RESUMO
INTRODUCTION AND IMPORTANCE: Heterotopic ossification (HO) often arises in response to trauma, prior surgical procedures, neurological injuries, or burns. However, its presentation as a complication of shoulder arthroscopy is uncommon and can sometimes lead to functional impairment. In our study, we report a case of HO complicating rotator cuff repair, along with details of the surgical treatment and subsequent progression. CASE PRESENTATION: We report the case of a 45-year-old man with no medical history, who had undergone a rotator cuff arthroscopic repair of his left shoulder. Despite initial improvements, he developed intense pain and stiffness of the operated shoulder. X-rays revealed an extensive HO. Surgical revision and excision of the ossification, followed by high-dose indomethacin in combination with proton pump inhibitors and specialized physiotherapy, resulted in remarkable improvement in shoulder function. CLINICAL DISCUSSION: Studies investigating HO in shoulder arthroplasty have unveiled a diverse range of formation rates, spanning from 15 % to 62 %. Nonetheless, it's noteworthy that the prevalence of HO around the shoulder remains less common in comparison to other anatomical sites, especially in the context of arthroscopic surgical procedures. The exact mechanism and pathophysiology that leads to HO formation remains unknown. It is believed to stem from a combination of multiple factors and is associated with various contributors. Arthroscopic intervention, coupled with high-dose Indomethacin, offers an effective approach for managing HO. CONCLUSION: While HO remains an uncommon complication after shoulder arthroscopy, it is crucial for clinicians to consider it in patients experiencing post-surgery stiffness and pain.
RESUMO
INTRODUCTION AND IMPORTANCE: Solitary spinal plasmacytoma (SSP) is an uncommon neoplasm originating from bone marrow plasma cells. Although infrequent in the thoracic region, it has the potential to induce substantial damage. In this study, we present the case of a patient with thoracic spine SSP treated through surgical intervention. CASE PRESENTATION: We report the case of a 38-year-old female who presented with progressive mid-back pain, numbness, weakness in both lower limbs and gait disturbance. Imaging showed an osteolytic lesion with vertebral collapse of T11. MRI was strongly suggestive of solitary plasmocytoma. Hematologic tests were normal. Surgery was carried out. At the first stage, a posterior approach with laminectomy and fixation were performed. Biopsy of tumor cells confirmed the diagnosis of SSP. At the second stage, a trans-thoracic approach was performed, the tumor was resected in a single block and anterior interbody fusion was done. After the surgery the patient fully recovered from the paraparesis and at two years follow up no recurrence of tumor cells was detected. CLINICAL DISCUSSION: Spinal malignant bone tumors are rare, with solitary plasmacytoma being the most common. Diagnosis of SSP is based on bone biopsy findings. MRI and CT scans assess tumor extent and spinal stability. Prognosis relates to the likelihood of progressing into multiple myeloma. Though radiotherapy is common, surgery offers local control, especially for instability and neurological issues. CONCLUSION: SSP in the thoracic spine is a rare condition that requires a multidisciplinary approach and a prompt treatment.