Monostotic fibrous dysplasia of the spine: report of a case involving the lumbar transverse process and review of the literature

Fibrous Dysplasia at Unusual Anatomic Sites: A Series of 86 Cases With Emphasis on Histologic Patterns

Aims. Fibrous dysplasia (FD) is a benign fibro-osseous neoplasm that most commonly arises in the ribs, femur, and craniofacial bones. We analyzed features of FD arising in the spine/short tubular/small bones of the hands/feet (STSBHF), specifically assessing for pattern of bone formation (conventional, complex/anastomosing, psammomatoid/cementum like), myxoid change, and presence of osteoclast-type giant cells. Materials and methods. A total of 1958 cases of FD were reviewed, of which 131 arose in the spine/STSBHF representing 2.5% of institutional and 10% of consultation cases, respectively. Eighty-six cases had material available for review. Anatomic sites included vertebrae (n = 58, 67%), short tubular bones (n = 20, 23%), and small bones of the hands/feet (n = 8, 9%). The most common morphologic pattern of bone identified was conventional (n = 77, 90%), followed by complex/anastomosing (n = 22, 26%) and psammomatoid/cementum like (n = 22, 26%). Eighteen cases (21%) had matrix-poor areas. Hypercellular areas were identified in 6 cases, 2 cases of which showed matrix-poor areas. Osteoclast-type giant cells were noted in 9 cases and myxoid change was present in 3 cases. Radiologic imaging studies available for 41 cases nearly all demonstrated features typical of FD, but the diagnosis was not predicted due to the unexpected location. Conclusions. FD arising in the spine/STSBHF is rare and frequently results in expert consultation. A significant number of cases exhibited less commonly recognized patterns of bone formation, and stromal changes including osteoclast-type giant cells, and matrix poor areas. Furthermore, imaging features in the STSBHF are often less specific. Awareness of the morphologic spectrum at these locations coupled with radiologic correlation should aid in accurate classification.

Kyphotic deformity of the lumbar spine due to a monostotic fibrous dysplasia of the second lumbar vertebra: a case report and its surgical management

Monostotic fibrous dysplasia (MFD) of the lumbar spine represents an exceedingly rare lesion. A 26-year-old patient presented with a progressive osteolytic lesion of the vertebral body L2 and the diagnosis of MFD. A minimally invasive left-sided eXtreme Lateral Interbody Fusion (XLIF) approach with resection of the vertebral body L2 with placement of a mesh cage was performed. No complications were observed perioperatively and the symptoms rapidly improved. Minimally invasive piecemeal resection with a combined dorsolateral approach showed a favorable clinical and radiological outcome and seems to be a safe and reliable technique for MFD.

Locally aggressive monostotic fibrous dysplasia of the cervical spine mimicking malignancy: a case report and literature review

We report the case of a 30-year-old woman with histologically proven monostotic fibrous dysplasia of C2 revealed by a pathological fracture of the odontoid process. Radiological investigations showed a ground-glass mineralization of the vertebral body, a centimetric lytic area with poorly defined margins involving the inferior part of the vertebral body and inferior endplate and a fracture through an osteolytic area in the base of the odontoid process. Owing to the vertebral instability, a surgical procedure combining C0-C5 fixation and posterior bone grafting was performed. The surgical biopsy was inconclusive and pathological confirmation was finally obtained through a percutaneous needle biopsy under fluoroscopic guidance. At 26-month follow-up, the patient still experienced mild persistent cervical posterior neck pain and stiffness possibly related to a C5-6 laxity below the intervertebral fixation. This case combines three radiological findings, which are unusual in fibrous dysplasia: monostotic presentation involving the spine, some aggressive radiographic features, and a pathological fracture.

Fibrous dysplasia of the mobile spine: report of 8 cases and review of the literature

STUDY DESIGN

Eight cases of fibrous dysplasia (FD) of the mobile spine treated surgically at the same center were retrospectively reviewed.

OBJECTIVE

The study focuses on the issues concerning the diagnosis of FD and the outcome of conventional surgical techniques (resection or curettage) and vertebroplasty in the treatment of spinal FD lesions.

SUMMARY OF BACKGROUND DATA

Surgical excision or curettage is considered the standard treatment of spinal FD, whereas vertebroplasty is also performed occasionally.

METHODS

Between January 2005 and October 2010, 8 consecutive patients with spinal FD underwent conventional surgery (6 cases) or combined with vertebroplasty (2 cases). Before surgery, 4 patients underwent percutaneous computed tomography-guided biopsy, whereas 3 had incorrect histopathological diagnosis. In each of the 8 cases, the final pathological diagnosis was established after their open surgery.

RESULTS

Pain relief was observed postoperatively in all patients. Three patients with neurological impairment became symptom-free after surgery. No cement extravasation was observed. Screw loosening and allograft resorption were observed in 1 case each. Signs of radiological improvement (filling of lytic lesions or thickening of the bone cortex surrounding the lesions) were not detected in any case.

CONCLUSION

The radiological features of spinal FD may be atypical. The rate of correct preoperative pathological diagnosis by computed tomography-guided biopsy was low for patients with suspected spinal FD. Vertebroplasty is probably a valuable therapeutic option for spinal FD with pathological fractures. Limited decompression and stability with vertebroplasty might be recommended for patients with neurological deficits.

CT and MRI of fibrous dysplasia of the spine

OBJECTIVES

The purpose of this study was to present the CT and MRI findings of patients with fibrous dysplasia (FD) of the spine.

METHODS

Among the patients with pathologically proven skeletal FD, 12 (8 males and 4 females; mean age, 43 years) who were evaluated with either spine CT or MRI were included. The number and location of the involved vertebral segments, the presence of lytic lesions, ground-glass opacity (GGO), an expansile nature, cortical disruption, a sclerotic rim, a decrease in body height and contour deformity were examined on CT scans (n=12), while signal intensity, enhancement patterns and the presence of a dark signal rim on the lesion were examined using MRI (n=9).

RESULTS

Nine patients had polyostotic FD, including one with an isolated spinal localisation, while three had monostotic FD. An expansile nature (n=3) and osteolytic lesions with GGO (n=3) were seen. On CT images, GGO was noted in all patients. An expansile nature (n=11) and presence of lytic lesions (n=11) were noted. A decrease in body height (n=9) and sclerotic rim formation (n=9) were indicated. Contour deformities were visible in six patients. The MRI findings were non-specific. Dark signal rims were visible on MRI in seven patients.

CONCLUSION

Typical imaging findings of extraspinal FD were noted on spine CT scans. These characteristic CT imaging findings of spinal FD may be helpful in differentiating FD from other common spine diseases.

Monostotic fibrous dysplasia of a lumbar vertebral body with secondary aneurysmal bone cyst formation: a case report

We report the case of a 25-year-old Caucasian woman with symptomatic monostotic fibrous dysplasia of the fourth lumbar vertebral body. The patient suffered from a five-week history of progressive low back pain, radiating continuously to the left leg. Her medical history and physical and neurological examination did not demonstrate any significant abnormalities. Radiographs, computed tomography and magnetic resonance imaging revealed an osteolytic expansive lesion with a cystic component of the fourth lumbar vertebral body. Percutaneous transpedicular biopsy showed histological characteristics of fibrous dysplasia superimposed by the formation of aneurysmal bone cyst components. The patient was treated by subtotal vertebrectomy of the L4 vertebral body with anterior reconstruction and her postoperative course was uncomplicated. To our knowledge, this is the first reported case of a monostotic fibrous dysplasia with superimposed secondary aneurysmal bone cysts of a lumbar vertebral body.

Scoliosis and spine involvement in fibrous dysplasia of bone

Few studies focused on the prevalence of scoliosis and involvement of the spine in patients with fibrous dysplasia (FD) of bone. We examined for FD involvement of the spine and scoliosis in 56 patients affected by FD of bone. Fifty patients were part of a cohort reported in a multicentric study on FD promoted by European Pediatric Orthopedic Society (EPOS) in 1999, and six were new patients. There were 30 females and 26 males (mean age 12.5 years; range 1-42 years). Twenty-three had monostotic FD, 9 polyostotic FD, and 24 McCune-Albright Syndrome (MAS). Scoliosis was observed in 11 cases of polyostotic FD and MAS (33.3%). In seven of the patients with scoliosis (63.3%) spine was involved by FD lesional tissue. FD lesions involved the thoracic or lumbar spine in all patients but one, where cervical spine was also affected. A correlation between scoliosis and either spinal (p<0.01) or pelvic lesions (p<0.05) and pelvic obliquity (p<0.01) was observed. Three of the 11 patients showed familiarity for scoliosis but in 2 of them spine was involved by FD. Scoliosis and spine involvement were never detected in monostotic FD. This study indicates that in FD patients with polyostotic disease (1) the prevalences of FD involvement of the spine and scoliosis are high enough to include spine in the clinico-radiographic survey of these patients, and (2) the involvement of the spine and pelvis by FD lesions and pelvic obliquity are important determinants in the occurrence of scoliosis.

Odontoid fracture complicating Jaffe-Lichtenstein disease. Case report

The authors report the case of a 31-year-old man with polyostotic fibrous dysplasia who suffered a traumatic odontoid fracture in an area of a preexisting bone lesion. Conservative treatment was successfully performed. Jaffe-Lichtenstein disease is discussed along with differential diagnoses and alternative methods of treatment.

Polyostotic fibrous dysplasia of the cervical spine: case report and review of the literature

BACKGROUND CONTEXT

Multiple lytic lesions of the spine usually represent metastatic or infectious disease processes.

PURPOSE

To describe an extremely rare presentation of an uncommon disease process.

STUDY DESIGN/SETTING

Case report/university hospital.

METHODS

We describe the management of a patient who presented with a pathological fracture of C3 and multiple lytic lesions of the cervical spine.

RESULTS

After reconstructive surgery, the final pathological diagnosis was fibrous dysplasia.

CONCLUSION

Fibrous dysplasia is rarely seen in the cervical spine and may mimic other pathological processes. The surgical and medical management of spinal fibrous dysplasia is described.

Primary bone tumors of the spine in children

OBJECT

Tumors originating in the vertebrae in children are difficult to treat. In this paper the authors sought to evaluate the decision-making process and outcome of surgical intervention in this population given the complex issues of spinal stability, continued skeletal growth, intraoperative blood loss, and long-term outcome.

METHODS

To select patients for this study, the authors retrospectively reviewed medical records and images at the University of Iowa Hospitals and Clinics between 1996 and 2005. Their inclusion criteria were age younger than 18 years at the time of diagnosis and histopathological findings confirming that the tumor originated from vertebral bone. Sixteen patients met these requirements. In addition, the authors conducted a comparison with 45 patients in whom similar diagnoses were made prior to 1996. Gross-total resection of all nonmetastatic primary bone tumors is desired, as exemplified in 11 patients in this series; biopsy sampling only was performed in two others. Gross-total resection was also not performed in three patients with eosinophilic granuloma (EG). These three patients underwent nonsurgical treatment, which is different from how patients with EG were treated in the earlier study. Nine histopathological diagnoses were included; with a mean follow-up period of 3.7 years, the survival rate is 94%. The tumor recurred in one patient with a giant cell tumor of the sacrum. The authors performed preoperative tumor embolization and found that it was a useful adjunct to resection. Provocative testing prior to embolization was part of the protocol to reduce ischemic complications. Motion-sparing surgical procedures were performed in which a few segments were fused, preserving axial mobility.

CONCLUSIONS

Overall, early intervention offers the best symptomatic relief, which can only be rendered if sufficient clinical suspicion provokes early diagnostic imaging.

Monostotic fibrous dysplasia of the spine: report of a case involving a cervical vertebra

Monostotic fibrous dysplasia of the spine is a rare entity. Only 26 cases, of which 11 were located in the cervical spine, are to be found in the literature. We report a 56-year-old male patient with cervicobrachialgia of half year's duration. Radiographs showed a diffuse destruction of the vertebral body and the spinous process of C4. A biopsy of the spinous process confirmed histopathologically a fibrous dysplasia. Due to minor symptoms, no surgical treatment was performed or is planned unless in case of increasing pain, an acute instability or neurological symptoms.

Monostotic Fibrous Dysplasia of the Lumbar Spine

Monostotic fibrous dysplasia of the spine is extremely rare. We present a 57-year-old man who complained of persistent low back pain with monostotic fibrous dysplasia of the lumbar spine. Computed tomography revealed a lytic expansile lesion and marginal sclerosis in the L2 posterior element, although a bone scan did not reveal increased uptake in the lesion. The patient underwent total excision of the tumor via a posterior approach. Two years later, he is asymptomatic with no recurrence of the lesion, as confirmed by imaging.