"Spinolith": case report of a loose body in the spinal canal

Rare radiculopathy from an osteochondral loose body: a case report and literature review

Lumbar radiculopathy is usually caused by nerve compression due to herniated disc material or compression by degenerative pathology such as enlarged facet joints, thickened ligamentum flavum or synovial cysts. We report the case of a 48-year-old female with L5 sciatica due to an osteochondral loose body in the foramen. This is only the third reported case of a single osteochondral loose body in the lumbar spine and the first reported case found in the foramen.

Multiple Loose Bodies in the Lumbar Facet Joint: Case Report

We describe here a patient diagnosed with multiple loose bodies in the lumbar facet joint. The patient was a 52-year-old woman who presented with left sciatic pain. Neurological findings indicated L5 radiculopathy. Radiological findings revealed lateral recess stenosis at the L4–L5 level, and loose bodies in the left L4–L5 facet joint were noted that compressed the left L5 nerve root. We performed laminotomy at the left L4–L5 level, and removed five loose bodies located on the dorsal side of the ligamentum flavum. Following removal of the loose bodies and flavectomy, the L5 nerve root was decompressed. Postoperatively, the patient’s symptoms improved markedly. Symptomatic multiple loose bodies in the lumbar facet joint are very rare, and can cause lumbar radiculopathy. It is important for spine surgeons to recognize this pathology.

Osteochondral loose body: an unusual cause of lumbar spinal stenosis

Lumbar spinal stenosis is most often a degenerate condition observed in the older population. We describe the case of a lady with typical claudicant symptoms with an unusual cause of stenosis identified at the time of her decompressive surgery. On review of the literature this is only the second case of osteochondral loose body as a cause for lumbar spinal stenosis and thus remains a rare phenomenon.

Multiple Osseous Loose Bodies Associated with Lumbar Isthmic Spondylolisthesis

BACKGROUND

Multiple osseous loose bodies in the lumbar spine have never been reported. We describe a rare surgical case of multiple osseous loose bodies associated with lumbar isthmic spondylolisthesis.

CASE DESCRIPTION

A 74-year-old man who experienced left foot numbness and bilateral gluteal pain was diagnosed with lumbar spondylolisthesis 7 years previously and managed conservatively. He reported recurrence of the left foot numbness 6 months previously, at which time aggressive (rather than conservative) therapy became a consideration. Radiographs of the lumbar spine revealed L5 isthmic spondylolisthesis with dynamic instability at L5/S1. Magnetic resonance imaging of the lumbar spine revealed multiple mass lesions dorsally located in the lumbar canal. Computed tomography myelography demonstrated multiple osseous materials near the isthmic portion at the L5 level where compression of the dural sac by the lesions induced lumbar canal stenosis. The patient underwent posterior decompression surgery that enabled total removal of the osseous lesions. Intraoperative findings revealed osseous lesions located in the fibrocartilage material and no connection of the lytic portion at the L5 level or ligamentum flavum. Postoperative course of the patient was uneventful as his neurological symptoms improved.

CONCLUSIONS

We described the first instance of multiple loose bodies in the spinal canal with lumbar canal stenosis. It is presumed that long standing minor trauma due to dynamic instability with a trend of hyperossification induced secondary synovial osteochondromatosis forming multiple loose bodies.

Enlargement of an osseous loose body in the cervical spine with cord compression

BACKGROUND CONTEXT

Loose bodies in the spinal canal are extremely rare, with only two cases reported previously in the literature.

PURPOSE

To report a rare case of an osseous loose body in the cervical spine with radiographic evidence of dramatic enlargement of the loose body in the spinal canal over the course of 9 years.

STUDY DESIGN/SETTING

Case report.

PATIENT SAMPLE

A 50-year-old man presented with progressive numbness and weakness of the upper and lower extremities and swaying gait in 2007. He had a history of temporary incomplete tetraplegia after a fall in 1998. Magnetic resonance imaging revealed enlargement of the posterior mass-occupying lesion compressing the cord at C5-C6 over the course of 9 years.

OUTCOME MEASURES

Neurological examination with motor and sensory status.

RESULTS

Posterior decompressive laminectomy was performed. An isolated, smooth-surfaced, bony, hard mass was found between the ligamentum flavum and facet joint and removed. Histological examination demonstrated trabecular bone and peripheral cartilage mixed with fibrous and fibrocartilaginous tissue. Clinical evaluation of the patient 6 months postoperatively showed total resolution of neurological symptoms.

CONCLUSION

We report herein an extremely rare case of an osseous loose body in the spinal canal with cord compression. This report represents the first documented case of growth of a loose body in the spinal canal.