Spinal phosphaturic mesenchymal tumors: a rare etiology causing tumor-induced osteomalacia-a review of experience at a UK tertiary referral center and literature review.

PURPOSE: This article aims to provide a comprehensive review of the management challenges associated with Spinal Phosphaturic Mesenchymal tumors (PMTs) and evaluates the surgical management outcomes for this rare entity linked to Tumor-induced osteolysis. The primary objective of this study is to enhance the familiarity of treating physicians with the clinical features, diagnosis, and treatment options for Spinal PMTs. METHODS: A retrospective analysis was conducted, reviewing electronic medical records of patients diagnosed with spinal PMTs at our hospital between January 2019 and December 2022. The data collected included demographic information, clinical presentation, radiological findings, surgical details, and follow-up outcomes. RESULTS: A total of three cases of Spinal PMTs causing Tumor-induced osteomalacia were identified. The diagnosis of Spinal PMTs presented challenges, with incidental detection often occurring during routine imaging. Surgical management was undertaken, resulting in successful symptom resolution and normalization of phosphate levels. The application of 68 Ga-DOTA-TATE PET/CT scans facilitated tumor localization, aiding in surgical planning. Spinal PMTs demonstrated a favorable response to surgical intervention. CONCLUSION: Spinal PMTs play a significant role in Tumor-induced osteolysis, warranting timely and accurate diagnosis. Although diagnosing Spinal PMTs presents challenges, surgical management has proven to yield favorable outcomes, effectively alleviating symptoms and restoring phosphate levels. A multidisciplinary approach and continued vigilance are essential in ensuring early diagnosis, effective treatment, and long-term monitoring for patients affected by spinal PMTs.

Kaposiform Hemangioendothelioma in the Thoracic Spine: A Case Report and Review of the Literature.

BACKGROUND: Kaposiform hemangioendothelioma (KHE) is a rare, locally aggressive vascular tumor of childhood. It has been most commonly reported in the trunk, retroperitoneum, and extremities, but cases involving the head and neck have been described. While thought to have limited metastatic potential, it is associated with Kasabach-Merritt syndrome (KMS), a consumptive coagulopathy and profound thrombocytopenia that is associated with significant mortality. Twelve cases of KHE with bony involvement have previously been reported. Of these, only 2 involved the spine, and both were managed with medical therapy alone. CASE PRESENTATION: We report the first case of spinal KHE causing spinal cord compression managed with surgical excision presented in the literature to date. CONCLUSIONS: There are a number of treatment modalities outlined in the literature. The lack of a consensus is due to the varying methods of presentation, difficulty in diagnosis, and disease rarity. Our case highlights the potential speed of local growth of this tumor, meaning that excision may be a technical challenge, especially when there is epidural extension. Treating clinicians should be aware of the risk of progression beyond the initial tumor boundaries to involve new vertebrae.

Segmental Pelvic Correlation (SPeC): a novel approach to understanding sagittal plane spinal alignment.

BACKGROUND CONTEXT: Lumbar lordosis (LL) correlates with pelvic morphology, and it has been demonstrated that as LL increases, the inflection point and apex of lordosis move cranially. This suggests that each segment of the lumbar spine relates to pelvic morphology in a unique way. OBJECTIVES: This study aimed to establish whether there is a direct relationship between pelvic morphology and lumbar segmental angulation in the sagittal plane. STUDY DESIGN: A retrospective analysis of 41 patient radiographs was carried out. PATIENT SAMPLE: Inclusion criteria included patients with full length standing anterioposterior and lateral radiographs of the spine from base of occiput to proximal femora, with clearly visible vertebral end plates from T12 to S1 and a thoracic kyphosis (TK) and LL within the normal range. Patients were excluded if they had a coronal spinal deformity affecting the lumbar spine, chronic back pain, spondylolisthesis, spondylolysis, congenital scoliosis, or skeletal dysplasia. OUTCOME MEASURES: Spinopelvic radiographic parameters of pelvic incidence (PI), LL, TK, and segmental angulation at each level from L1 to the sacrum were the outcome measures. METHODS: Forty-one lateral whole spine radiographs with normal sagittal profiles from the spinal deformity clinic were retrospectively reviewed. Pelvic incidence, LL, TK, and segmental angulation at each level from L1 to the sacrum were measured (from end plate to end plate), distinguishing the vertebral body and intervertebral disc contribution. Pearson correlation coefficients were used to analyze any relationship between pelvic parameters and segmental angulation. RESULTS: A strong correlation was found between PI and LL. Pelvic incidence correlated strongly with the L1 and L2 motion segments (p=.0001, p=.03), notably at the intervertebral discs but not the L4 and L5 motion segments. The proportion of total LL contributed at L4-L5 and L5-S1 reduced as PI increased. CONCLUSIONS: Pelvic incidence can predict segmental angulation. Although the majority of LL is produced at the L4 and L5 motion segments, cephalad lumbar segments sequentially become increasingly important as PI increases. This describes a continuum where the L1 and L2 motion segments crucially fine-tune total LL according to PI. This allows segmental abnormalities to be identified when compensation in adjacent segments maintain normal total LL. It also paves the way for anatomical segmental reconstruction in degenerative adult deformity based on pelvic morphology.

Removing symptomatic gallstones at their first emergency presentation.

INTRODUCTION: Early operations for symptomatic gallstones are gaining favour as the complication rate is thought to be lower and it reduces the overall morbidity. This study was performed to clarify how frequently early operations were being performed and what benefits resulted. PATIENTS AND METHODS: Case notes of 171 patients who underwent laparoscopic cholecystectomy at Princess Alexandra Hospital Harlow were retrospectively reviewed. They were grouped according to their initial diagnosis (cholelithiasis, acute cholecystitis) and the delay to surgery (early, interval). Forty-one cases were excluded as they either had incomplete notes or the initial diagnosis was a different manifestation of gallstones such as pancreatitis. Those receiving interval operations were then grouped according to the mode of their initial presentation. A total of 130 case notes were analysed. RESULTS: The delay for an interval operation was 3-6 months compared with less than 2 weeks for early operations. Of patients with acute cholecystitis, 43% had early operations but only 12% of patients with cholelithiasis. Waiting for interval operations was associated with multiple re-admissions equivalent to an average of one extra presentation to accident and emergency per patient. This was particularly marked if the initial presentation was to accident and emergency rather than outpatients (P = 0.003). Complication rates were also higher in the interval group. CONCLUSIONS: Early cholecystectomy on the next available list is likely to reduce morbidity and the long-term in-patient burden so should be recommended for all patients presenting as an emergency with symptomatic gallstones.