Background Patients with Marfan syndrome commonly require spinal deformity surgery. The purpose of this case report is to present a rare thoracotomy complication. We present the management of such a patient. Case summary In a known case of Marfan syndrome, an 18-year-old Persian man was admitted to our hospital with scoliosis. The patient underwent radiological examinations, and thoracic scoliosis of 70° was diagnosed. A right thoracotomy for anterior spinal fusion from the sixth rib and posterior spinal fusion were performed successfully. Two months later, he was readmitted because of winging of the right scapula due to serratus anterior palsy. Electromyography and nerve conduction velocity confirmed long thoracic nerve injury. Conservative treatment was provided. Ultimately, the patient recovered completely in the last follow-up visit 6 months after the surgery. Discussion This is the first report of ipsilateral winged scapula after thoracotomy. Attention needs to be paid to surgical techniques in patients with Marfan syndrome.

Background Primary lymphoma of the spinal vertebrae (PLSV) is an exceedingly rare disease with an unclear optimal treatment plan. We analyzed the clinical features of PLSV in the patient to strengthen our understanding of the disease and to review the literature. Case presentation A 65-year-old Persian man was admitted to our hospital with severe low back pain. The patient underwent radiological examinations including computed tomography (CT) scan, magnetic resonance imaging (MRI), and single-photon emission computed tomography (SPECT). These examinations revealed a lesion in the L3 vertebra. Histological analysis showed a high-grade lymphoma. The patient underwent an L3 corpectomy with expandable cage placement, followed by an L2–L4 lateral screw placement with rod fixation. Also, facetectomy, laminectomy, and total spondylectomy were performed. Pedicle screws were inserted from L1 to L5. Titanium mesh was placed on the post-laminectomy defect. The treatment continued with local radiotherapy and chemotherapy. Post-treatment, the patient showed no new neurological deficit, and in the final follow-up, the patient had achieved a good recovery. Conclusion To our knowledge, no prior published literature has revealed a primary lymphoma of the lumbar vertebrae. Here, we report this case of PLSV for the first time and provide a brief review of the literature.

Background Spinal metastasis from adenoid cystic carcinoma of the salivary gland is extremely rare. We present two interesting cases of spinal metastasis from adenoid cystic carcinoma of the parotid gland. Case summary A 29-year-old Persian male and a 48-year-old Persian female presented with parotid gland mass. The two patients received parotidectomy and radiotherapy. The pathological examination result was adenoid cystic carcinoma. Because of intractable back pain, patients were referred to the hospital after 7 years and 9 months, respectively. Both cases underwent spinal surgery. Histopathology confirmed spinal metastasis from adenoid cystic carcinoma of the parotid gland (case 1: T6, T12, and L1; case 2: T12). Anterior corpectomy of T12 and lateral screw fixation at T11 and L1 were done in case 2. Posterior spinal fusions from T2 to L3 and from T10 to L2 were performed in case 1 and case 2, respectively. Both patients showed good clinical improvement. The last follow-up (case 1: 24 months; case 2: 6 months after surgery), plain radiographs and computed tomography scan showed good fusion without instrumental failure and magnetic resonance imaging revealed good decompression of the spinal cord of both cases. Conclusion Although spinal metastasis from adenoid cystic carcinoma of the parotid gland is extremely rare, it is necessary to be careful in the differential diagnosis.

Simple bone cyst (SBC) is not a common lesion in the spine and especially in the vertebral body. We intend to report two cases of SBC located in the vertebral body, and review the literature. Two cases include a 24 year-old male and 26 year-old male with vertebral body lesion of T12 and L5 vertebrae,retrospectively. Both lesions were found to be SBC and confirmed by pathology. Both cases were managed with surgery, the cavity was filled with bone graft and posterior spinal fusion and instrumentation with pedicle screws, and rods were carried out. There was no recurrence. There have been 21 cases of SBCs in English literature, and only 8 cases have been reported in the vertebral body. SBC is a rare benign lesion in the spine and it should be considered in the differential diagnosis when suggested by radiologic investigations.

Introduction ESR and CRP are nonspecific markers of inflammation, used to evaluate post operative infection. CRP is a predictable consisting of a post operative rise and a peak followed by a decrease toward the normal value. Deviation from normal kinematics may be an indication of infection Material and Methods ESR and CRP collected before surgery – 1 – 3 – 7 – 14 – 30 – 45 days post operative in consecutive patients. All infection and abnormal elevation recorded. 60 patients collected with below criteria's (age – sex – etiology – blood loss –Hb – operation time – ESR & CRP before and after operation- temperature – levels of operation - anatomic area and operation approach). Results CRP increased post operative and then decreased slowly during 30 days post operatively, second rise or failure to decrease was not specific in our study. More than 80% of our patients had CRP & ESR elevated more than 30 days without symptoms and signs of infection. We had one superficial. CRP++ or+++ can be for 30 days and ESR more than 20 mm Hg can be 40 days without early post operative infection in spinal surgery. There were correlation between soft tissue damage (long op time – number of levels – combined ASF & PSF) and increased CRP and ESR. ASF alone had no high rise in CRP. In Lumbar PSF operation CRP riser was more than thoracic – cervical or ASF alone. Conclusion ESR and CRP are not predictable factors for early post spinal surgeries infection diagnosis, but specificity and sensitivity of CRP is higher than ESR, when a second rise will be happen.

Background Copenhagen syndrome (CS) is a rare disorder mostly observed in adolescent. The onset of the disease, with a progressive anterior vertebral ankylosis in the thoracic and/or lumbar areas often clinically revealed by thoracolumbar kyphosis. We report a series of three patients of CS with good outcome. Case presentation The mean age of patients were 14.0 (SD = 3.6) years at admission time. Patients underwent clinical and radiological examination (MRI, CT scan, and bone scan) before surgery and revealed Copenhagen syndrome. Case 2 received conservative treatment braces and regular follow-up. Finally, all patients were treated according to their clinical conditions through a combined surgical approach such as pedicle subtraction osteotomy (PSO), ponte osteotomy, hook, pedicular screw insertion, and fusion. In postoperative follow-up, the deformity correction was achieved with proper alignment in all the cases. Conclusion The treatment of CS with PSO plus ponte osteotomy seems to result in an excellent surgical procedure and outcome for our patients based on deformity severity. Bone scan imaging could be considered as an aid to differential diagnosis, which is an effective method.