Vialle Raphaël, Wolff Stéphane, David Philippe, Lepeintre Jean-François, Hautefort Patrick, Tadie Marc
Service de chirurgie orthopédique et traumatologique, Fondation Hôpital Saint Joseph, Paris, France.
J Spinal Disord Tech. 2005 Dec;18(6):531-4. doi: 10.1097/01.bsd.0000132285.19961.30.
We report the case of a young girl treated at age 16 for a progressive scoliosis by posterior instrumented arthrodesis. Ten years later, she suddenly developed lumbar pain and paraplegia. The surgical procedure showed a mass infiltrating the vertebral canal and the dural sheath following a supralaminar hook. Histology revealed a diagnosis of leiomyosarcoma. The outcome was poor with a rapid and fatal extension of the tumor. There is nothing to justify a causal link between the scoliosis and the late onset of a malignant tumor. Nevertheless, we discuss the potential role of diagnostic irradiation consecutive to scoliosis monitoring during growth and the potential role of environmental carcinogens like metallic biomaterials. Finally, rapid intrusion of this extraspinal tumor into the dural sheath resulted in a confusing clinical picture and delayed the diagnosis and treatment of the tumor.
我们报告了一名年轻女孩的病例，她16岁时因进行性脊柱侧弯接受了后路器械固定融合术治疗。十年后，她突然出现腰痛和截瘫。手术过程中发现一个肿块，该肿块沿椎板上钩浸润椎管和硬膜鞘。组织学检查确诊为平滑肌肉瘤。预后很差，肿瘤迅速致命性扩散。没有任何理由证明脊柱侧弯与恶性肿瘤的晚期发生之间存在因果关系。然而，我们讨论了生长期间脊柱侧弯监测的诊断性辐射的潜在作用以及金属生物材料等环境致癌物的潜在作用。最后，这种椎管外肿瘤迅速侵入硬膜鞘导致了令人困惑的临床表现，并延误了肿瘤的诊断和治疗。
