21/279. Treatment of cervical cord compression, caused by hereditary multiple exostosis, with laminoplasty: a case report. STUDY DESIGN: Case report. OBJECTIVES: Successful excision of the exostosis within the spinal canal. SUMMARY OF BACKGROUND DATA: Myelopathy caused by exostosis within the spinal canal developed in a 13-year-old boy with hereditary multiple exostosis. methods: Spinous process-splitting laminoplasty with an ultrasonic knife was performed to remove the mass and minimize the possibility of postlaminectomy kyphosis. RESULTS: The spinal canal exostosis with cervical cord compression was excised successfully with laminoplasty. After surgery there has been no recurrence of tumor, and the stability of the cervical spine has been preserved. CONCLUSION: This is the first report of laminoplasty as a useful surgical approach for intraspinal exostosis to prevent postoperative cervical instability. ( info) |
22/279. osteochondroma of the C5 lamina with cord compression: case report and review of the literature. STUDY DESIGN: Case report of a solitary osteochondroma of the cervical spine causing myelopathy in a 66-year-old woman. OBJECTIVES: To review the relevant literature and describe a highly unusual clinical manifestation of solitary osteochondroma. SUMMARY OF BACKGROUND DATA: Osteochondromas are common benign bony lesions that seldom occur in the axial skeleton. These lesions are more commonly reported with neural compression in cases of hereditary multiple exostoses (Bessel-Hagel syndrome, diaphyseal aclasis). methods: Chart review, review of relevant radiographic examinations and histopathologic specimens, clinical follow-up with examination, and literature review. RESULTS: Manifestation with new neurologic deficit in a 66-year-old patient was singular. CONCLUSIONS: Osteochondromas are unusual in the axial skeleton, and are rarely signaled by neural compression. Occurrence is generally in young adults in the second and third decades. Initial manifestation with a new neurologic deficit in a 66-year-old patient was highly unusual. ( info) |
| A new case with 14-year follow-up of an extremely rare variety of congenital hand macrodactyly is presented. The disease characteristically presents a diffuse proliferation of fibrofatty tissue, but in this special type, osteocartilaginous deposits around the joints can also be found. The case presented included the troublesome feature of a lipofibromatous hamartoma in the median nerve at the wrist and its branches producing carpal tunnel syndrome. The patient obtained benefit from carpal tunnel release and epineurolysis. The hyperostotic development was managed with conservative resection of the periarticular osteochondromas. The literature reviewed suggests that the hyperostotic cases of macrodactyly do not differ from general cases of this congenital condition, except for the osteochondral deposits. These tumours develop during adulthood or after previous trauma, before epiphyseal closure. ( info) |
24/279. Pseudoaneurysm of the popliteal artery caused by exostosis of the femur: case report and review of the literature. A 13-year-old boy with a solitary exostosis of the left femur was seen with a pseudo-aneurysm of the popliteal artery. When left leg pain occurred 3 months earlier, radiographic examination revealed an exostosis with a cartilage cap. Serial radiographic examination demonstrated gradual disruption of the cartilage cap of the exostosis as the pseudoaneurysm developed. An exostosis with an irregular surface was found at surgery. A literature review disclosed 39 similar cases in which loss of the cartilage cap was considered as one of the causes of the aneurysm formation. Considering the clinical course of our patient, however, we believe that exostoses lose their cartilage caps by pressure destruction due to the aneurysms. It is highly probable that loss of the cartilage does not cause the aneurysms. ( info) |
| osteochondroma of the pubic symphysis is a rare benign skeletal tumor. We report here a case of an osteochondroma of the pubic symphysis associated with a sexual disturbance, where a computed tomography scan clearly showed a tumor lesion of the pubic symphysis. The case is reported not only because of its rarity but also because it is important that gynecologists should bear this disease in mind, since a patient with this tumor may not visit an orthopedist but a gynecologist. ( info) |
26/279. Cervical myelopathy due to an osteochondroma in a 73-year-old female. The oldest case in the literature. An osteochondroma is a common developmental tumor of bone characterized by abnormal peri-physeal ectopic enchondral ossification. This results in a cartilage-capped subperiosteal bony projection, which may be either sessile or pedunculated. These lesions are said to grow until skeletal maturity. The cartilage cap is thought to become thinner as the patient ages beyond skeletal maturity. Apparent growth beyond skeletal maturity may be a sign of malignant conversion, usually to a chondroma. Osteochondromas are usually appreciated in the first decades of life, and are most commonly located in the extremities, usually in the knees, ankles, or wrists. Clinical complaints generally relate to the mass effect of the lesion. Solitary osteochondromas of the axial skeleton are less common and may present with a neurological deficit. We report on such a case, in a woman significantly older than other cases described in the literature. ( info) |
27/279. A solitary osteochondroma of the pediatric thoracic spine: a case report and review of the literature. The objective of this study design is to describe the diagnosis and successful treatment of a pediatric patient with an osteochondroma of the thoracic spine. An osteochondroma is a bone tumor that rarely occurs in the thoracic spine, especially in the pediatric population. A simple painless mass may be the only presenting symptom. The laboratory findings are usually nonspecific. Radiographs may be nondiagnostic in certain cases, and computed tomography is the imaging modality of choice. The diagnosis, treatment, and outcome of a pediatric patient with an osteochondroma of the thoracic spine, including a possible genetic predisposition, are reviewed, along with a complete review of the literature. Anteroposterior and lateral plain radiographs illustrated a well-defined solid mass arising from the posterior elements of the tenth thoracic vertebrae. A computed tomography (CT) scan further delineated that the mass arose from the spinous process with no obvious impingement of the nerve roots. After excision of the lesion, gross pathological and histologic evaluation was consistent with an osteochondroma. The use of CT allowed accurate diagnosis of the osteochondroma. This led to appropriate surgical intervention, resulting in definitive treatment. ( info) |
28/279. Scapular osteochondroma with reactive bursitis presenting as a chest wall tumour. A 32-year-old male presented with a painful, rapidly enlarging chest wall mass. A malignant chest wall neoplasm was suspected. A CT scan was performed which showed a mass extending from under the scapular and an exostosis arising from the anterior surface of the scapular. The mass and exostosis were resected resulting in complete resolution of symptoms. Histological examination showed the mass to be a reactive bursa, with no evidence of neoplasia. ( info) |
29/279. Juxtacortical osteosarcoma. A distinct malignant bone neoplasm. The purpose of this report is the study of a malignant bone tumor of similar histological picture with conventional (intramedullary) osteosarcoma. Contributing factors in the study of juxtacortical osteosarcoma are the clinical, X-ray and histologic pictures. A case of parosteal osteosarcoma in a 28-year-old male is reported. In conjuction with X-ray findings we review the histological characteristics of the tumor through serial sections of the peripheral, central and parosteal parts and the findings are described in detail. In addition to the histological findings, differential diagnosis and prognosis are also discussed. From the general study of the tumor it has been shown that juxtacortical osteogenic sarcoma behaves differently in contrast to classic osteosarcoma, depending on the degree of differentiation of the tumor. ( info) |
30/279. Severe extensor tendon attrition and multiple tendon ruptures resulting from Kienbock's disease. Kienbock's disease is a rare but recognized cause of chronic wrist pain. Occasionally, complications arise leading to tendon rupture. The authors present the first reported case of attrition to all extensors of the hand, and extensor tendon rupture to the little finger in a patient with a 45-year history of Kienbock's disease. This is also the first reported incidence of this complication in whites. Clinical features, surgical management, and the successful outcome are discussed. ( info) |