Pediatric vertebral and spinal epidural tumors: a retrospective review of twelve cases.

OBJECTIVE: Pediatric vertebral tumors are rare, and most of the reported series have limited numbers of cases. Diagnosis of these tumors is difficult because of the patients' age and the rarity of the lesions. We aimed to report the clinical, radiological and pathological characteristics in a small series of pediatric vertebral and spinal epidural tumors and to discuss diagnostic and treatment difficulties. MATERIALS AND METHODS: Twelve consecutive pediatric cases with vertebral or spinal epidural tumors were reviewed retrospectively. RESULTS: The mean age was 12.6 years, and male and female patients were equal in number. The most common symptom was pain. There were some neurological or local findings in all patients, and there were some positive results on plain radiographs in all cases except 2. The tumors were removed totally in 9 cases. There were histologically malignant lesions in 3 and benign lesions in 9 cases. Three patients with malignant tumors were treated by radiotherapy and 2 by chemotherapy. One patient with thoracic hemangioma was also treated by embolization after surgery. One case with cervical Dabska's tumor died due to air embolization. The other patients were followed for 48.3 months. The preoperative neurological deficits were resolved completely in all patients except the one with only biopsy performed at the last follow-up. There were no new spinal deformities on follow-up. CONCLUSION: Children with vertebral tumors and spinal epidural tumors usually present with pain and neurological deficits or local findings, and there are some indications on plain radiographs. Therefore, a careful physical examination and detailed evaluation of radiographs may minimize the rate of misdiagnosis and underestimation. Most of these tumors are benign, therefore, their outcome is good, and cure may be possible for many of the cases.

Thoracic and lumbar tuberculous spondylitis treated by posterior debridement, graft placement, and instrumentation: a retrospective analysis in 19 cases.

OBJECT: Surgical treatment of thoracic and lumbar tuberculous spondylitis is controversial. An anterior approach is usually recommended. The aim of the present study was to assess the efficacy of posterior debridement and the placement of posterior instrumentation for the treatment of patients with thoracic and lumbar tuberculous spondylitis. METHODS: Nineteen patients with thoracic and lumbar tuberculous spondylitis underwent single-stage posterior decompression and debridement as well as the placement of posterior interbody grafts if necessary, instrumentation and posterior or posterolateral grafts. No postoperative neurological deterioration was noted. One patient died of myocardial infarction on Day 10. The mean follow-up duration, excluding the one death, was 52.7 months (range 16-125 months). In a 70-year-old patient, a single pedicle screw broke after 3 months. All patients were in better neurological condition after surgery and at the last follow-up examination. Neurological deficits were present in only two patients at the last follow up (one American Spinal Injury Association Grade B and one Grade C deficit preoperatively). Three other patients suffered intermittent back or low-back pain. The mean angulation measured in 13 patients with kyphotic deformity was 18.2 degrees (range 5-42 degrees) preoperatively; this was reduced to 17.3 degrees (range 0-42 degrees) after surgery. There was a 2.8 degrees loss of correction (range 2-5 degrees) after 44.3 months (16-64 months). Kyphosis did not progress beyond 15 months in any patient. CONCLUSIONS: A posterior approach in combination with internal fixation and posterior or posterolateral fusion (with or without placement of posterior interbody grafts) may be sufficient for the debridement of the infection and to allow spinal stabilization in patients with thoracic and lumbar tuberculous spondylitis. This procedure is associated with easy access to the spinal canal for neural decompression, prevention of loss of corrected vertebral alignment in the long term, and facilitation of early mobilization.

Vertebral osteoid osteoma associated with paravertebral soft-tissue changes on magnetic resonance imaging. Report of two cases.

Soft-tissue changes associated with osteoid osteoma have been described in the digits of the hands and feet as well as the long bones. Only six cases in which such changes occurred in the spine have been reported. Magnetic resonance (MR) imaging facilitates the determination of such changes. Establishing a diagnosis, however, is especially difficult in spinal osteoid osteoma when using MR imaging. Therefore, osteoid osteoma-related soft-tissue changes demonstrated on MR imaging raise the question of malignancy and may lead to unnecessary long-term treatment or biopsy sampling. The authors report two cases of spinal osteoid osteoma in which paravertebral soft-tissue changes were observed on MR imaging to mimic malignant soft-tissue tumors.