Fibula allograft transplantation combined with locking plate for treatment of recurrent monostotic fibular fibrous dysplasia: A case report.

BACKGROUND: Fibrous dysplasia is a congenital disorder in which normal bone is replaced by fibro-osseous tissue or irregular trabeculae of woven bone intermixed with mature collagenous tissue. A single or multiple bones are affected. This rare bone disorder has three clinical patterns including monostotic, polyostotic, and that associated with McCune-Albright syndrome. Most studies report primary fibrous dysplasia. However, a few cases of recurrent monostotic fibular fibrous dysplasia have been reported. Here, we report a therapeutic strategy for recurrent fibular fibrous dysplasia. CASE SUMMARY: A 4-year-old boy was admitted for persistent pain in the left lower limb and abnormal gait over the previous 9 mo. He had no history of present or past illness. Preoperative imaging data showed erosion-like changes with bone expansion of the left middle and lower fibular segment. Tumor tissue in the fibular bone marrow cavity was removed by curettage, and rapid intraoperative pathological examination suggested fibular fibrous dysplasia. An allograft was implanted into the fibular medullary cavity. However, he was readmitted with clinical symptoms including persistent pain, abnormal gait, and local swelling at the age of 6 years. He was diagnosed with recurrent fibular fibrous dysplasia based on the second medical examination. He underwent fibular bone tumor radical resection and longus fibular allograft transplantation combined with fibular bone locking plate and screws. Good host bone to allogenic bone graft fusion was observed by the physician on postoperative regular follow-up. CONCLUSION: Radical resection of fibrous dysplasia and longus fibula allograft combined with internal fixation for reconstruction are suitable for the treatment of recurrent monostotic fibular fibrous dysplasia.

Surgery for fibrous dysplasia associated with aneurysmal-bone-cyst-like changes in right proximal femur: A case report.

BACKGROUND: Fibrous dysplasia associated with aneurysmal bone cyst (ABC)-like changes in the right proximal femur has a low incidence. It is considered more difficult to make early diagnosis than for single fibrous dysplasia. CASE SUMMARY: A 14-year-old woman was admitted because of persistent pain in the right hip and abnormal gait over the previous 2 mo. She had no history of present or past illness. Preoperative photography, enhanced computed tomography, and magnetic resonance imaging showed ground-glass appearance with cortical scalloping and expansion of the right proximal femur and femoral neck. Pathological examination by preoperative puncture biopsy revealed fibrous dysplasia of the right proximal femur. The patient was diagnosed with fibrous dysplasia based on medical history, physical examination, and results of laboratory, imaging and pathological examinations. According to final pathological examination, the patient was diagnosed with fibrous dysplasia of the right proximal femur associated with ABC. Curettage and allograft along with fixation of compression screws was performed for fibrous dysplasia associated with ABC-like changes. No obvious allograft absorption, loosening of fixation, or secondary fracture were observed during 6-months' follow-up with re-examination by plain radiography and computed tomography. Fibrous dysplasia associated with ABC-like changes in the right proximal femur has a low incidence and early diagnosis is considered more difficult than for single fibrous dysplasia. CONCLUSION: We report a cases of fibrous dysplasia associated with ABC-like changes in the right proximal femur treated with curettage and allograft along with hip compression screws.

Potential risk of impertinent administration of methylprednisolone in lumbar spine surgery: A case report.

INTRODUCTION: Several complications of intravenous administration of Methylprednisolone in spine surgery have been reported previously. However, perioperative Addisonian crisis resulting from postoperative routine cessation of intravenous Methylprednisolone has been rarely reported. We here report a case of perioperative Addisonian crisis induced by postoperative routine cessation of intravenous Methylprednisolone. PRESENTATION OF CASE: To report a 56-year-old lady was diagnosed with Addisonian crisis on postoperative duration of lumbar spine surgery after routine cessation of intravenous Methylprednisolone on postoperative day 5. DISCUSSION: There are potential risk and medical complexity of the intravenous administration of Methylprednisolone perioperatively when patients underwent spine surgery, especially the patients with a history of adrenal insufficiency or hypothyroidism, and other endocrine diseases. The early diagnosis and effective replacement therapy after cessation of intravenous glucocorticoid to keep normal serum hormone levels can reduce risk and complication of Addisonian crisis. CONCLUSION: Addisonian crisis may be triggered by the discontinuation of exogenous glucocorticoid. Physicians need to be immediately aware of this potentially lethal complication in patients with endocrine system diseases.

Efficacy and complications of 125I seeds combined with percutaneous vertebroplasty for metastatic spinal tumors: A literature review.

To review the efficacy and complications of 125I seeds combined with percutaneous vertebroplasty for the treatment of metastatic spinal tumors. We searched PubMed/MEDLINE from its inception to November 2018 for articles on metastatic spinal tumors treated with 125I seeds combined with percutaneous vertebroplasty. A total of 273 articles were identified in PubMed/MEDLINE based on the search criteria. After deleting duplicate articles including two retrospective studies and three case control studies, five studies were included in this systematic review. In total, 161 patients aged from 49.2 to 62 years were included. The operative levels consisted of the thoracic vertebrae and lumbar vertebrae. Bone cement leakage occurred in 7 cases. None of the patients developed radiation myelopathy. Percutaneous vertebroplasty plus 125I seeds implantation is an effective palliative treatment and can alleviate back pain and enhance vertebral body strength in patients with end-stage spinal metastatic tumors. In future research, the effective dosage of 125I seeds implantation, the anchoring of seeds with safe distance, and the bone cement distribution in the vertebral body will be next research hotspot.

Effect of Intra-wound Vancomycin for Spinal Surgery: A Systematic Review and Meta-analysis.

Intra-site prophylactic vancomycin in spine surgery is an effective method of decreasing the incidence of postsurgical wound infection. However, there are differences in the prophylactic programs used for various spinal surgeries. Thus, this systematic review and meta-analysis aimed to evaluate the effectiveness of using intra-wound vancomycin during spinal surgery and to explore the effects of dose-dependence and the method of administration in a subgroup analysis. A total of 628 citations or studies were searched in PubMed, Ovid, Web of Science, and Google Scholar that were published before August 2016 with the terms "local vancomycin", "intra-wound vancomycin", "intraoperative vancomycin", "intra-site vancomycin", "topical vancomycin", "spine surgery", and "spinal surgery". Finally, 19 retrospective cohort studies and one prospective case study were eligible for inclusion in the systematic review and meta-analysis. The odds of developing postsurgical wound infection without prophylactic local vancomycin use were 2.83-fold higher than the odds of experiencing wound infection with the use of intra-wound vancomycin (95% confidence interval, 2.03-3.95; P = 0.083; I2 = 32.2%). The subgroup analysis including the dosage and the method of administration, revealed different results compared to previous research. The value of I2 in the 1-g group was 27.2%, which was much lower than in the 2-g group (I2 = 57.6%). At the same time, the value of I2 was 0.0% (P = 0.792, OR = 2.70) when vancomycin powder was directly sprinkled into all layers of the wound. However, there is high heterogenicity (I2 = 60.0%, P = 0.007, OR = 2.83) when vancomycin powder is not exposed to the bone graft and instrumentation. There are differences found with the method of local application of vancomycin for reducing postoperative wounds and further studies are necessary, including investigations focusing on the dose-dependent effects during spinal or the topical pharmacokinetic and other orthopaedic surgeries.