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To report a rare case of axis brown tumor and to review literature of cervical spine brown tumor. Brown tumor is a rare bone lesion, incidence less than 5% in primary hyperparathyroidism. It is more common in secondary hyperparathyroidism with up to 13% of cases. Brown tumor reactive lesion forms as a result of disturbed bone remodeling due to long standing increase in parathyroid hormones. Cervical spine involvement is extremely rare, can be confused with serous spine lesions. To date, only four cases of cervical spine involvement have been reported. Three were due to secondary hyperparathyroidism. Only one was reported to involve the axis and was due to secondary hyperparathyroidism. This is the first reported case of axis brown tumor due to primary hyperparathyroidism. A case report of brown tumor is presented. A literature review was conducted by a Medline search of reported cases of brown tumor, key words: brown tumor, osteoclastoma and cervical lesions. The resulting papers were reviewed and cervical spine cases were listed then classified according to the level, cause, and management. Only four previous cases involved the cervical spine. Three were caused by secondary hyperparathyroidism and one was by primary hyperparathyroidism which involved the C6. Our case was the first case of C2 involvement of primary hyperparathyroidism and it was managed conservatively. Brown tumor, a rare spinal tumor that presents with high PTH and giant cells, requires a high level of suspicion.

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Study DesignA retrospective analysis of 7 patients with traumatic rotatory atlanto-axial subluxation.Overview of LiteratureCases of traumatic rotatory atlantoaxial subluxation in children are difficult to be stabilized. Surgical challenges include: narrow pedicles, medial vertebral arteries, vertebral artery anomalies, fractured pedicles or lateral masses, and fixed subluxation. The use of O-arm and computer-assisted navigation are still tested as aiding tools in such operative modalities.PurposeReport of clinical series for evaluation of the safety of use of the O-arm and computed assisted-navigation in screw fixation in children with traumatic rotatory atlantoaxial subluxation.MethodsIn the present study, 7 cases of rotatory atlantoaxial traumatic subluxation were operated between December 2009 and March 2011. All patient-cases had undergone open reduction and instrumentation using atlas lateral mass and axis pedicle screws with intraoperative O-arm with computer-assisted navigation.ResultsAll hardware was safely placed in the planned trajectories in all the 7 cases. Intraoperative O-arm and computer assisted-navigation were useful in securing neural and vascular tissues safety with tough-bony purchases of the hardware from the first and only trial of application with sufficient reduction of the subluxation.ConclusionsSuccessful surgery is possible with using the intraoperative O-arm and computer-assisted navigation in safe and proper placement of difficult atlas lateral mass and axis pedicle screws for rotatory atlantoaxial subluxation in children.

Background:Percutaneous insertion of pedicle screws was developed as a minimally invasive alternative to the different open spinal procedures. Here, we determined the accuracy of percutaneous pedicle screw insertion.Methods:For 60 consecutive patients with thoracic/lumbar spine fractures, computed tomography (CT) studies were utilized to assess the accuracy of percutaneous pedicle screw positioning. A screw was identified as cortical encroachment if the pedicle cortex could not be visualized, while Frank penetration was defined if screw trajectory being located obviously outside the pedicle boundaries [e.g., subdivided as minor (<3 mm), moderate (3–6 mm), and severe (>6 mm)].Results:Sixty patients received 410 pedicle screws placed percutaneously. Of these, 294 screws (71.7%) were ideally placed inside the pedicle. Alternatively, 56 screws (13.6%: 18 cases) showed pedicle encroachment and 60 screws (14.6%: 23 cases) showed pedicle penetration, e.g., 38 (9.2%) minor penetration and 22 (5.3%) were malpositioned (4.8% moderate and 0.5% severe). New postoperative neurological symptoms were identified in two cases (3.3%), where severe screw penetration was identified.Conclusion:Percutaneous pedicle screw insertion in 60 patients receiving 410 percutaneously placed pedicle screws yielded 294 ideally placed, 56 showing pedicle encroachment, 60 (14.3%, 23 cases) exhibiting varying degrees of pedicle penetration, with 2 showing new postoperative neurological deficits (severe screw misplacement). Of interest, this technique proved to be more challenging in the thoracic spine. Larger series are needed to better establish the average rate of neurological injuries associated with percutaneous thoracic/lumbar screw misplacement.