A case of spinal melorheostosis.

Melorheostosis is a rare bone dysplasia of unknown etiology with an incidence of 0.9 cases per million. It typically affects the upper or lower limbs and can cause severe deformity and functional impairment. Diagnosis is radiological and is often described as a "flowing candle wax" appearance on the radiograph. Treatment is individualized depending on the site and severity of symptoms. We report a rare case of spinal melorheostosis. We demonstrate the imaging features of melorheostosis on CT and MRI. We discuss the classification, genetics, and management of this condition.

Vertebral compression fractures--new clinical signs to aid diagnosis.

INTRODUCTION: Acute osteoporotic vertebral compression fractures are common and usually managed conservatively. However, a significant number will remain symptomatic, causing significant pain with considerable associated morbidity and mortality. These fractures can be effectively treated with cement augmentation. However, it is impossible to distinguish between an acute and a chronic healed fracture on plain radiographs. The definitive investigation is a magnetic resonance scan. The aim of this paper is to describe and evaluate two new clinical signs to help in the diagnosis of symptomatic fractures. A prospective study of 83 patients with suspected acute osteoporotic vertebral compression fractures was carried out. All patients had a full clinical assessment, which included closed-fist percussion of their spine and asking the patient to lie supine on the examination couch. All patients had a MRI scan. RESULTS: The closed-fist percussion sign had a sensitivity of 87.5% and a specificity of 90%. The supine sign had a sensitivity of 81.25% and a specificity of 93.33%. CONCLUSIONS: These tests will enable the practitioner to predict more accurately which patients have an acute fracture, guiding referral for further imaging.

The management of spinal metastases from renal cell carcinoma.

INTRODUCTION: Osseous metastases occur in 50% of patients with renal cell carcinoma; of these, 15% occur in the spine. The treatment options for spinal metastases secondary to renal cell carcinoma are limited. This paper considers the current management options available for spinal metastases secondary to renal cell carcinoma. PATIENTS AND METHODS: A review of four patients with spinal metastases secondary to renal cell carcinoma. RESULTS: The presentation of four cases highlighting the current management options for spinal metastases secondary to renal cell carcinoma. CONCLUSIONS: Historically, spinal metastases from renal cell carcinoma have been poorly managed; however, as the treatment of the primary disease improves, better treatment of the secondary disease is needed. Cement augmentation, used alone for prophylactic stabilisation or in conjunction with a posterior decompression and fixation, provides a useful addition in the management of these patients optimising their chance to remain ambulant, continent, and pain-free.

Prophylactic stabilization of vertebral body metastasis at risk of imminent fracture using balloon kyphoplasty.

STUDY DESIGN: Case report. OBJECTIVE: Presentation of the previously unreported technique of balloon kyphoplasty being used to prophylactically stabilize a vertebral body metastasis at risk of imminent fracture. SUMMARY OF BACKGROUND DATA: Many patients with spinal metastases are not suitable for a total en bloc resection. Untreated these metastases may fracture, with the risk of cord compression. METHODS: We present the case of a 53-year-old gentleman with an isolated T10 renal cell metastasis. This gentleman presented with back pain, and was deemed to be at risk of imminent fracture. The metastasis was prophylactically stabilized using balloon kyphoplasty. RESULTS: Lasting pain relief and spinal stability were achieved following treatment with balloon kyphoplasty. He remains pain free 14-months post treatment. CONCLUSION: This is the first reported case of balloon kyphoplasty being used to prophylactically stabilize a vertebral body containing a metastasis, achieving both mechanical stability and pain relief.