Tang Oliver Y, Sullivan Patricia Zadnik, Tubre Teddi, Feler Joshua, Shao Belinda, Hart Jesse, Gokaslan Ziya L
Departments of1Neurosurgery and.
2Pathology, Rhode Island Hospital, The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island.
J Neurosurg Case Lessons. 2022 Jul 25;4(4):CASE22213. doi: 10.3171/CASE22213.
Tumoral calcinosis is an uncommon disease resulting from dystrophic calcium phosphate crystal deposition, with only 7% of cases involving the spine, and it may diagnostically mimic neoplasms.
In this case, a 54-year-old woman with history of systemic scleroderma presented with 10 months of progressive left lumbosacral pain. Imaging revealed an expansile, 4 × 7-cm, well-circumscribed mass in the lumbosacral spine with L5-S1 neuroforaminal compression. Because intractable pain and computed tomography (CT)-guided needle biopsy did not entirely rule out malignancy, operative management was pursued. The patient underwent L4-S2 laminectomies, left L5-S1 facetectomy, L5 and S1 pediculectomies, and en bloc resection, performed under stereotactic CT-guided intraoperative navigation. Subsequently, instrumented fusion was performed with L4 and L5 pedicle screws and S2 alar-iliac screws. Pathological examination was consistent with tumoral calcinosis, with multiple nodules of amorphous basophilic granular calcified material lined by histiocytes. There was no evidence of recurrence or neurological deficits at 5-month follow-up.
Because spinal tumoral calcinosis may mimic neoplasms on imaging or gross intraoperative appearance, awareness of this clinical entity is essential for any spine surgeon. A review of all case reports of lumbosacral tumoral calcinosis (n = 14 from 1952 to 2016) was additionally performed. The case featured in this report presents the first known case of navigation-assisted resection of lumbosacral tumoral calcinosis.
肿瘤性钙化是一种由营养不良性磷酸钙晶体沉积引起的罕见疾病，仅7%的病例累及脊柱，在诊断上可能会与肿瘤相混淆。
在本病例中，一名有系统性硬化症病史的54岁女性出现了10个月的进行性左腰骶部疼痛。影像学检查显示腰骶部有一个4×7厘米、边界清晰的膨胀性肿块，压迫L5 - S1神经孔。由于顽固性疼痛以及计算机断层扫描（CT）引导下的穿刺活检未能完全排除恶性肿瘤，因此采取了手术治疗。患者在立体定向CT引导下的术中导航下行L4 - S2椎板切除术、左侧L5 - S1小关节切除术、L5和S1椎弓根切除术以及整块切除术。随后，使用L4和L5椎弓根螺钉以及S2翼状髂骨螺钉进行器械融合。病理检查结果与肿瘤性钙化一致，有多个由组织细胞衬里的无定形嗜碱性颗粒状钙化物质结节。在5个月的随访中，没有复发或神经功能缺损的证据。
由于脊柱肿瘤性钙化在影像学或术中大体表现上可能与肿瘤相似，任何脊柱外科医生都必须了解这一临床实体。此外，还对所有腰骶部肿瘤性钙化的病例报告（1952年至2016年共14例）进行了回顾。本报告中的病例是已知首例采用导航辅助切除腰骶部肿瘤性钙化的病例。
