Osseous spinal sarcoidosis: an unusual but important entity to remember

Zubairi, Ali Bin Sarwar; Sheerani, Mughis; Haque, Ahmed Suleman; Ahsan, Humera; Fatima, Kulsoom

doi:10.1136/bcr.12.2009.2518

Cited by 7 publications

(6 citation statements)

References 7 publications

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“…Rarely, atypical cases of sarcoidosis can present with lytic lesions in the spine. 1 Although mediastinal lymph nodes were present in our patient, serum calcium and angiotensin-converting enzyme levels were normal. Histopathological examination of the paravertebral collection revealed extensive necrosis, which is unusual in sarcoidosis.…”

mentioning

confidence: 48%

Tuberculosis of the Axial Skeleton Mimicking Malignancy

Sardana

Sardana²,

Sharma

2020

Journal of the Royal College of Physicians of Edinburgh

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Multifocal bony lesions involving vertebral bodies and cancellous bones commonly occur in metastases and haematological malignancies. However, tuberculosis being a ‘great mimic', can have a similar presentation. We present a young Indian female who had bony lesions involving multiple cancellous bones, without constitutional features. Extensive search for a neoplastic cause revealed negative results. Histopathological examination of the involved tissue revealed diagnosis of tuberculosis, which was not suspected. The patient improved remarkably with antitubercular therapy. Tuberculosis of the spine commonly presents with destructive spondylitis (Pott's spine), leading to spinal deformity. Multifocal involvement of the skeleton is an atypical presentation of musculoskeletal tuberculosis. This case highlights the fact that tuberculosis should always be considered in patients with multifocal bony lesions in countries where it is endemic, like India, even in the absence of constitutional features.

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mentioning

confidence: 48%

Tuberculosis of the Axial Skeleton Mimicking Malignancy

Sardana

Sardana²,

Sharma

2020

Journal of the Royal College of Physicians of Edinburgh

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“… 22 , 26 Sarcoidosis has been described to manifest both in the vertebral bodies and within the spinal canal. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Those with intraspinal presentation are almost exclusively intradural sarcoidosis. 13 14 15 16 17 18 19 20 21 To the best of our knowledge, there are nine reported cases of intraspinal epidural sarcoidosis in the literature, including ours (Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…Several case reports have documented the presentation of sarcoidosis in the vertebral bodies. 2 3 4 5 6 7 8 9 10 11 12 However, cases of intraspinal sarcoidosis have been reported but are almost exclusively that of intradural spinal cord disease. 13 14 15 16 17 18 19 There are eight reported cases of intraspinal epidural sarcoidosis published.…”

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confidence: 99%

Recurrence of Epidural Spinal Sarcoidosis

Magdon¹,

Elliott²,

Cheng³

2021

JAAOS Glob Res Rev

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Neurosarcoidosis involving the spine is uncommon. Sarcoidosis of the spine usually presents as an intramedullary lesion and rarely an epidural lesion. To have recurrence of neurosarcoidosis is an even rarer presentation. Here, we present a 37-year-old man with poorly controlled sarcoidosis who initially presented to our medical center in 2015 with thoracic myelopathy from epidural spinal sarcoidosis treated with thoracic decompression and fusion. He presented to the hospital 5 years later with a month history of progressive upper extremity weakness. MRI revealed recurrent stenosis and spinal cord compression in the cervicothoracic junction. Urgent surgical intervention along with medical management resulted in symptomatic and functional improvement. Surgical intervention and compliance with postoperative corticosteroid therapy seem to yield a favorable prognosis for patients with epidural spinal sarcoidosis and to avoid recurrence.

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“…Sarcoidosis is a chronic inflammatory systemic disease of unknown etiology, characterized by multiorgan noncaseating granulomatous infiltrations 1 . It affects primarily the lungs, lymphatic system, eyes, skin, heart, and nervous system 2,3 .…”

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confidence: 99%

Fracture of the Dens Axis Due to Spinal Manifestation of Sarcoidosis

Eid

Friedrich

Kudlek

et al. 2021

Spine

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Study Design. Case report and literature review. Objective. We present a case of a pathologic unstable fracture of the odontoid process due to vertebral osseous sarcoidosis. The surgical management of this unreported pathology is described and a review of the literature is given. Summary of Background Data. Sarcoidosis is a chronic inflammatory systemic disease of unknown etiology, characterized by multiorgan noncaseating granulomatous infiltrations. It affects primarily the lungs, lymphatic system, eyes, skin, heart, and nervous system. Osseous sarcoidosis is usually clinically asymptomatic and therefore frequently under-diagnosed. When it does affect the skull or vertebral column, specific surgical therapy is only necessary in cases with nonmanageable pain or where structural integrity is threatened. Methods. Our patient underwent a so-called semiconservative approach, consisting of a minimally invasive transoral-transpharyngeal approach, surgical debridement of the lytic bony lesion, transplantation of cancellous homologous bone, and carbon chest halo-immobilization. Halo-immobilization was left for 8 weeks, followed by a further 6 weeks with a hard cervical collar. Results. Routine computed tomography scans 3 days, 6, 12, 18 weeks, and 1 year after surgery showed good filling of the original defect with cancellous bone, correct alignment of the upper cervical spine, and progressive fracture consolidation and stability. Surgical site infection (SSI) was not observed. The patient had no neurological postoperative deficits. After initial dysphagia, swallowing was not permanently impaired. Conclusion. Sarcoidosis-induced odontoid fractures can be managed successfully using a semiconservative approach, consisting of transoral-transmucosal, minimally invasive surgical procedure for debridement of the lesion and transplantation of cancellous bone with additional halo-immobilization. Permanent fusion of C1-2 with loss of the cervical range of motion is avoided. Despite performing bone surgery in a potentially markedly contaminated site, bacterial infection was not an issue, possibly supported by the temporary discontinuation of immunosuppressive agents and the prudent use of antibiotics.

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Osseous spinal sarcoidosis: an unusual but important entity to remember

Cited by 7 publications

References 7 publications

Tuberculosis of the Axial Skeleton Mimicking Malignancy

Tuberculosis of the Axial Skeleton Mimicking Malignancy

Recurrence of Epidural Spinal Sarcoidosis

Fracture of the Dens Axis Due to Spinal Manifestation of Sarcoidosis

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