BackgroundMeningeal melanocytoma is considered a rare lesion arising from leptomeningeal melanocytes. Nearly two thirds of meningeal melanocytomas were reported in the intracranial compartment and the remaining one third in the spine. Spinal melanocytomas can be extradural or intradural, with extradural variant being more common, and the majority of cases have been single reports.MethodsA 5-year-old male presented with a 4-month history of non-radiating low back pain persistent at rest, with otherwise non-remarkable medical history. The patient was neurologically intact with no deficits. Preoperatively, routine laboratory investigations were non-remarkable. MRI imaging was done and showed a lesion at the level of T11 to L4, hyperintense on T1 and hypointense on T2 with homogenous contrast enhancement. Intraoperatively, the lesion was hemorrhagic, brownish, and rubbery in consistency attached to the ventral dura. Microscopic picture revealed dense cytoplasmic brown melanin pigments, with no significant mitoses or nuclear atypia. What is unique about our case is the age of the patient (5 years).ResultsTo the best of our knowledge, after reviewing the literature, this is the youngest case to be reported.ConclusionsSMM is an extremely rare tumor with a benign course. Complete surgical excision should be attempted. Age of presentation may be as young as in our case and the diagnosis of such a tumor should never be excluded in this early age group with persistent low back ache.
BACKGROUND: Surgical treatment for lower limb manifestations of lumbar disc prolapse and lumbar canal stenosis is a standard procedure. However, there is considerable debate about the proper management of associated low back pain. OBJECT:We aimed to assess the outcome of back pain in patients with lumbar canal stenosis after decompression without fusion or instrumentation. METHODS:Fifty patients were included in the current retrospective study. Intraoperative formal laminectomy or minimally invasive unilateral or bilateral laminotomy was done. The back pain and leg pain were evaluated preoperatively and at 6 months postoperatively using the visual analogue scale (VAS). RESULTS:The baseline of low back pain was 6 or more according to the VAS. The mean age of the patients was 50.2 years, 60% of them were males. The mean body mass index (BMI) was 33.36. Single level decompression was done in 44% of the patients, while 56% had 2 or more levels of decompression. The mean preoperative and postoperative back pain according to VAS, were 6.46 and 4.74, respectively, while the mean preoperative and postoperative leg pain according to VAS was 7.48 and 3.5, respectively. CONCLUSION: After a postoperative period of 6 months, low back pain improved significantly after decompression only surgery in patients with lumbar canal stenosis in the absence of spondylolisthesis, sagittal mal-alignment or scoliosis.
BACKGROUND: Sacroiliitis following lumbosacral fixation is an important cause of postoperative low back pain and should be properly diagnosed and managed to improve the short-and long-term postoperative outcomes. OBJECT:We aimed to assess the prevalence of sacroiliitis following lumbar fusion procedures and the possible options of treatment available for such complication. METHODS:In this retrospective cross-sectional study, 100 patients who underwent spinal fusion surgery were included and observed for the next 3 months following surgery to detect postoperative sacroiliitis. RESULTS:One hundred patients aged 23-65 years were included in the current study, with a mean age of 43.1±5.7 years. Fifty seven percent were females and 43% were males. Forty-seven patients (47%), 22 females (46.8%) and 25 males (53.2%), experienced sacroiliitis after a duration of 23.7 to 71 days post-operative with a mean of 33.8±1.7 days post-operative. Muscle relaxants and non-steroidal anti-inflammatory drugs (NSAID) were prescribed to all patients; 26 out of 47 patients (55%) responded well to medical treatment for 28 days with reduction of pain visual analogue scale (PVAS) from 7.3±2.1 to 3.3±1.4. In 21 patients (45%), medical treatment failed and physiotherapy sessions were added to medical treatment for 28 days with improvement of PVAS from 6.5±1 after 28 days medical treatment to 2.9±1.9 after medical treatment plus physiotherapy sessions. Five patients needed intra-articular steroid injection with further improvement of PVAS to <1. CONCLUSION:Sacroiliitis is an important cause of low back pain post lumbar fixation. Sacroiliitis is a frequent complication after lumbar fusion surgery detected in 47% of our study group. It was successfully managed with NSAIDs and physiotherapy in most of the cases.
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