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Kalagara R, Asfaw ZK, Carr M, Quinones A, Downes MH, Vasan V, Li T, McCarthy L, Hrabarchuk EI, Genadry L, Schupper AJ, DeMaria S, Gal JS, Choudhri TF. Clinical Considerations and Outcomes for Spine Surgery Patients with a History of Transplant: A Systematic Scoping Review. World Neurosurg 2024; 183:94-105. [PMID: 38123131 DOI: 10.1016/j.wneu.2023.12.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE The objective of this study was to investigate the perioperative management and outcomes of patients with a prior history of successful transplantation undergoing spine surgery. METHODS We searched Medline, Embase, and Cochrane Central Register of Controlled Trials for matching reports in July 2021. We included case reports, cohort studies, and retrospective analyses, including terms for various transplant types and an exhaustive list of key words for various forms of spine surgery. RESULTS We included 45 studies consisting of 34 case reports (published 1982-2021), 3 cohort analyses (published 2005-2006), and 8 retrospective analyses (published 2006-2020). The total number of patients included in the case reports, cohort studies, and retrospective analysis was 35, 48, and 9695, respectively. The mean 1-year mortality rate from retrospective analyses was 4.6% ± 1.93%, while the prevalence of perioperative complications was 24%. Cohort studies demonstrated an 8.5% ± 12.03% 30-day readmission rate. The most common procedure performed was laminectomy (38.9%) among the case reports. Mortality after spine surgery was noted for 4 of 35 case report patients (11.4%). CONCLUSIONS This is the first systematic scoping review examining the population of transplant patients with subsequent unrelated spine surgery. There is significant heterogeneity in the outcomes of post-transplant spine surgery patients. Given the inherent complexity of managing this group and elevated mortality and complications compared to the general spine surgery population, further investigation into their clinical care is warranted.
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Affiliation(s)
- Roshini Kalagara
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Zerubabbel K Asfaw
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matthew Carr
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Addison Quinones
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Margaret H Downes
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vikram Vasan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Troy Li
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lily McCarthy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eugene I Hrabarchuk
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lisa Genadry
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samuel DeMaria
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jonathan S Gal
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tanvir F Choudhri
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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2
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Liu Z, Yang H, Tan H, Song R, Zhang Y, Zhao L. Brown tumor of the cervical spine with primary hyperparathyroidism: A case report and literature review. Medicine (Baltimore) 2023; 102:e32768. [PMID: 36820584 PMCID: PMC9907965 DOI: 10.1097/md.0000000000032768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
RATIONALE Brown tumor (BT), an uncommon focal lytic bone tumor, is a non-neoplastic and reactive process caused by increased osteoclastic activity and fibroblastic proliferation in primary or secondary hyperparathyroidism. Vertebral tumor causing neural compression is relatively rare, especially in the cervical spine. PATIENT CONCERNS A 29-year-old man developed neck pain and arm radicular pain 4 months ago, with the level of serum calcium significantly higher than normal. Computed tomography scan of the cervical spine revealed an expansile lytic lesion occupying the C6 body, left pedicle, and left lamina of C5-6. DIAGNOSES Osteoclastoma according to imaging and histopathological results. INTERVENTIONS A laminectomy of C5-6 was performed. OUTCOMES One month later, he was re-hospitalized due to nausea and vomiting and the serum calcium, was still, kept at a high level. Additionally, the parathormone (PTH) was greatly higher than normal. BT with primary hyperparathyroidism due to the parathyroid tumor was considered. After the surgery of the right parathyroid gland was performed, serum calcium and PTH both decreased, and computed tomography showed good recovery. LESSONS BTs might be misdiagnosed as other giant cell tumors, thus when giant cell tumors are considered, serum calcium and PTH examination may be needed to exclude BTs.
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Affiliation(s)
- Zirui Liu
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hao Yang
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongyu Tan
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruipeng Song
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yang Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liang Zhao
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- * Correspondence: Liang Zhao, Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (e-mail: )
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Priyanthan T, Hermann AP, Bojsen JA, Krøigaard AB, Bistrup C, Pedersen EB. Multiple Focal Brown Tumors (Osteitis Fibrosa Cystica) in a Renal Transplant Recipient. Case Rep Nephrol 2022; 2022:4675041. [PMID: 35295209 PMCID: PMC8920699 DOI: 10.1155/2022/4675041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 02/11/2022] [Indexed: 11/17/2022] Open
Abstract
Brown tumors (BTs) are manifestations of osteitis fibrosa cystica that develops due to increased osteoclast activity secondary to hyperparathyroidism (HPTH). The name comes from its characteristic brown color due to high hemosiderin level and hemorrhage surrounded by osteoclastic giant cells, fibrous tissue, and bone fragments. Presentation can be either unifocal or rarely multifocal. Misdiagnosis of BT compared to malignant giant cell tumor is not uncommon. Early diagnosis and intervention may prevent destructive bone changes. Treatment of BTs due to chronic renal failure should be aimed primarily at its prevention with phosphate binders, vitamin D (analogues), calcimimetics, and prolonged dialysis sessions. Parathyroidectomy can be the option in nonresponsive cases. In this report, we present an unusual case of multiple brown tumors in a 54-year-old female renal transplant patient involving the spine, jaw, and scapula, initially misdiagnosed as giant cell tumor. Five years later, the patient was diagnosed with BT because of the medical history, morphology, and negative p63 staining in combination with secondary/tertiary hyperparathyroidism. The patient subsequently underwent subtotal parathyroidectomy.
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Affiliation(s)
| | - Anne Pernille Hermann
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jonas Asgaard Bojsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | | | - Claus Bistrup
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Erik Bo Pedersen
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Shaaban ATE, Ibrahem M, Saleh A, Haider A, Alyafai A. Brown tumor due to primary hyperparathyroidism resulting in acute paraparesis: Case report and literature review. Surg Neurol Int 2020; 11:355. [PMID: 33194288 PMCID: PMC7656022 DOI: 10.25259/sni_653_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/03/2020] [Indexed: 11/07/2022] Open
Abstract
Background: Brown tumor (Osteoclastoma) is a rare benign, focal, lytic bone lesion most commonly attributed to a parathyroid adenoma; it occurs in approximately 5% of patients with primary hyperparathyroidism, and 13% of patients with secondary hyperparathyroidism. Most tumors are located in the mandible, pelvis, ribs, and large bones; only rarely is it found in the axial spine. Case Description: A 37-year-old male with primary hyperparathyroidism presented with an MR-documented T4 and T5 brown tumor (Osteitis Fibrosa Cystica) resulting in an acute paraparesis. The patient successfully underwent excisional biopsy of an expansile, enhancing, bony destructive lesion at the T4-5 level. Subsequently, he required subtotal excision of a left upper parathyroid tumor. Conclusion: Patient with primary hyperparathyroidism may acutely present with paraparesis attributed to brown tumors of the spine warranting emergent operative decompression.
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Affiliation(s)
| | - Mostafa Ibrahem
- Department of Neurosurgery, Hamad Medical Corporation, Hamad General Hospital, Doha, Qatar
| | - Ahmed Saleh
- Department of Neurosurgery, Hamad Medical Corporation, Hamad General Hospital, Doha, Qatar
| | - Abdulrazzaq Haider
- Department of Pathology, Hamad Medical Corporation, Hamad General Hospital, Doha, Qatar
| | - Abdulnasser Alyafai
- Department of Neurosurgery, Hamad Medical Corporation, Hamad General Hospital, Doha, Qatar
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Jia Q, Gao X, Zhou Z, Lan B, Zhao J, Liu T, Yang X, Wei H, Xiao J. Urgent surgery for spinal instability or neurological impairment caused by spinal brown tumors occurring in the context of end-stage renal disease. J Neurosurg Spine 2019; 30:850-857. [PMID: 30835712 DOI: 10.3171/2018.12.spine181044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 12/05/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spinal instability or neurological impairment caused by spinal brown tumors (BTs) with end-stage renal disease (ESRD) is an acute condition that needs urgent surgery. There is not much published information on BTs of the mobile spine given the rarity of the disease, and the literature shows inconsistent treatment options and ambiguous follow-up information. The aim of the present study was to elucidate the clinical features, anesthesia management, and surgical treatment for this rare disease through long-term follow-up observations. METHODS Clinical, laboratory, radiological, and perioperative data on 6 consecutive patients with spinal BTs who had been admitted to the authors' institution between 2010 and 2016 were retrospectively reviewed. The literature on spinal BT with secondary hyperparathyroidism was also reviewed. Summaries of the clinical features and anesthesia management are provided. RESULTS The mean age of the 6 patients was 45.5 years (range 35-62 years). Lesions were located in the cervical segment (2 cases) and thoracic segment (4 cases). Localized pain was the most common complaint, and pathological fracture occurred in 5 patients. Elevation of serum alkaline phosphate (AKP) and parathyroid hormone (PTH) was a common phenomenon. Four patients underwent circumferential resection and 2 underwent laminectomy, with parathyroidectomy performed in all patients. The anesthesia process was uneventful for all patients. The mean follow-up was 33 months (range 26-40 months). No spinal lesion progression occurred in any patient. The Karnofsky Performance Status score improved to 80-90 by 3 months after surgery. CONCLUSIONS Although uncommon, spinal BTs should be a diagnostic consideration in patients with ESRD. The thoracic spine is the most frequently affected site. ESRD is not a contraindication for surgery; with the assistance of experienced anesthesiologists, urgent surgery is the preferred option to alleviate neurological impairment and restore spinal stability.
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Affiliation(s)
- Qi Jia
- 1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai; and
| | - Xin Gao
- 1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai; and
| | - Zhenhua Zhou
- 1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai; and
| | - Bin Lan
- 2Medical Center of Military Unit 32151, Xingtai, Hebei, People's Republic of China
| | - Jian Zhao
- 1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai; and
| | - Tielong Liu
- 1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai; and
| | - Xinghai Yang
- 1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai; and
| | - Haifeng Wei
- 1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai; and
| | - Jianru Xiao
- 1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai; and
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Eroglu E, Kontas ME, Kocyigit I, Kontas O, Donmez H, Kucuk A, Sipahioglu MH, Tokgoz B, Oymak O. Brown tumor of the thoracic spine presenting with paraplegia in a patient with peritoneal dialysis. CEN Case Rep 2019; 8:227-232. [PMID: 31089951 DOI: 10.1007/s13730-019-00398-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 04/18/2019] [Indexed: 11/26/2022] Open
Abstract
Secondary and tertiary hyperparathyroidism is an important problem of chronic kidney disease. Brown tumor is a benign, unusual, reactive lesion as a result of disturbed bone remodeling, from long-standing increase in parathyroid hormone level. Brown tumors may cause morbidity due to pressure symptoms on neural structures and spontaneous bone fractures. Herein, we presented a peritoneal dialysis patient with tertiary hyperparathyroidism under calcand calcitriol treatment for 4 years due to refusing of the parathyroidectomy operation. She admitted to hospital for sudden onset back pain with difficulty in gait and walking, and imaging studies showed an expansile mass lesion in the thoracic spine. She was operated for mass and diagnosed with brown tumor. After operation, she lost the ability of walking than become paraplegic and she underwent rehabilitation program. Preventive measures including calcitriol and cinacalcet may cause a modest decrease in parathyroid hormone levels but it should be remembered for the development of bone complications such as brown tumor formation in patients with moderate elevated PTH levels, especially those with tertiary hyperparathyroidism. Parathyroidectomy should be performed without delay in these cases.
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Affiliation(s)
- Eray Eroglu
- Division of Nephrology, Department of Internal Medicine, Erciyes University Medical Faculty, 38039, Kayseri, Turkey.
| | - Mustafa Eymen Kontas
- Department of Internal Medicine, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Ismail Kocyigit
- Division of Nephrology, Department of Internal Medicine, Erciyes University Medical Faculty, 38039, Kayseri, Turkey
| | - Olgun Kontas
- Department of Pathology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Halil Donmez
- Department of Radiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Ahmet Kucuk
- Department of Neurosurgery, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Murat Hayri Sipahioglu
- Division of Nephrology, Department of Internal Medicine, Erciyes University Medical Faculty, 38039, Kayseri, Turkey
| | - Bulent Tokgoz
- Division of Nephrology, Department of Internal Medicine, Erciyes University Medical Faculty, 38039, Kayseri, Turkey
| | - Oktay Oymak
- Division of Nephrology, Department of Internal Medicine, Erciyes University Medical Faculty, 38039, Kayseri, Turkey
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Arsalanizadeh B, Westacott R. Osteoclastomas ('brown tumours') and spinal cord compression: a review. Clin Kidney J 2015; 6:220-3. [PMID: 26019852 PMCID: PMC4432455 DOI: 10.1093/ckj/sft021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Accepted: 02/14/2013] [Indexed: 01/08/2023] Open
Abstract
Brown tumours are an uncommon manifestation of primary and secondary hyperparathyroidism. There are numerous case reports of brown tumours arising in various parts of the skeleton. They can therefore present a wide range of clinical manifestations. A recent case highlighted the need for heightened awareness of the diagnosis and prompted a literature review.
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Affiliation(s)
| | - Rachel Westacott
- John Walls Renal Unit , University Hospitals of Leicester, Leicester General Hospital , Leicester , UK
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8
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Tayfun H, Metin O, Hakan S, Zafer B, Vardar AF. Brown tumor as an unusual but preventable cause of spinal cord compression: Case report and review of the literature. Asian J Neurosurg 2014; 9:40-4. [PMID: 24891890 PMCID: PMC4038866 DOI: 10.4103/1793-5482.131074] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Brown tumor (BT), also known as osteoclastoma, may appear in the context of primary and secondary hyperparathyroidism. Spinal cord compression due to the BT is extremely rare. We present here an unusual case of BT involving thoracal spine and mandible. A 26-year-old woman, who had been on hemodialysis for chronic renal failure for over 6 years, got admitted with dorsal pain and progressive weakness in her lower extremities and gait disturbances. Neurological examination revealed spastic paraparesis and symmetrically hyperactive tendon reflex in the lower extremities. She had hypoesthesia under T10 level. On physical examination, a swelling on the left side of her jaw was also detected. Magnetic resonance imaging (MRI) showed cord compression due to an extradural mass lesion at T8 level. A computerized tomography (CT) scan showed that this expansile lytic lesion was caused by the collapse of vertebra corpus (T8) at that level. CT of the mandible revealed an expansile lytic lesion on left arm of the mandible. Laboratory findings were nearly normal except parathormone level elevation to 1289 pg/mL (normal 30-70 pg/mL). Ultrasound examination showed enlargement of the parathyroid glands. The patient underwent an emergency decompression and stabilization surgery. The lesion was fragile and reddish in appearance and was easy to aspirate. The tumor was reported as "BT." Her weakness in the lower extremities improved in the early postoperative period. Following surgical intervention, the patient was transferred to nephrology clinic for additional medical treatment.
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Affiliation(s)
- Hakan Tayfun
- Haydarpaşa Numune Teaching and Research Hospital, Neurosurgery Clinic, İstanbul, Turkey
| | - Orakdöğen Metin
- Haydarpaşa Numune Teaching and Research Hospital, Neurosurgery Clinic, İstanbul, Turkey
| | - Somay Hakan
- Haydarpaşa Numune Teaching and Research Hospital, Neurosurgery Clinic, İstanbul, Turkey
| | - Berkman Zafer
- Haydarpaşa Numune Teaching and Research Hospital, Neurosurgery Clinic, İstanbul, Turkey
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Araújo SMHA, Bruin VMS, Nunes AS, Pereira ENS, Mota ACM, Ribeiro MZD, Sobreira CTP, Daher EF. Multiple brown tumors causing spinal cord compression in association with secondary hyperparathyroidism. Int Urol Nephrol 2012; 45:913-6. [PMID: 22249370 DOI: 10.1007/s11255-012-0123-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 01/05/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Brown tumor, a non-neoplastic process resulting from excess osteoclast activity, is found in primary hyperparathyroidism (HPTP) and secondary hyperparathyroidism (HPTS). We report a rare case of multiple spinal cord compression by brown tumors. CASE REPORT A 47-year-old male with end-stage renal disease caused by hypertensive nephrosclerosis, on hemodialysis for 10 years and diagnosed with severe HPTS, developed back pain and sudden onset of gait difficulties progressing to paraplegia. A previous computed tomography (CT) of the lumbosacral spine demonstrated a solid lesion, located in the body of the sacrum, at S1-S2 level, with fine bone edge sclerosis, suggestive of brown tumor. A magnetic resonance imaging without gadolinium injection was performed. The examination revealed an insufflating bone lesion at thoracic level (T5/T6). Posterior laminectomy was followed by tumor excision. Histopathological analysis showed osteoid tissue streaked by fibroplasia with hemosiderin granulation. CONCLUSION Differential diagnosis of sudden neurologic deficits and paraplegia in renal patients with secondary HPPT must consider the possibility of brown tumor.
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Affiliation(s)
- Sônia M H A Araújo
- Department of Internal Medicine, Federal University of Ceará, Rua Professor Costa Mendes, no 2609, Fortaleza, CE, CEP 60430-040, Brazil.
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10
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Brown tumor of the cervical spine: a case report and review of the literature. Clin Rheumatol 2010; 30:419-24. [DOI: 10.1007/s10067-010-1608-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 10/13/2010] [Indexed: 10/18/2022]
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