1
|
Whittaker B, Frydenberg E, Earls P, Wang D, Steel T. Rare radiculopathy from an osteochondral loose body: a case report and literature review. AME Case Rep 2019; 3:38. [PMID: 31728436 DOI: 10.21037/acr.2019.09.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/16/2019] [Indexed: 11/06/2022]
Abstract
Lumbar radiculopathy is usually caused by nerve compression due to herniated disc material or compression by degenerative pathology such as enlarged facet joints, thickened ligamentum flavum or synovial cysts. We report the case of a 48-year-old female with L5 sciatica due to an osteochondral loose body in the foramen. This is only the third reported case of a single osteochondral loose body in the lumbar spine and the first reported case found in the foramen.
Collapse
Affiliation(s)
- Brent Whittaker
- School of Medicine, University of New South Wales, Sydney, Australia
| | - Ellen Frydenberg
- School of Medicine, University of New South Wales, Sydney, Australia.,Department of Neurosurgery, St Vincent's Hospital, Darlinghurst, Australia
| | - Peter Earls
- Department of Pathology, St Vincent's Hospital, Darlinghurst, Australia
| | - Duo Wang
- School of Medicine, University of New South Wales, Sydney, Australia.,Department of Pathology, St Vincent's Hospital, Darlinghurst, Australia
| | - Timothy Steel
- School of Medicine, University of New South Wales, Sydney, Australia.,Department of Neurosurgery, St Vincent's Hospital, Darlinghurst, Australia
| |
Collapse
|
2
|
Yu S, Wu M, Zhou G, Ishikawa T, Liang J, Nallapothula D, Singh RR, Wang Q, Wang M. Potential utility of anti-TNF drugs in synovial chondromatosis associated with ankylosing spondylitis. Int J Rheum Dis 2019; 22:2073-2079. [PMID: 31647182 DOI: 10.1111/1756-185x.13734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 11/29/2022]
Abstract
We describe a previously unreported association of ankylosing spondylitis with synovial chondromatosis, and briefly review previously reported cases and treatment of synovial chondromatosis in patients with other immune-mediated inflammatory arthritides. A 20-year-old man with ankylosing spondylitis whose axial disease was in remission with nonsteroidal anti-inflammatory drugs and oral disease-modifying anti-rheumatic drugs developed recurrent right knee pain and swelling. Magnetic resonance imaging of his right knee revealed calcified loose bodies, suggestive of synovial chondromatosis. While waiting for the surgical intervention and other invasive therapy previously reported in patients with synovial chondromatosis, a trial of etanercept eliminated the pain and swelling of the knee; however, the loose bodies have persisted during the 2-year follow-up. Thus, synovial chondromatosis should be considered in the differential diagnoses of a refractory monoarticular pain and swelling in patients with otherwise controlled inflammatory arthritis. Our report advocates a trial of anti-tumor necrosis factor drugs, which might delay the need for invasive therapy in patients with synovial chondromatosis.
Collapse
Affiliation(s)
- Shengyan Yu
- Department of Rheumatology and Immunology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Meifang Wu
- Autoimmunity and Tolerance Laboratory, Division of Rheumatology, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Gengmin Zhou
- Department of Rheumatology and Immunology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Tatsuya Ishikawa
- Autoimmunity and Tolerance Laboratory, Division of Rheumatology, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Jianle Liang
- Department of Medical Imaging, Peking University Shenzhen Hospital, Shenzhen, China
| | - Dhiraj Nallapothula
- Autoimmunity and Tolerance Laboratory, Division of Rheumatology, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Ram Raj Singh
- Autoimmunity and Tolerance Laboratory, Division of Rheumatology, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Qingwen Wang
- Department of Rheumatology and Immunology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Meiying Wang
- Department of Rheumatology and Immunology, Peking University Shenzhen Hospital, Shenzhen, China.,Autoimmunity and Tolerance Laboratory, Division of Rheumatology, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, CA, USA
| |
Collapse
|
3
|
Yamasaki Y, Tezuka F, Yamashita K, Takata Y, Sakai T, Maeda T, Sairyo K. Multiple Loose Bodies in the Lumbar Facet Joint: Case Report. NMC Case Rep J 2019; 6:79-81. [PMID: 31417836 PMCID: PMC6692599 DOI: 10.2176/nmccrj.cr.2017-0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/04/2019] [Indexed: 11/20/2022] Open
Abstract
We describe here a patient diagnosed with multiple loose bodies in the lumbar facet joint. The patient was a 52-year-old woman who presented with left sciatic pain. Neurological findings indicated L5 radiculopathy. Radiological findings revealed lateral recess stenosis at the L4–L5 level, and loose bodies in the left L4–L5 facet joint were noted that compressed the left L5 nerve root. We performed laminotomy at the left L4–L5 level, and removed five loose bodies located on the dorsal side of the ligamentum flavum. Following removal of the loose bodies and flavectomy, the L5 nerve root was decompressed. Postoperatively, the patient’s symptoms improved markedly. Symptomatic multiple loose bodies in the lumbar facet joint are very rare, and can cause lumbar radiculopathy. It is important for spine surgeons to recognize this pathology.
Collapse
Affiliation(s)
- Yuhei Yamasaki
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Yoichiro Takata
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Toshinori Sakai
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Toru Maeda
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| |
Collapse
|
4
|
Osteochondral loose body: an unusual cause of lumbar spinal stenosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:167-169. [PMID: 28185063 DOI: 10.1007/s00586-017-4989-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/06/2017] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
Abstract
Lumbar spinal stenosis is most often a degenerate condition observed in the older population. We describe the case of a lady with typical claudicant symptoms with an unusual cause of stenosis identified at the time of her decompressive surgery. On review of the literature this is only the second case of osteochondral loose body as a cause for lumbar spinal stenosis and thus remains a rare phenomenon.
Collapse
|