3.

Lumbo-sacral chordoma is a rare, slow-growing tumor, arising from embryonic nothocordal remnants. Wide en bloc excision with clear margins remains mandatory to achieve satisfactory recurrence rates and disease-free survival. No chemotherapy has been demonstrated to be effective and radiotherapy is only marginally effective. Tyrosine kinase receptor inhibitors have showed encouraging results in locally advanced and metastatic chordoma. Reconstructive surgery may become very complex. Multidisciplinary approach in tertiary hospitals is always necessary.

HighlightsSymptomatic sacral perineural cysts are uncommon in opposition to the AVN of the femoral head which is a common diagnosis.Tarlov cysts should be considered only after exclusion the other possibles diagnostics in the differential diagnosis.

Baastrup’s disease is a rare condition of the vertebral column often misdiagnosed and wrongly treated due to poor knowledge, characterized by low back pain arising from the close approximation of adjacent posterior spinous processes and resultant degenerative changes. Diagnosis rests on clinical examination and detailed imaging studies. Proposed therapies include conservative treatment, percutaneous infiltrations or surgical therapies. We present the case of a 31-year-old man with persistent chronic lumbago for several years. In whom, the diagnosis of Baastrup’s disease was high suspected clinically, with a final surgical treatment despite the absence of inflammation on imaging studies, which allowed the diagnostic confirmation and the return to a normal social and professional life. We wish through this case, to expose the different steps of interventional diagnostic/therapeutical procedures until the surgical management in a clinical suspicion of Baastrup’s diseases with unclear radiological findings.

After a low-energy fall, an 83-year-old man presented with bilateral weakness of the upper arms without loss of sensation associated with a rigid cervical spine (ankylosing spinal disorder, ASD). Because of an atypical presentation during history, examination and initial imaging, a late diagnosis of a transdiscal C4-C5 fracture was made by dynamic radiographs. Anterior cervical discectomy and fusion were performed with delay. Strength improved from grade C to D (American Spinal Injury Association classification) after surgery. To our knowledge, this is the first description of a bilateral, isolated upper limb C5 paralysis without any loss of sensation caused by a transdiscal C4-C5 fracture. A high clinical and diagnostic index of suspicion is mandatory to make the diagnosis. We present three clinical ‘Awareness Criteria’ (1: recognition of ASD; 2: high index of fracture suspicion; 3: necessary imaging) helping clinicians to safely and promptly diagnose occult spinal fractures in ASD.