Osseous erosion by herniated nucleus pulposus mimicking intraspinal tumor: a case report

Yoshioka, Shinji; Sairyo, Koichi; Sakai, Toshinori; Tamura, Tatsuya; Kosaka, Hirofumi; Yasui, Natsuo

doi:10.1007/s10195-010-0119-6

Cited by 3 publications

(3 citation statements)

References 17 publications

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“…The conservative therapy for intradural extramedullary schwannoma is limited with lasting effects noted in only a small number of cases [3]. Surgical intervention should be used when conservative therapy fails or in cases of initial signs of sensory and motor loss [4], [5].…”

Section: Introductionmentioning

confidence: 99%

Treatment Results in the Differential Surgery of Intradural Extramedullary Schwannoma of 110 Cases

et al. 2013

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Study DesignA retrospective study of intradural extramedullary schwannoma.ObjectiveThe purpose of this study was to compare treatment results in the differential surgery of intradural extramedullary schwannoma.BackgroundA reference guide to the surgical procedures available to treat intradural extramedullary schwannoma has not yet been established.MethodsThe study retrospectively reviewed 110 patients: Group A: laminectomy+microscopic excision; Group B: hemilaminectomy+microscopic excision; Group C: laminectomy+microscopic excision+pedicle screw fixation. Researchers selected patients for this retrospective review by applying the following criteria: 1) back pain spread out from the tumor level, sensory and motor loss; 2) treatment by surgery; 3) clinical diagnosis made by physical examination, magnetic resonance imaging (MRI), and pathology; 4) a minimum clinical and radiologic follow-up of 12 months. The clinical outcomes were assessed by comparing the Visual Analogue Pain Scores (VAS) and the Japanese Orthopedic Association Scores (JOA score). The study also performed a cost-effectiveness analysis.ResultsCervical vertebrae: The estimated blood loss in Group B was significantly less than in Group C (P<0.05) (Table 1). Thoracic vertebrae: The duration of hospital stay and estimated blood loss in Group A was significantly less than in Group C (P<0.05) (Table 2, 3). Lumbar vertebrae: The resection rate in Group C was significantly higher than in Group A and Group B (P<0.05) (Table 4). Treatment in Group B was the least expensive, and therefore, the most cost-effective.ConclusionIn the case of appropriate surgical indications, the study suggests that hemilaminectomy+microscopic excision is advantageous in the removal of cervical schwannoma, and that laminectomy+microscopic excision is advantageous in the removal of thoracic schwannoma; lumbar intradural extramedullary schwannoma can be managed by laminectomy+microscopic excision+pedicle screw fixation.

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Section: Introductionmentioning

confidence: 99%

Treatment Results in the Differential Surgery of Intradural Extramedullary Schwannoma of 110 Cases

et al. 2013

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“…In addition, dumbbell tumors with a dilated intervertebral foramen due to neurogenic tumors (e.g., schwannomas, neurofibromas, and meningiomas) have been widely reported [ 19 , 20 ]. Benign intraspinal lesions, such as perineural (Tarlov) cysts and herniated discs, are also known to cause vertebral scalloping [ 21 – 23 ]. Vertebral scalloping due to chronic SEHs is extremely rare, with only two cases having been previously reported in the English literature [ 2 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

Chronic spontaneous epidural hematoma in the lumbar spine with cauda equina syndrome and severe vertebral scalloping mimicking a spinal tumor: a case report

Fukatsu

Ogihara

Imada

et al. 2022

BMC Musculoskelet Disord

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Background Chronic spinal epidural hematomas (SEHs) are rare clinical entities. SEH with vertebral scalloping is extremely rare, with only a few cases having been reported to date. We report a unique case of spontaneous chronic SEH in the lumbar spine with severe vertebral scalloping mimicking an epidural tumor. Case presentation A 71-year-old man presented with a 2-month history of lumbar pain and a 3-week history of paresthesia and pain in the right lower extremity, hypesthesia in the perineal and perianal regions, and bladder dysfunction. Computed tomography following myelography revealed an epidural mass lesion on the right side that compressed the dural sac and was associated with severe bony scalloping on the posterior wall of the L4 vertebral body. Magnetic resonance imaging (MRI) on T1- and T2-weighted images revealed a space-occupying lesion with heterogeneous intensity, and T1-gadolinium images showed an intralesional heterogeneous enhancement effect. A tumoral lesion in the spinal canal was suspected, based on preoperative imaging; therefore, a total spinal tumor resection was planned. Intraoperative findings revealed that the brownish lesion adhered to the dura and epidural tissues in the spinal canal, and the space-occupying mass in the scalloped cavity of the posterior wall of the L4 vertebra was encapsulated in red-brownish soft tissues. The lesion was totally resected in a piecemeal fashion, and pathological examination revealed a mixture of tissues that contained a relatively new hematoma with hemoglobin, as well as an obsolete hematoma with hemosiderin and amyloid deposits. The mass was diagnosed as a chronic epidural hematoma with recurrent hemorrhage. The postoperative course was uneventful, and the preoperative neurological symptoms immediately improved. Conclusions The preoperative diagnosis of chronic SEHs is challenging, as MRI results may not be conclusive, particularly in patients with scalloping of bony structures. Thus, chronic SEHs should be considered as a differential diagnosis in cases of suspected tumoral lesions in the spinal canal. To the best of our knowledge, this is the first reported case of acute exacerbation of chronic SEH with cauda equina syndrome and severe vertebral scalloping.

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“…The first strategy was laminectomy, the spinal cord was released and the tumor was removed [28], [29]. Based on the laminectomy, but less radical, was the hemilaminectomy, which only removed the hemi-lamina [30], [31]. Relief of the strangulated spinal cord can be obtained by removing the lamina, which at the same time removes the tumor and also prevents neurological deterioration.…”

Section: Discussionmentioning

confidence: 99%

Workshop 1: The 3rd international workshop on information security, theory and practice (ISTP-2013)

Zeng

Zong

et al. 2013

2013 IEEE Third International Conference on Information Science and Technology (ICIST)

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Conservative therapy for intraspinal tumor is mentioned very often in the literature. However, there is no clear reference on surgical method choices for intraspinal tumors. Therefore, we conducted a systematic review to investigate the difference of preoperative and postoperative symptoms between the hemilaminectomy (HEM) and laminectomy (LAM) on intraspinal tumor. A computer based online search of the computerized data bases MEDLINE and PUBMED and EMBASE and ISI Web of Science for articles published from 1970 to January 2011 was performed. Studies that compared hemilaminectomy with laminectomy were included. Data were evaluated by RevMan 5.0 for the systematic review. Six eligible trials including 409 intraspinal cases were considered.The systematic review indicates that hemilaminectomy was more efficient in the improvement of early symptoms than laminectomy. The combined odds ratios (OR) were 2.82, with 95% confidence intervals (CIs) (1.75-4.54). The systematic review indicates that hemilaminectomy was more efficient than laminectomy in the improvement of advanced symptoms. The combined OR was 2.42, with 95% CI (1.56-3.74). In the case of appropriate surgical indications, the choice of hemilaminectomy was better for improving symptoms as cerebrospinal fluid leakage, infection, poor circulation and other possible complications for patients with intraspinal tumor.

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Osseous erosion by herniated nucleus pulposus mimicking intraspinal tumor: a case report

Cited by 3 publications

References 17 publications

Treatment Results in the Differential Surgery of Intradural Extramedullary Schwannoma of 110 Cases

Treatment Results in the Differential Surgery of Intradural Extramedullary Schwannoma of 110 Cases

Chronic spontaneous epidural hematoma in the lumbar spine with cauda equina syndrome and severe vertebral scalloping mimicking a spinal tumor: a case report

Workshop 1: The 3rd international workshop on information security, theory and practice (ISTP-2013)

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