Infected primary non-Hodgkin lymphoma of spine

Liu, Che-Wei; Tsai, Tsung-Ying; Li, Yao‐Feng; Lin, Leou-Chyr; Wang, Shyu-Jye

doi:10.4103/0019-5413.98835

Cited by 18 publications

(7 citation statements)

References 26 publications

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“…However, no studies examined reinforcement of a fractured vertebra with a combination of bone cement with two additional fracture-level screws. Several biomechanical studies have suggested that reinforcement with fracture-level screws could improve the biomechanical stability of the construct [21–23]. Clinical studies have also suggested that reinforcement with additional screws at the fractured level can provide better kyphotic correction, more effectively restore fractured vertebra height, and allow earlier ambulation for patients with thoracolumbar burst fractures [24, 25].…”

Section: Discussionmentioning

confidence: 99%

Treatment of thoracolumbar burst fractures by short-segment pedicle screw fixation using a combination of two additional pedicle screws and vertebroplasty at the level of the fracture: a finite element analysis

Liao

Chen

Wang

2017

BMC Musculoskelet Disord

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BackgroundTraditional one-above and one-below four-screw posterior short-segment instrumentation is used for unstable thoracolumbar burst fractures. However, this method has a high rate of implant failure and early loss of reduction. The purpose of this study was to use finite element (FE) analysis to determine the effect of treating thoracolumbar burst fractures by short-segment pedicle screw fixation using a combination of two additional pedicle screws and vertebroplasty at the level of the fracture.MethodsAn intact T11-L1 spine FE model was created from the computed tomography images of a male subject. Four fixation models with posterior fusion devices (pedicle screws, rods, cross-link) were established to simulate an unstable thoracolumbar fracture with different fusion surgeries: short-segment fixation with: 1) a link (S-L); 2) intermediate bilateral screws (S-I); 3) a link and calcium sulfate cement (S-L-C); 4) intermediate bilateral screws and calcium sulfate cement (S-I-C). Different loading conditions (flexion, extension, lateral bending, and axial rotation) were applied on the models and analyzed with a FE package. The range of motion (ROM), and the maximum value and distribution of the implant stress, and the stress in the facet joint, were compared between the intact and fixation models.ResultsThe ROM in flexion, extension, axial rotation, and lateral bending was the smallest in the S-I-C model, followed by the S-I, S-L-C, and S-L models. Maximum von Mises stress values were larger under lateral bending and axial rotation loadings than under flexion and extension loading. High stress was concentrated at the crosslink and rod junctions. Maximal von Mises stress on the superior vertebral body for all loading conditions was larger than that on the inferior vertebral body. The maximal von Mises stress of the pedicle screws during all states of motion were 265.3 MPa in S-L fixation, 192.9 MPa in S-I fixation, 258.4 MPa in S-L-C fixation, and 162.3 MPa in S-I-C fixation.ConclusionsShort-segment fixation with two intermediate pedicle screws together with calcium sulfate cement at the fractured vertebrae may provide a stiffer construct and less von Mises stress of the pedicle screws and rods as compared to other types of short-segment fixation.

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Section: Discussionmentioning

confidence: 99%

Treatment of thoracolumbar burst fractures by short-segment pedicle screw fixation using a combination of two additional pedicle screws and vertebroplasty at the level of the fracture: a finite element analysis

Liao

Chen

Wang

2017

BMC Musculoskelet Disord

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“…Of those, chronic osteomyelitis has been of the ankle or knee joints, and a few of the mandibular bones [ 7 – 11 ] . These articles suggest that a chronic inflammatory process secondary to the underlying PBL malignancy stimulates an infection of the deteriorating bone, such as osteomyelitis [ 7 – 11 ] .…”

Section: Discussionmentioning

confidence: 99%

“…Chronic OM often presents with low-grade symptoms [6] . Few studies in current literature describe cases of PBL disguised as osteomyelitis [7][8][9][10][11] ; there are only a handful of articles which describe PBL manifesting as acute or chronic osteomyelitis [7][8][9][10][11] . Of those, chronic osteomyelitis has been of the ankle or knee joints, and a few of the mandibular bones [7][8][9][10][11] .…”

Section: Discussionmentioning

confidence: 99%

Diffuse B-cell lymphoma of the mandible disguised as acute osteomyelitis

Adalja,

Tagliaferri,

Rezkalla

et al. 2024

European Journal of Case Reports in Internal Medicine

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Background: Primary bone lymphoma (PBL) is a rare form of extra nodal non-Hodgkin’s lymphoma (NHL). Case description: We describe a 39-year-old-male with no medical history who presented with unilateral facial swelling following a tooth extraction. Initial diagnoses after various presentations over the course of three weeks, based on inflammatory and infectious aetiologies. However, the patient was ultimately diagnosed with diffuse large B-cell lymphoma. Discussion: Symptoms of PBL are very similar to inflammatory and infectious diseases of the bone, such as osteomyelitis or osteonecrosis. Clinical features of PBL involving the head and neck include persistent jaw pain, tooth mobility secondary to extensive destruction of bone, and in advanced cases, lip numbness and swelling. On examination it may present as an exposed necrotic bone with surrounding soft tissue oedema. Misdiagnosis of these lesions as an infectious or inflammatory aetiology may lead to an unnecessary delay in lymphoma treatment, and subsequently worsen the prognosis if caught at a later stage. Therefore, any concerning lesion, especially in the oral cavity, must be subjected to early histopathological evaluation to differentiate PBL from osteomyelitis and/or osteonecrosis. Conclusion: This case report highlights the importance of an early histopathological evaluation to prevent delay in the diagnosis of primary bone lymphomas.

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“…Our previous study suggested that the intermediate screw fixation technique can significantly increase the stability of the spine in both the Mps fixation group and Pps fixation group. However, the Mps fixation group exhibited more stability in flexion and extension than the Pps fixation group [5]. Fixation models including MMM, PPP, PMM, MPM, MMP, MPP, PMP, and PPM showed less ROM than the intact normal spine model, and the redistributed ROM of the MMM model in flexion, extension, and axial rotation was the smallest.…”

Section: Discussionmentioning

confidence: 99%

“…Posterior short-segment pedicle screw fixation is widely used for the management of traumatic thoracolumbar burst fractures [1–3], posterior intermediate screw fixation technique (ISFT) at the fracture level can help improve and maintain the kyphosis correction, and the biomechanical stability also can be increased [4–18]. As a result, improved design and implantation techniques of pedicle screws such as polyaxial pedicle screws have reduced the rate of a pedicle screw and rod breakage and facilitated efficient application of the connecting rod without undue stress on the construct [5, 11, 12, 19–21]. If the heads of the pedicle screws are not in a straight line, polyaxial pedicle screws should be placed for the facilitated efficient application of the connecting rod.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical comparison of posterior intermediate screw fixation techniques with hybrid monoaxial and polyaxial pedicle screws in the treatment of thoracolumbar burst fracture: a finite element study

et al. 2019

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Background To compare the biomechanical characteristics of different posterior intermediate screw fixation techniques (ISFTs) with hybrid monoaxial pedicle screws (Mps) and polyaxial pedicle screws (Pps) used in thoracolumbar burst fractures. Methods Fixation techniques are compared with regard to the von Mises stress (VMS) of the instrumentations and intradiscal pressures (IDPs) of the adjacent segments by finite element method (FEM). Results The redistributed ROM of the fixation models with Pps fixed at the lowest segment was twice of the other fixation models in flexion and extension. The largest value of maximal VMS of a pedicle screw was located at the lowest pedicle screws when Mps are fixed at the lowest segment. The largest value of maximal VMS of the rods was decreased when more Pps are fixed at the models. Maximal IDPs of the upper adjacent segments were all larger than those of the lower adjacent segments. The maximal IDPs of the fixation model with MPs fixed at the lowest segment were larger than the other fixation models in flexion and extension. Conclusions Polyaxial pedicle screws could be placed at the upper or the median segment for the facilitated efficient application of the connecting rod. We should focus on the adjacent segmental degeneration especially the upper adjacent segment in the fixation model with Mps fixed at the lowest segment.

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Infected primary non-Hodgkin lymphoma of spine

Cited by 18 publications

References 26 publications

Treatment of thoracolumbar burst fractures by short-segment pedicle screw fixation using a combination of two additional pedicle screws and vertebroplasty at the level of the fracture: a finite element analysis

Treatment of thoracolumbar burst fractures by short-segment pedicle screw fixation using a combination of two additional pedicle screws and vertebroplasty at the level of the fracture: a finite element analysis

Diffuse B-cell lymphoma of the mandible disguised as acute osteomyelitis

Biomechanical comparison of posterior intermediate screw fixation techniques with hybrid monoaxial and polyaxial pedicle screws in the treatment of thoracolumbar burst fracture: a finite element study

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