No abstract

No abstract

Intraosseous schwannomas of the mobile spine are extremely rare. To our knowledge, only 21 cases have been reported in the literature. In this report, we present a case of schwannoma involving the lumbar spine, with a review of the literature and discussion of this rare tumor. A 44-yearold male presented with a 3-year history of intermittent low back pain, with radiation into the right lower extremity during the last 2 years. Radiographs revealed an approximately 4×4 cm irregular mass with marginal sclerosis located at the L5 vertebra, involving the right pedicle and extruding into the spinal canal. The tumor was resected completely and was confirmed as schwannoma by histological examination. At follow-up after 12 months, the patient was free of pain and with no recurrence. Despite its low incidence, intraosseous schwannomas should be considered as the differential diagnosis of an extradural mass involving the vertebrae. Surgery is the preferred treatment method and usually carries a good prognosis. KEywoRds: Intraosseous schwannoma, Lumbar vertebra, Surgery ÖZHareketli omurganın intraosseöz şıvanomları son derece nadirdir. Bildiğimiz kadarıyla literatürde sadece 21 olgu bildirilmiştir. Bu raporda bir literatür derlemesi ile birlikte lomber omurgayla ilgili bir şıvanom olgusu sunuyor ve bu nadir tümörü tartışıyoruz. 44 yaşında bir erkek hasta 3 yıldır devam eden ve son 2 yıldır sağ alt ekstremiteye yayılan aralıklı bel ağrısı öyküsüyle geldi. Radyografiler L5 vertebrada sağ pedikülü tutan ve spinal kanal içine ekstrüzyon yapan, marjinal sklerozlu yaklaşık 4x4 cm irregüler kitle gösterdi. Tümör rezeksiyonla tamamen çıkarıldı ve histolojik incelemede şıvanom olduğu doğrulandı. 12 aylık takipte hastada ağrı veya nüks yoktu. Düşük insidansına rağmen intraosseöz şıvanomlar vertebraları tutan ekstradural kitlelerin ayırıcı tanısında dikkate alınmalıdır. Tercih edilen tedavi yöntemi cerrahidir ve prognoz genellikle iyidir.

Our results suggest that PLIF with cage appears to be an appropriate technique for the treatment of double-level isthmic spondylolisthesis.

T he term spondylolisthesis is derived from the combined Greek terms spondylos (vertebra), and listhesis (to slip). The term literally means the "slippage of one vertebra forward in relation to the adjacent vertebra." Five types were classified according to the Wiltse classification system: dysplastic, isthmic, degenerative, traumatic, and pathologic.18 Isthmic spondylolisthesis is caused by a defect in the pars interarticularis area of the lamina, and is the most common spondylolytic disorder. The reported incidence is 4%-6% of the general population.13 However, true double-level spondylolisthesis of the spine is revealed in only a few cases. We present the case of a patient with a double-level isthmic spondylolisthesis. To our knowledge, there have been no published reports of double-level spondylolisthesis treated with posterior lumbar interbody fusion (PLIF) with autogenous bone chips. Case ReportHistory. This 64-year-old woman presented with a 20-year history of intermittent low-back pain, with radiation into the bilateral lower extremity during the last 3 years. The pain was aggravated by activities such as extension and prolonged standing. She had no previous trauma or family history of low-back pain. At the time of presentation, the patient's pain was intense and restricted her everyday activities.Examination. On examination, there was a stepoff in the lumbosacral region on palpation. The range of lumbar spinal motion was decreased, especially with regard to the extension of the lumbar spine. The straight leg test was limited to 50° on the right side, reproducing right buttock and leg pain. Furthermore, there was decreased sensation to light touch over the right L-5 distribution. Motor strength of the lower limb was normal, and patellar and Achilles tendon reflexes were equal and symmetrical.Radiographs revealed pars defects at L-4 and L-5, and Grade 2 spondylolisthesis at both L4-5 and L5-S1 (Fig. 1). The angles of lumbar lordosis, pelvic incidence, and sacral inclination were 54°, 65°, 46°, respectively. The slip angle was -9° at the L4-5 level and -3° at the L5-S1 level. The CT scans demonstrated bilateral pars defects involving the L-4 and L-5 levels ( Fig. 2A and B). The MRI studies showed degenerative disc disease at L4-5 and L5-S1, hypertrophic ligamentum flavum at L4-5, and Modic Type 2 changes at the vertebral endplate of L-5 and S-1 (Fig. 2C and D).After 6 months of conservative treatment, including Isthmic spondylolisthesis, which is demonstrated in 4%-6% of the general population, is one of the most common types of spondylolisthesis. However, double-level isthmic spondylolisthesis is extremely rare. Only a few reports have examined the outcomes of surgical treatment of double-level spondylolisthesis. The authors present an unusual case of double-level isthmic spondylolisthesis of the lumbar spine. The patient had low-back pain for 20 years and did not respond to conservative treatment. Radiographs revealed bilateral pars defects at L-4 and L-5. Grade 2 isthmic spondylolisthesis was present, b...