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Background: Sarcoidosis, a multisystem inflammatory non-caseating granulomatous disease, can present with neurologic lesions in up to 10% of patients. Case Description: A 57-year-old male presented with three months of worsening upper extremity radicular pain associated with dysmetria, hyperreflexia, bilateral Hoffman's, and positive Babinski signs. The contrast magnetic resonance imaging (MRI) showed a diffuse T2 signal hyperintensity and T1-enhancing 2.5 cm lesion extending sagittally between C4 and C6. The cerebrospinal fluid analysis showed a high protein level and lymphocytic pleocytosis. A cardiac positron emission tomography scan was consistent with the diagnosis of cardiac sarcoidosis. With the diagnosis of multisystemic/probable neurosarcoidosis, the patient was unsuccessfully treated with intravenous methylprednisolone, followed by infliximab. Due to severe cord compression/myelopathy, a C3-C6 laminectomy and C3-C7 posterior spinal fusion were performed. Postoperatively, the patient developed a transient right-sided hemiparesis. Over nine postoperative months, the patient had four relapses of transient repeated episodes of paresis, although follow-up cervical MRI scans revealed adequate cord decompression with a stable intramedullary hyperintense lesion. Conclusion: Patients with neurosarcoidosis respond unpredictably to surgical decompression and require prolonged medical care, which is often unsuccessful.
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Introduction: The use of carbon fiber implants in orthopaedic oncology has increased within recent years. The most widely used type of polymer is carbon fiber polyether ether ketone (CF-PEEK). Its radiolucency enables targeted radiotherapy and artifact-free tumor surveillance, which provides major advantages over metallic hardware. We aim to summarize the unique benefits within orthopaedic oncology, clinical pitfalls, and recent advancements. Methods: Four representative patient cases from a single tertiary academic medical center were treated with carbon fiber implants (n = 2 nails, n = 2 plates) from 2021 to 2022. Results: There were no adverse events noted during intraoperative implantation or postoperative follow up. All patients reported improvements in pain and no difficulties in ambulation. There were no instances of catastrophic failure or implant loosening. Conclusion: CF implants offer a diverse array of advantages regarding its radiolucency, low scatter density, and bioinert profile. Nonetheless, further research is required to understand the long-term surgical outcomes and robustness of CF implants. Multi institutional trials could address important aspects of durability and stability over extended periods, feasibility and ease-of-use for different anatomical sites and bone quality, as well as cost-effectiveness in post-operative imaging, healthcare resource utilization, and revision rates. Providing orthopaedic surgeons with valuable insight will enable thorough clinically supported, informed decision making regarding optimal use of implants.