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Dr nitin garg


Various tumors – both benign and malignant affect the vertberae. Common ones include metastasis, plasmacytoma, aneurysmal bone cyst, hemangioma. Patient present with persistent back pain and neurological deficit in those with cord compression.
Treatment options include adjuvant focal radiotherapy in metastatic spine disease without neurological deficits and maintained vertebrae. Surgical methods include vertebroplasty, fixation with or without decompression. Those with neurological deficits require decompression to relieve the cord compression and allow for neurological recovery.
A 35 year old lady presented with upper dorsal pain and progressive myelopathy. MRI (Figure 1) and CT scan (Figure 2) revealed bony tumor involving D4 vertebrae with significant cord compression. On CT scan, the bony architecture was significantly destroyed with intact cortical margins. The patient underwent posterior approach, decompressive laminectomy, D4 vertebroplasty and D3-D5 transpedicular screw fixation. The patient tolerated the procedure well and recovered uneventfully. Post-procedure imaging showed appropriate position of the cement and screws (Figure 3).
Aids used: C-arm, PMMA cement

Figure 1a: Pre-op MRI with D3 body tumor and cord compression

Figure 2: Pre-op CT scan with bony involvement
Dr Nitin Garg