Aneurysmal bone cyst of the lumbar spine involvement: a case of atypical groin pain misdiagnosed as an inguinal hernia

Lomber vertebra tutulumu gösteren anevrizmal kemik kisti - inguinal herni ile karışan atipik kasık ağrılı bir olgu sunumu

Abstract

Purpose: The signs and symptoms of aggressive aneurismal bone cyst of lumbar 1 (L1) vertebrae and the results of surgery were investigated. Material and Method: Amale patient (23 years- old) had back pain for a year. He was misdiagnosed with inguinal hernia and received an operation at a different center. His pain increased during postoperative 2nd week. A brief history and physical examination revealed L1 dermatome hypoesthesia, back pain while walking, neurologic claudication, decrease in muscle power (4/5), and sensitive L1 spinous process at palpation. Anteroposterior and lateral lumbar radiography, computerized tomography (CT), magnetic resonance imaging (MRI), scintigraphic and blood tests were studied. Biopsy, pathologic investigation and proper surgical technique were planned simultaneously. Results: In addition to clinical sign and symptoms, radiologic studies showed a lobulated, 3.5x2.5x2.2 cm bony mass, which was damaging the cortex, expanding through spinal canal and pressurizing dura and right L1 and lumbar 2 (L2) roots. Simultaneous thorasic 12 (T12) – L2 posterior approach was used. There was cortical defect over right lamina of L1. All posterior elements of L1 except left superior facet joint and left transverse process were removed. Tumor mass diffused onto right L1 root like a sheath. All pathologic mass was removed without any neurologic impairment. T12 and L2 vertebrae were instrumented with pedicle screws. Autogenous graft was applied to the right side for fusion. Left lower extremity sign and symptoms disappeared immediately after surgery. Pathology report revealed an aneurismal bone cyst. There was no sign or symptom at postoperative sixty month visit. Patient returned to normal life. Conclusion: CT is the best viewing modality for aneurysmal bone cyst. MRI clearly shows epidural expansion. Surgical procedure must be done meticulously. With limited surgical intervention the patient went back to work. Patient was satisfied with treatment and there was no recurrence.

Özet

Anevrizma kemik kisti (AKK) yaklaşık olarak tüm kemik tümörlerinin % 1.4ʼnü ve tüm primer omurga tümörlerinin % 15ʼni kapsar. AKK gibi omurganın bazı benign primer kemik lezyonları agresif seyirlidir (Osteoblastoma ve dev hücreli tümör gibi). Klinik semptomları dikkat edilmezse başka patolojiler ile karıştırılabilir. İnguinal bölgedeki ağrı şikayeti için herni şüphesi ile daha önce opere edilen 23 yaşındaki erkek hastada, nörolojik semptomlarla birlikte Lomber 1 vertebra posterior nöral ark tutulumlu nadir rastlanan agresif AKK tespit edildi. Posterior nöral ark ve medulla üzerinde bası oluşturan kitle total olarak çıkarılıp bir üst ve alt seviyeye pediküler vida fiksasyonu uygulandı. Postoperatif erken dönem tam iyileşme sağlandı, 5 yıllık takip sonucu rekürrensle karşılaşılmadı, klinik ve radyolojik olarak sonuçların çok iyi olduğu belirlendi.