Severe progressive osteoporotic spine deformity with cardiopulmonary impairment in a young patient. A case report.

STUDY DESIGN: This report describes a young patient with a rapidly progressive kyphosis caused by collapse of a severely osteoporotic thoracolumbar spine, which led to impairment of cardiopulmonary function. OBJECTIVES: To highlight the treatment strategy, difficulty of diagnosis, operative stabilization, and outcome. SUMMARY OF BACKGROUND DATA: Little is known about natural history, treatment options, and results of this condition. METHODS: The magnitude of bone loss was measured by dual-energy x-ray absorptiometry, and the deformity was visualized by computed tomography and magnetic resonance imaging. Laboratory investigations also were performed before and during halotraction in an attempt to establish a diagnosis. These data constituted the preoperation information required to assess later results of medical and surgical intervention. RESULTS: An extensive evaluation of possible underlying etiologies failed to identify a specific etiology. Before and during halotraction, bone mineral substitutes were given, partially correcting the bone mineral content as measured on repeated dual-energy x-ray absorptiometry scans. In addition, the thoracic kyphosis was partially corrected, from 100 degrees to 70 degrees Cobb's angle. Subsequently, a combined anterior and posterior stabilization was performed from C7 to S1 using a vascularized fibula graft, a double Isola rod system (AcroMed, Cleveland, OH), and a carbonate apatite cancellous bone cement to reinforce the pedicle screws. At follow-up assessment 40 months surgery, the patient was asymptomatic and fully mobilized, with radiographs showing complete incorporation of the grafts and no loosening of the fixation device. CONCLUSIONS: The diagnostic and therapeutic difficulties of progressive spine deformity caused by severe osteoporosis in young patients emphasizes the importance of a thoroughly planned treatment strategy. Halotraction is recommended to stop progression of the deformity, or even partially correct it, and to allow time to search for the diagnosis and bone mineral substitution. Surgical treatment using vascularized fibular strut grafts and a strong fixation device was successful. Biocompatible carbonated apatite cancellous bone cement was successfully used to reinforce pedicle screw fixation.

Transient osteoporosis and osteogenesis imperfecta. A case report.

The authors report migratory transient osteoporsis of the ipsilateral hip and ankle in a patient with ostengenesis imperfecta. The diagnosis was made with modern imaging techniques (magnetic resonance imaging, bone scintigraphy, and dual energy xray absorptiometry). Histologic examination after bone biopsy of the proximal femur showed possible microfractures. The treatment consisted of a regimen of nonweightbearing. One year after onset, the patient had no symptoms and no residual evidence of transient osteoporosis on radiographic studies. The etiology of transient osteoporosis in patients who have osteogenesis imperfecta is uncertain. The authors' findings suggest that microfractures may play a role in the early pathophysiologic process.

Chondrosarcoma secondary to synovial chondromatosis. Report of two cases and a review of the literature.

Malignant transformation of synovial chondromatosis into chondrosarcoma is unusual. Thirteen cases and one series have been reported; only four of them developed in the hip. The overall survival is about 50%, possibly because of the difficulty of arriving at a correct early diagnosis (radiographically and histologically) and subsequent adequate surgical therapy. We report two patients (ages 30 and 50 years) in whom synovial chondrosarcoma developed in previously excised synovial chondromatosis of the hip. The diagnosis was made with modern imaging techniques (computed tomography and magnetic resonance imaging) and verified by open biopsy. The early recognition allowed a wide limb-saving resection; both patients are disease free 3 and 2 years after surgery.

Nonfunctioning malignant paraganglioma of the posterior mediastinum with spinal cord compression. A case report.

STUDY DESIGN: Case report and review of the literature. OBJECTIVE: To present a case with an uncommon nonfunctioning malignant paraganglioma of the posterior mediastinum with compression of the spinal cord. An update survey is given with respect to diagnostic, histopathologic, and therapeutic aspects of paragangliomas. SUMMARY OF BACKGROUND DATA: Paragangliomas in the posterior mediastinum are uncommon and rarely may produce spinal cord compression. To illustrate the low incidence, only two cases of paraganglioma of the posterior mediastinum were reported by the Mayo Clinic, Rochester, Minnesota, during a 40-year period. METHOD: Case report and review of the literature. RESULT: The diagnosis was made by modern imaging techniques (computed tomography, magnetic resonance imaging, and metaiodobenzylguanidine scan) and verified by computed tomography guided per thoracic puncture. A wide local resection was performed; the patient is disease-free 1 year after surgery. CONCLUSION: The uncertainty of prognosis and possibility of local recurrence of paragangliomas even after a long period emphasizes the importance of wide local surgical resection with or without adjuvant therapy and makes long-term follow-up and continued surveillance of the patient mandatory.

Index finger extension and strength after extensor indicis proprius transfer.

We reviewed the long-term morbidity of the donor index finger following extensor indicis proprius tendon transfer in 34 patients with an average follow-up period of 8 years. An extension lag of the donor index was found to present in 24 patients. In all patients a reduced extension strength of the donor index finger was noticed, either measured dependently (with concurrent long finger extension) or independently (without long finger extension). Despite these findings, 30 of the patients described no limitations in their daily life activities. In nearly all patients the dependent extension strength was superior to the independent extension strength. To prevent an extension lag, the surgeon should avoid surgical trauma to the dorsal aponeurosis ("hood") by sectioning the index tendon proximal to the hood.

Extensor indicis proprius transfer for loss of extensor pollicis longus function.

In the period 1969-1991, 46 extensor indicis proprius tendon transfers were performed for functional loss of extensor pollicis longus. The long-term function of the thumb was reviewed in 22 patients with an average follow-up of 7 years. Based on Geldmacher's evaluation scheme for assessment of the results of extensor tendon reconstruction, we report 5 excellent (23%), 4 good (18%), 12 satisfactory (55%) and 1 poor (4%) result. The mean loss of pinch strength was 8% compared with the contralateral, non-operated thumb. Subjectively, the majority of the patients (86%) described no limitations in their daily life activities. It is recommended that the transfer be tight enough to give full thumb extension and that the hand be immobilized with the thumb in this position for 4 weeks.