attributed between two arms (p=0.576). Also comparing inflammatory cell counts detected in the specimens no significant statistical difference could be detected either (p=0.465). &quot;nConclusion: According to this study using gel foam during the laminectomy surgery in rabbits has no obvious effect in reducing post laminectomy epidural fibrosis after eight weeks of follow-up

Osteochondroma of foramen magnum: a case report

&quot;n 800x600 Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman","serif";} Background: Osteochondroma is a common tumor of the skeletal bone and is a common benign tumor of the bone constitutes 10-15% of all and 20-50% of the benign bone tumors. The lesion is an exophytic bony protrusion covered by a cartilaginous cap. It is most commonly found in long bones, and especially at the epiphysis. Nearly 40% of cases are seen around the knee joint. Osteochondroma rarely affect skull bones, occurrence of an intracranial osteochondroma is a rarity in the neurosurgical literature and only anecdotal reports are available in the literature. To our knowledge no case arising from foramen magnum has been reported. &quot;n&quot;nCase presentation: We present a 73 years old male with gait problem and limb paresis. Imaging investigation showed a bony mass in the foramen magnum, that compresses neural elements. The patient also complained of persistent headache in his occipitocervical region. There was no history of previous trauma. The patient underwent surgery and histopathological examination confirmed the lesion to be osteochondroma.&quot;n&quot;nConclusion: Many types of lesion may be seen in foramen magnum area, and in differential diagnosis of such lesion rare, osseous tumors such as osteochondroma should be considered

Radilogic evaluation of pedicle lumbar and spinal canal dimensions in north-west of Iran using computed tomography

&quot;n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Pedicular screws are currently the gold standard of internal fixation of spinal column. Pedicular screws have their own complications, however the surgeon should be aware of morphometery of pedicles, as well as the anatomy of surrounding neural structures to minimize these risks. No national study has ever examined the physical characteristics of lumbar pedicles and this study is unique for this purpose.&quot;n&quot;nMethods: This study covers the patients undergoing lumbar spinal CT-scanning due to variable causes. 25 vertebrae were selected in either gender, 18 years or older and E-Film computer software was employed to measure different diameters of pedicle and the results were analyzed with p&amp;le;0.05 regarded as significant.&quot;n&quot;nResults: L5 pedicle was the widest (16.8 mm), while L1 was the narrowest (8.25 mm). this figure was 8.82, 10.48 and 12.86 mm for L2, L3, L4 respectively. Longitudinal depth of pedicle was 47.98, 48.68, 50.42, 48.32 and 47.8 mm for L1, L2, L3, L4, L5 respectively. Statistically significant differences were found between some dimensions detected in our study and similar studies.&quot;n&quot;nConclusions: The advantages of pedicular screws and rods to stabilize spinal column are well known. To avoid neurological complications, an understanding of anatomy and pedicle orientation is mandatory. The shape and diameters of pedicles are different base on races. Some differences were found in our study regarding pedicle dimensions

Effects of epidural injection of glucocorticoid and its combination with bupivacaine in palliating chronic low back pain due to discopathy

Chronic low back pain is defined as consistent or pendulous pain over 3 months. Epidural steroid injections (ESI) are common in treatment of chronic back pain. The present study was aimed to investigate the effects of epidural injection of glucocorticoid and bupivacaine compared to glucocorticoid alone in relieving chronic back pain due to discopathy. A randomized clinical trial was performed in the Shohada Medical Educational Center, Tabriz, Iran. Patients with chronic back pain who were candidates for epidural drug injection were recruited. They were divided into two groups of steroids or steroid and bupivacaine. Pain intensity, Oswestry Disability Index (ODI), Straight Leg Rising (SLR) test as well as clinical variables were evaluated before treatment and 3th month thereafter. Overall, 17 males and 23 females with a mean age ± SD of 47.54 ± 12.11 years were enrolled in two equal groups. No significant difference was observed between two groups in terms of gender and body mass index. In both groups, a significant relationship was observed for ODI (p =0.001), pain intensity (p =0.001), and SLR test (p=0.001) before and after treatment. However, the corresponding association was not observed for ODI, pain intensity and SLR test (p>0.05). Epidural steroid injections either alone or combined with Bupivacaine with no priority are effectively relief chronic low back pain due to discopathy