RESUMO
BACKGROUND Giant cell tumors of the bone (GCTB) are rare, locally aggressive benign neoplasms that primarily occur in the metaphyses of long bones. In less than 2% of cases, GCTBs arise in the spine, predominantly below the sacrum. We report the clinical manifestations, diagnostic approach, and successful surgical treatment of a patient with a GCTB of the thoracic spine. CASE REPORT A 21-year-old female patient presented to the Emergency Department with back pain and upper motor neuron syndrome. A thorough clinical and imaging examination revealed a tumor and pathological fracture of the T7 vertebra. Histopathological analysis confirmed the diagnosis of a GCTB. The tumor was successfully excised surgically via a posterior thoracic approach, including bilateral decompressive laminectomy, lateral costotransversectomy, and posterior corpectomy, followed by transpedicular instrumentation of the T5-T6 and T8-T9 vertebrae, and anterior arthrodesis with an autologous graft. The patient also received adjuvant radiotherapy. One year later, the patient had no signs of recurrence or physical limitations. CONCLUSIONS GCTBs located in the thoracic spine are uncommon and pose a significant challenge for healthcare professionals due to their non-specific clinical manifestations and the need for a multidisciplinary approach to their management. This case highlights the diagnostic and therapeutic implications of a GCTB of the thoracic spine and describes a successful surgical strategy resulting in complete recovery. The presented case adds to the limited published literature on GCTBs in this unusual location and further elaborates on their presentation and management.
Assuntos
Tumor de Células Gigantes do Osso , Neoplasias da Coluna Vertebral , Neoplasias Torácicas , Humanos , Feminino , Adulto Jovem , Adulto , México , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Tumor de Células Gigantes do Osso/diagnóstico por imagem , Tumor de Células Gigantes do Osso/cirurgia , Neoplasias Torácicas/patologia , Células Gigantes/patologiaRESUMO
Background: This study correlated the extent of spinal canal compression from retropulsed traumatic burst cervical, thoracic, and lumbar spine fractures with the severity of neurological dysfunction. Methods: One hundred and sixty-nine patients with cervical, thoracic, or lumbar sub-axial traumatic burst fractures were seen in an emergency department from 2019 to 2021; 79.3% were men, averaging 37 years of age. The lumbar spine was most frequently involved (42%), followed by the thoracic (36.1%) and cervical (21.9%) levels. The extent of spinal canal compression was quantitated utilizing Hashimoto's method, and correlated with patients' extent of neurological injury based on their American Spinal Injury Association scores. Results: There was a positive correlation between the extent of cervical and thoracic spinal cord compression due to retro pulsed burst fragments and the severity of the patients' neurological deficits, but this was not true for the lumbar spine. Conclusion: The extent of spinal cord compression from retropulsed cervical and thoracic traumatic burst fractures was readily correlated with the severity of patients' neurological dysfunction. However, there was no such correlation between the extent of cauda equina compression from retropulsed lumbar burst fractures and the severity of their cauda equina syndromes.