Delayed perforation of posterior pharyngeal wall caused by dislodged bioresorbable interbody cage. Case report

A 48-year-old man was admitted for the management of congenital anomalies: Arnold–Chiari type I malformation combined with odontoid upward migration. He also had degenerative stenosis of the spinal canal by spurs at C2/C3 and C3/C4 levels. Osseous deformities caused ischaemic changes of the brainstem as well as spinal cord compression. Authors used the Biocage – interbody cage covered by bioresorbable layer to fill the surgically created gap after removal of the right part of C3 vertebral body. Twenty-seven months after implantation, the implant was extruded through posterior pharyngeal wall. Authors describe this unusual case and discuss possible causes of Biocage extrusion

Neurofibromatosis type 2 (NF 2) or schwannomatosis? – Case report study and diagnostic criteria

Introduction Neurofibromatosis type 2 (NF2) and schwannomatosis are entities that may, due to the similarity of clinical symptoms, cause diagnostic difficulties. Incidence rate of both diseases is similar and estimated between 1:25,000 and 1:40,000. The genes associated with the development of the aforementioned disorders are located on chromosome 22 and lay in proxmity. Schwannomatosis is characterized by an incomplete penetrance and the risk of its transmission to the offspring is significantly lower than in the case of NF 2. Schwannomatosis clinical characteristic is similar to the NF2, however vestibular schwannomas are not present. Therefore the imaging studies evaluated by an experienced radiologist play a key role in the diagnostic process. Case report Forty two-year-old female hospitalized three times because of the tumors of the spinal canal was admitted to the Department of Neurosurgery and Peripheral Nerve Surgery in 2008 because of the cervical pain syndrome with concomitant headache. She was diagnosed with a schwannomatosis, recently distinguished, the third form of neurofibromatosis. MRI imaging revealed craniocervical junction tumor. Suboccipital craniectomy with concomitant C1–C2 laminectomy was done in order to remove the lesion. After the surgery the patient did not present any deficits in neurological examination and was discharged from hospital in good general condition. Conclusions The patient was diagnosed with schwannomatosis, recently established neurofibromatosis entity which may resemble NF2 clinically. In patients after the age of 30, in whom we observe multiple schwannomas without the concomitant hearing impairment, the diagnosis of schwannomatosis is very likely

Zastosowanie cementu zawierającego fosforan wapnia do wertebroplastyki podstawy zęba kręgu obrotowego

The authors describe the use of bone cement containing calcium phosphate for vertebroplasty of the cavity in the base of odontoid process. A 23-year-old female patient was operated on by incision in lateral cervical area (anterior open access). After a blunt dissection, the working cannula (Kyphon) was introduced under fluoroscopic guidance through the C2 vertebral body to the cavity in the base of the odontoid process. Intraoperatively biopsy of the lesion was taken and histopathological examination excluded the presence of neoplasm. The cavity, presumably haemangioma, was successfully filled with calcium phosphate bone cement KyphOs™ FS (Kyphon). The proper filling without paravertebral cement leak was confirmed by postoperative computed tomography (CT). The CT and magnetic resonance imaging performed 9 months after the procedure showed that cement was still present in the cavity. This is the first use of calcium phosphate cement to conduct the vertebroplasty of C2 vertebra.Autorzy opisują zastosowanie cementu zawierającego nieorganiczne sole fosforanu wapnia do wertebroplastyki podstawy zęba kręgu C2. Zabieg wykonano u 23-letniej pacjentki. Przez kilkucentymetrowe nacięcie skóry w prawej okolicy bocznej szyi (otwarty dostęp przedni) do trzonu C2 wprowadzono w linii pośrodkowej kaniulę roboczą (Kyphon). Przez kaniulę pobrano materiał do badania histopatologicznego. Po wykluczeniu obecności komórek nowotworowych, do jamistej strefy na granicy trzonu i zęba kręgu obrotowego, określonej jako naczyniak, podano cement KyphOs™ FS (Kyphon). Pooperacyjna tomografia komputerowa (TK) potwierdziła całkowite wypełnienie jamy oraz kanału wytworzonego przez kaniulę; cement nie wydostał się poza kręg C2. Wykonane po 9 miesiącach TK i obrazowanie za pomocą rezonansu magnetycznego potwierdziły obecność cementu w miejscu podania. Jest to pierwsze zastosowanie cementu zawierającego fosforan wapnia do wertebroplastyki w obrębie kręgu C2

Cervical Paraspinal Chordoma: A Literature Review with a Novel Case Report

Chordomas are rare malignant neoplasms, accounting for 1–4% of all primary bone tumors. Most spinal chordomas occur in the sacrococcygeal region and the base of the skull; however, 6% of chordomas are observed in the cervical spine. In these cases, the lesion is mainly located in the midline. These tumors slowly grow before becoming symptomatic and encase the surrounding vascular and nerve structures. Patients with advanced chordoma have a poor prognosis due to local recurrence with infiltration and destruction of adjacent bone and tissues. Systemic chemotherapy options have not been fully effective in these tumors, especially for recurrent chordomas. Thus, new combinations of currently available targeted molecular and biological therapies with radiotherapy have been proposed as potential treatment modalities. Here, the present paper describes the case of a 41-year-old male with a C2–C4 chordoma located paravertebrally, who underwent surgical resection with a debulking procedure for a cervical chordoma. Computed tomography angiography revealed a paraspinal mass with bone remodeling and the MRI showed a paravertebral mass penetrating to the spinal canal with a widening of the intervertebral C2–C3 foramen. Initially, the tumor was diagnosed as schwannoma based on its localization and imaging features; however, the histopathology specimen confirmed the diagnosis of chordoma. This case study highlights the effectivity of radical surgical resection as a mainstay treatment for chordomas, discusses neuroimaging, diagnosis, and the use of currently available targeted therapies and forthcoming treatment strategies, as alternative treatment options for chordoma