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PubMed2003

Chondroblastoma of the lumbar spine with cauda equina syndrome.

STUDY DESIGN: Case report. OBJECTIVE: To describe the clinical presentations, radiological features and clinical progress of a rare case of chondroblastoma of the lumbar spine. SETTING: Regional Hospital, Hong Kong, China. METHOD: A 54-year-old male patient presented with low back pain and left sciatica. X-ray and MRI revealed tumour infiltration of the fifth lumbar vertebrae and left paraspinal muscles, which was found to be a chondroblastoma by repeated open biopsies. The tumour was removed surgically by combined anterior and posterior approaches, followed by spinal fusion and instrumentation. RESULTS: The anterior tricortical bone graft was complicated with fracture and nonunion. Surgical re-exploration confirmed local recurrence of tumour macroscopically and histologically. The patient developed symptoms and signs of cauda equina syndrome gradually despite repeated surgery and irradiation. The patient eventually died of complications of local recurrence and neurological deficit at 3 years and 8 months after the first operation. CONCLUSION: This is the first case report of chondroblastoma of the lumbar spine. The clinical profile of this patient and the evidence from the literature review suggests that spinal chondroblastoma has a very aggressive behaviour with high recurrence and mortality rate.

Bone Neoplasms↗
PubMed1999

[Hypothesis concerning the anatomical basis of cauda equina syndrome and transient nerve root irritation after spinal anesthesia].

OBJECTIVE: Cauda equine syndrome is a rare neurological complication associated with subarachnoid anesthesia, and particularly with the use of 5% hyperbaric lidocaine and small gauge catheters. Our aim was to study a possible anatomical factor that might impede adequate dilution of local anesthetic and explain the development of cauda equine syndrome and transitory radicular irritation. MATERIAL AND METHOD: The spinal dura matters and their contents from two male human cadavers were examined after organs had been extracted for transplantation. Both men had recently died at ages 56 and 65 years of age. Samples were fixed in a glutaraldehyde phosphate buffer and dehydrated in acetone, which was then removed by critical point elimination. The samples were then metallized with gold and observed under a scanning electron microscope. RESULTS: We found that one portion of the arachnoids was more compact and another was lax. The compact portion had a laminar structure formed by the fusion of fibers and cell components lining the inner surface of the dural mater. The lax portion was comprised of a weblike network of filaments and few cells bodies. This portion extended from the compact inner arachnoid lamina to the cell plane of the pia mater, where it dispersed, sending out compact arachnoid projections that wrapped around structures in the subarachnoid space. We termed these wrappings "arachnoid sheaths".

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