Navraj S Sagoo1, Edward P Southern2,3,4, Andrew G King5, Matthew W Stark6, Lori A McBride7,8. 1. School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA. 2. Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA. edsouthe@utmb.edu. 3. Department of Orthopaedic Surgery, Louisiana State University Health Science Center, New Orleans, LA, USA. edsouthe@utmb.edu. 4. Department of Orthopedic Surgery, The Institute for Western Surgery and Parkway Healthcare, Shanghai, China. edsouthe@utmb.edu. 5. Department of Orthopaedic Surgery, Louisiana State University Health Science Center, New Orleans, LA, USA. 6. Department of Pathology, Louisiana State University Health Science Center, New Orleans, LA, USA. 7. Department of Pediatric Neurosurgery, Children's Hospital of New Orleans, New Orleans, LA, USA. 8. Department of Pediatric Neurosurgery, Our Lady of the Lake Children's Health, Baton Rouge, LA, USA.
Abstract
PURPOSE: Chondroblastoma is a cartilaginous neoplasm which rarely presents in the spine, where it has been shown to exhibit aggressive behavior. We present a case of a late diagnosis of a T12 chondroblastoma causing paraparesis in an 11-year-old girl. Several missed classical radiographic and clinical features are highlighted. METHODS: We reviewed clinical, imaging, and pathology data from the time of transfer to our institution, followed by review of all outside clinical records and imaging data from 14 months prior to admission until onset of paraplegia. RESULTS: The patient was transferred to our center for emergent treatment of a large, expansile, exophytic lesion compressing the spinal cord at T12. Intravenous steroids improved her neurologic status to ASIA Grade B, and an en bloc posterior element resection was performed emergently within 24 h. She rapidly improved to an ASIA Grade E. After obtaining all prior imaging during detailed histopathologic work-up, the final diagnosis was that of spinal chondroblastoma. Subsequent anterior en bloc resection was performed. The patient remains disease-free with a stable, residual scoliosis 7 years postoperatively. CONCLUSIONS: Detailed review of radiographs is essential for scoliosis patients. Earlier recognition of the "winking owl" sign, a kyphotic sagittal alignment, and more concern about a child with a painful curve may have resulted in earlier diagnosis before the onset of neurologic deficits.
PURPOSE:Chondroblastoma is a cartilaginous neoplasm which rarely presents in the spine, where it has been shown to exhibit aggressive behavior. We present a case of a late diagnosis of a T12 chondroblastoma causing paraparesis in an 11-year-old girl. Several missed classical radiographic and clinical features are highlighted. METHODS: We reviewed clinical, imaging, and pathology data from the time of transfer to our institution, followed by review of all outside clinical records and imaging data from 14 months prior to admission until onset of paraplegia. RESULTS: The patient was transferred to our center for emergent treatment of a large, expansile, exophytic lesion compressing the spinal cord at T12. Intravenous steroids improved her neurologic status to ASIA Grade B, and an en bloc posterior element resection was performed emergently within 24 h. She rapidly improved to an ASIA Grade E. After obtaining all prior imaging during detailed histopathologic work-up, the final diagnosis was that of spinal chondroblastoma. Subsequent anterior en bloc resection was performed. The patient remains disease-free with a stable, residual scoliosis 7 years postoperatively. CONCLUSIONS: Detailed review of radiographs is essential for scoliosispatients. Earlier recognition of the "winking owl" sign, a kyphotic sagittal alignment, and more concern about a child with a painful curve may have resulted in earlier diagnosis before the onset of neurologic deficits.