Unusual presentation of Ewing sarcoma; a case report and literature review.

Introduction and importance Ewing's sarcoma is an aggressive malignancy primarily affecting skeletal system in children and young adults. CASE PRESENTATION: We report an unusual case of Ewing sarcoma in a 14-year-old boy with clinical and radiological features of rapid onset metachronous skeletal metastasis (within 4 weeks of diagnosis). CLINICAL DISCUSSION: Although the deterioration of symptoms was very rapid, it is unusual to note that in the presence of such widespread metastatic disease the lungs per se remained uninvolved. CONCLUSION: We describe a unique case of metastatic Ewing's sarcoma who showed rapid systemic disease progression with widespread skeletal metastases (and CNS involvement) but without any evidence of pulmonary involvement.

Using an Extreme Lateral Interbody Fusion (XLIF) in Revising Failed Transforaminal Lumbar Interbody Fusion (TLIF) With Exchange of Cage.

Minimally invasive techniques have gained popularity in spine surgery in recent years. Extreme lateral interbody fusion (XLIF) is one of these techniques. The rapid increase in the use of this approach in either primary or revision surgeries is related to its several advantages including less operative time, less blood loss and reduced length of hospital stay with fast recovery. We report a case of a failed transforaminal lumbar interbody fusion (TLIF) in L4-L5 level, one year after the primary procedure with persistent pain due to failed fusion. Underwent revision, by using XLIF with the removal of old cage and exchange with new large cage. Revision of failed interbody fusion can be achieved through anterior, posterior or lateral approach. The decision to proceed with either method depends on several factors, including previous surgeries, fibrosis and risk of neurovascular injury and surgeon's preference. XLIF approach should be considered in revision surgeries of failed interbody fusion. As it can provide several advantages compared to anterior or posterior approaches, in terms of better fusion rates and lower risk of neurovascular injuries by avoiding the use of the previous passage.

Psoas Hematoma and Late Femoral Nerve Palsy After Extreme Lateral Interbody Fusion and Posterior Spinal Fusion with Instrumentation: A Case Report.

INTRODUCTION: Psoas hematoma is an uncommon complication following spinal surgeries. It has been reported in both extreme lateral interbody fusion (XLIF) and posterior spinal fusion with instrumentation. Minimally invasive techniques are gaining popularity in recent years due to the appealing advantages of reduced operative time, blood loss, hospital stay, and faster recovery. CASE PRESENTATION: We are presenting a case of a 77-year-old male with chronic low back pain, diagnosed to have multilevel degenerative disc disease with central and foraminal disc protrusion at L2-L3, L3-L4, L4-L5 with secondary spinal stenosis, underwent XLIF at L3-L4, L4-L5 and then 2nd stage with posterior L3-L5 fusion with pedicle screws. On the fourth day post-operatively, the patient had flank pain and dropping hemoglobin with femoral nerve palsy symptoms, a CT scan revealed a large psoas hematoma. Conservative management was decided on; a follow-up CT scan and examination showed complete resolution of the hematoma and femoral nerve recovery. DISCUSSION: The approach to iliopsoas hematoma post spinal surgeries remains controversial. Iliopsoas hematoma should be suspected in any patients post spinal surgeries even with delayed presentations. The decision to proceed with either surgical intervention or conservative management depends on multiple factors, including patient hemodynamic status, progression of collection and femoral nerve palsy. CONCLUSION: The exact cause of iliopsoas hematoma post different spinal surgery approaches remains vague. In our opinion, other causes including pre- and post-operative anticoagulants should be investigated. Rushing to drain iliopsoas hematomas in case of femoral nerve palsy might not be the ideal option. Instead, monitoring patient responses to resuscitation and taking a watch and wait approach for femoral nerve palsy might be the proper approach.

Functional outcomes in bilateral upper limb Amelia patient with scoliosis post vertical expandable prosthetic titanium rib (VEPTR) application: A case report.

INTRODUCTION: Congenital upper limb Amelia is one of the extremely rare conditions in the world. Defined as complete absence of a limb which may present as isolated defect or as a part of syndrome with associated anomalies. PRESENTATION OF THE CASE: We report a case of a medically free 6-year-old boy with bilateral upper limb Amelia associated with right thoracolumbar idiopathic Scoliosis. DISCUSSION: Treatment for early onset scoliosis includes either posterior spinal fusion and instrumentation, or Vertical Expandable Prosthetic Titanium Rib (VEPTR). The choice of care for our patient was decided to be VEPTR alone as definitive management. Up to our knowledge, there are very scanty articles published regarding treatment for such cases. CONCLUSION: Patient underwent vertical expandable prosthetic titanium rib (VEPTR) application for his large 45-degree curve as a definitive treatment and still have his preoperative physical functions, in terms of using lower limbs in daily living activities.