Division of Neurosurgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Defense Medical Center, Taipei, Taiwan.
Division of Neurosurgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Neurocirugia (Astur : Engl Ed). 2022 Sep-Oct;33(5):237-241. doi: 10.1016/j.neucie.2021.01.005.
Ewing sarcoma (ES) is a rare primary neoplasm in the lumbar adult spine and may mimic a benign tumor. In this case, after a patient's three-month history of lower back pain and rapidly progressing leg numbness and weakness, magnetic resonance imaging (MRI) showed a mass in the third lumbar vertebra. At a two-month follow-up, imaging showed a fracture, compression and lesion enlargement. Decompression and fixation confirmed ES, and the patient began combined radiotherapy and chemotherapy. Two months postoperatively, residual ES was suspected on MRI. The patient underwent a second surgery, and histopathology confirmed necrosis. A six-month follow-up after the first surgery showed no tumor recurrence. This case supports the inclusion of ES in the differential diagnosis of pathologic spinal fracture. Early decompression and spinal fixation are critical for preserving neurologic and spinal functions in ES complicated by a compression fracture. Combined adjuvant radiotherapy and chemotherapy remain the standard therapeutic strategy.
尤因肉瘤（ES）是成人腰椎罕见的原发性肿瘤，可能类似于良性肿瘤。在本例中，患者出现三个月的腰痛病史，随后出现下肢麻木和无力进行性加重，磁共振成像（MRI）显示第三腰椎有肿块。两个月随访时，影像学显示骨折、压缩和病变扩大。减压和固定证实为 ES，患者开始接受联合放化疗。术后两个月，MRI 怀疑有残留 ES。患者接受了第二次手术，组织病理学证实为坏死。第一次手术后 6 个月随访未见肿瘤复发。本例支持将 ES 纳入病理性脊柱骨折的鉴别诊断。对于伴有压缩性骨折的 ES，早期减压和脊柱固定对于保留神经和脊柱功能至关重要。联合辅助放疗和化疗仍然是标准的治疗策略。
