There is a high prevalence of wrong level surgery among spine surgeons; 1 of every 2 spine surgeons may perform a wrong level surgery during his or her career. Although all spine surgeons surveyed report using at least 1 preventive action, the following measures are highly recommended but inconsistently adopted: direct preoperative communication with the patient by the surgeon, marking of the intended site, and the use of intraoperative verification radiograph.

To report a rare case of axis brown tumor and to review literature of cervical spine brown tumor. Brown tumor is a rare bone lesion, incidence less than 5% in primary hyperparathyroidism. It is more common in secondary hyperparathyroidism with up to 13% of cases. Brown tumor reactive lesion forms as a result of disturbed bone remodeling due to long standing increase in parathyroid hormones. Cervical spine involvement is extremely rare, can be confused with serous spine lesions. To date, only four cases of cervical spine involvement have been reported. Three were due to secondary hyperparathyroidism. Only one was reported to involve the axis and was due to secondary hyperparathyroidism. This is the first reported case of axis brown tumor due to primary hyperparathyroidism. A case report of brown tumor is presented. A literature review was conducted by a Medline search of reported cases of brown tumor, key words: brown tumor, osteoclastoma and cervical lesions. The resulting papers were reviewed and cervical spine cases were listed then classified according to the level, cause, and management. Only four previous cases involved the cervical spine. Three were caused by secondary hyperparathyroidism and one was by primary hyperparathyroidism which involved the C6. Our case was the first case of C2 involvement of primary hyperparathyroidism and it was managed conservatively. Brown tumor, a rare spinal tumor that presents with high PTH and giant cells, requires a high level of suspicion.

Background Chondrosarcoma is treated primarily by surgery. The prognosis of patients after local recurrence is not well defined. Both the survival of patients and the risk of further local relapse after surgical treatment of local recurrence have yet to be established. Questions/purposes We determined survival after local recurrence of chondrosarcoma, the rate of further local recurrences, and prognostic factors predicting survival. Patients and Methods We retrospectively reviewed 52 patients treated for locally recurrent conventional chondrosarcoma between 1975 and 2008. All patients had nonmetastatic disease at the time of diagnosis. There were 36 males and 16 females with a median age of 39 years (range, 16-79 years). We analyzed variables affecting overall and disease-free survival. The minimum followup was 12 months unless patients died of disease before 12 months (median, 68 months; range, 4-387 months).Results Thirty patients developed their first local recurrence in axial locations, while 22 developed recurrence in the appendicular skeleton. After local recurrence, overall survival was 74% at 5 years and 60% at 10 years. The mean number of local recurrences was three (range, 1-14).

In a pattern similar to how LRP4 mutations are predicted to negate the protein's antagonistic effect on Wnt/β-catenin signalling, we propose that reduction of APC may increase the availability of β-catenin by virtue of impaired degradation, leading to a similar phenotypic outcome. This is the first time APC is linked to a human phenotype distinct from its established role in oncology.

Patient: Male, 28Final Diagnosis: Intracardial cortoss leakSymptoms: Back painMedication: —Clinical Procedure: KyphoplastySpecialty: Orthopedics and TraumatologyObjective:Diagnostic/therapeutic accidentsBackground:Intracardiac leakage of bone cement after kyphoplasty and vertebroplasty is a rare and life-threatening complication. Cortoss, which is an injectable, non-absorbable, polymer composite that is designed to mimic cortical bone, can be used instead of cement. Here, we present the case of a patient with right intra-cardiac Cortoss embolization.Case Report:A 28-year-old man known to have ulcerative colitis since the age of 15 and treated with corticosteroids for more than 4 years and with anti-immune drugs presented to our hospital complaining of back pain and decreased body height due to osteomalacia with failed conservative treatment. Kyphoplasty and vertebroplasty of the thoracic 10–12 and first lumbar vertebrae were done with any complications. Three months later, the patient underwent kyphoplasty and vertebroplasty of lumbar 2–5 vertebrae by injecting Cortoss instead of cement, which was complicated with paravertebral intravascular leakage. We stopped surgery and transferred him to the recovery room, where he had slight chest pain that resolved spontaneously without neurological deficit.Two days later he developed severe chest pain and chest X-ray showed a large white shadow at the right side of the heart and another 2 small shadows just lateral to it. Sudden deterioration of patient status necessitated an emergency echocardiogram, which showed pericardial tamponade and a perforated right ventricle. Aspiration of pericardial blood and emergency open heart surgery were done. He was discharged 4 days later and was followed up at an outpatient clinic.Conclusions:Cardiac embolism is a serious condition that can complicate vertebral kyphoplasty; it requires a high level of suspicion and immediate action, and may need open heart surgery to save the patient’s life.