Reconstruction after Subtotal Sacrectomy for Sacral Ewing’s Sarcoma Using Tibial Allograft Strut Grafting: A Case Report

We present the case of a 15-year-old girl. Two months after becoming aware of pain, she was diagnosed with a sacral tumor and referred to our department. She was diagnosed with a sacral Ewing’s sarcoma; after chemotherapy, it was determined that the tumor could be resected, so surgical treatment was performed. The sacrum and ilium were partially resected at the lower end of S1, and the lumbar vertebrae and pelvis were fixed with a pedicle screw and two iliac screws on each side of L3, and the sacral resection was reconstructed with a tibial strut allograft. No tumor recurrence or metastasis has been observed 1 year postoperatively. She developed bladder and rectal dysfunction, but she remained independent in activities of daily living and her daily life was not limited. The bone fusion in the reconstructed area confirmed the lack of instrumentation looseness. Surgical treatment for sacral Ewing’s sarcoma was performed to cure the patient. We believe that the tibial allograft contributed to the patient’s ability to walk on her own due to its high mechanical stability. Postoperative bone healing was observed with the same material, suggesting that the tibial allograft is useful for similar procedures.

Anterior dural ectasia associated with cauda equine syndrome in ankylosing spondylitis: a case report

Background: Cauda equina syndrome (CES) is a rare neurologic complication in patients with long-standing ankylosing spondylitis (AS). MRI characteristically shows an enlarged caudal thecal sac, bone erosion and dural ectasia. Dural ectasia is more likely to occur in the posterior elements rather than the vertebral bodies. Methods: We report an uncommon case of CES in AS with formation of anterior dural ectasia. The origin of this rare pathology is analysed and relevant literatures are reviewed. Results: The patient had a 50-year history of AS and presented with weakness of his left leg but without bladder or rectal dysfunction. Radiographs of the full spine showed the classic features of AS with fusion of all spinal ligaments and bilateral sacroiliac joints. CT scanning demonstrated erosion-like lesions with marginal sclerosis in the posterior aspect of the T12 and L1 vertebral bodies. Lumbar MRI revealed anterior dural ectasia into the vertebral body, and ventral herniation of the spinal cord and adhesion to the dural sac. Conclusions: The clinical manifestations of anterior dural ectasia in AS with CES include lower limb numbness and weakness, bladder and rectal dysfunction, impotence, etc. MRI characteristically shows an enlarged caudal thecal sac, bone erosion and anterior dural ectasia at the junction of thoracolumbar and upper lumbar.

Successful Neurological Recovery with Multimodality Therapy without Surgery for Spinal Metastases from Advanced Gastric Cancer

Advanced gastric cancer with bone metastasis has a very poor prognosis with short median survival. To the best of our knowledge, no reports in literature have described extensive recovery of paralysis with multimodality treatment without surgery in these cases. This report describes the case of a 52-year-old severely paralyzed female patient with spinal metastasis from advanced gastric cancer. She was inoperable, owing to a large thrombus in the inferior vena cava; alternative multimodality treatments, including chemotherapy and radiotherapy, were administered. The paralysis and the bladder and rectal dysfunction improved considerably. In addition, the performance status (PS) and Frankel grade also improved dramatically, from 4 to 1 and grade B to D, respectively. At 1 year after initiation of treatment, she is ambulatory. Patients with poor PS are often offered palliative therapy. However, this case demonstrates that poor PS solely due to paralysis from spinal metastasis may necessitate multimodality treatment instead of palliative care.

Treatment Characteristics and Outcomes in 58 Children with Spinal Cord Injury

Background: Spinal cord injury (SCI) can change an individual’s life significantly and usually irreversibly. Recently, the incidence of spinal SCI in children has shown an upward trend. Many of them arise from back bends in dances. SCI can cause great suffering and dysfunction to children because they are still in the physical development stage and the degree of injury and prognosis are different from adults. This study aimed to analyze the characteristics of children with SCI and their prognosis, to study the causes of these injuries, and to explore rehabilitation strategies for children with SCI. Methods: The clinical data of children with SCI, including general conditions, cause and degree of injury, and effects of rehabilitation were analyzed and evaluated. Results: Out of the 58 patients, 22 (37.93%) had SCI at and above T6, 34 (58.62%) at T7-T12, and 2 (3.45%) at and below L1. The injuries were caused by a back bend in 35 cases (60.34%) and by traffic accidents in eight cases (13.79%). Upon discharge, seven patients (12.07%) achieved independent walking ability, 33 (56.90%) realized wheelchair independence, and 46 (79.31%) attained basic or complete self-care ability. Fifty-six (96.55%) of these children with SCI experienced bladder dysfunction, 55 (94.83%) experienced rectal dysfunction, and 20 (34.48%) had scoliosis. Conclusions: Children with incomplete SCI are able to gain a great degree of functional recovery while children with complete SCI can achieve better independent living ability through active comprehensive rehabilitation training.

Primary spinal cord astroblastoma: case report

Astroblastoma is a rare tumor that is thought to occur exclusively in the cerebrum. To the authors’ knowledge, no cases of spinal cord astroblastoma have been reported. A 20-year-old woman presented with numbness in her legs. MRI demonstrated a 2-cm intramedullary enhancing lesion in the spinal cord at the T-1 level. The patient declined to undergo resection of the tumor because she was able to walk unassisted; however, she returned for surgery 1 month later because she had developed paraplegia with bladder and rectal dysfunction, and MRI showed enlargement of the tumor. Intraoperatively, the border between the tumor and normal tissue was poorly defined. Biopsy samples were obtained for histopathological examinations, and a diagnosis of astroblastoma with a Ki-67 index of 5% was made. Considering the rapid tumor growth on MRI and remarkable deterioration in her symptoms, the patient was treated with a combination of radiation therapy, temozolomide (TMZ), and bevacizumab. After completion of the combined treatment, she was able to move her toes, and oral TMZ and bevacizumab injections were continued. Six months later, definite tumor shrinkage was identified on MRI, and the patient was able to stand up from a wheelchair without assistance and walk by herself. No therapeutic regimens for residual astroblastoma are established; however, in this case the authors’ therapeutic strategy was successful in treating the spinal cord astroblastoma.