Missed radiographic and clinical findings in a case of non-idiopathic scoliosis resulting from chondroblastoma
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CASE REPORT
Missed radiographic and clinical findings in a case of non‑idiopathic scoliosis resulting from chondroblastoma Navraj S. Sagoo1 · Edward P. Southern2,3,4 · Andrew G. King3 · Matthew W. Stark5 · Lori A. McBride6,7 Received: 23 June 2020 / Accepted: 1 August 2020 © Scoliosis Research Society 2020
Abstract Purpose Chondroblastoma is a cartilaginous neoplasm which rarely presents in the spine, where it has been shown to exhibit aggressive behavior. We present a case of a late diagnosis of a T12 chondroblastoma causing paraparesis in an 11-year-old girl. Several missed classical radiographic and clinical features are highlighted. Methods We reviewed clinical, imaging, and pathology data from the time of transfer to our institution, followed by review of all outside clinical records and imaging data from 14 months prior to admission until onset of paraplegia. Results The patient was transferred to our center for emergent treatment of a large, expansile, exophytic lesion compressing the spinal cord at T12. Intravenous steroids improved her neurologic status to ASIA Grade B, and an en bloc posterior element resection was performed emergently within 24 h. She rapidly improved to an ASIA Grade E. After obtaining all prior imaging during detailed histopathologic work-up, the final diagnosis was that of spinal chondroblastoma. Subsequent anterior en bloc resection was performed. The patient remains disease-free with a stable, residual scoliosis 7 years postoperatively. Conclusions Detailed review of radiographs is essential for scoliosis patients. Earlier recognition of the "winking owl" sign, a kyphotic sagittal alignment, and more concern about a child with a painful curve may have resulted in earlier diagnosis before the onset of neurologic deficits. Keywords Spine · Chondroblastoma · Scoliosis · Tumor
Introduction
* Edward P. Southern [email protected] 1
School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
2
Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
3
Department of Orthopaedic Surgery, Louisiana State University Health Science Center, New Orleans, LA, USA
4
Department of Orthopedic Surgery, The Institute for Western Surgery and Parkway Healthcare, Shanghai, China
5
Department of Pathology, Louisiana State University Health Science Center, New Orleans, LA, USA
6
Department of Pediatric Neurosurgery, Children’s Hospital of New Orleans, New Orleans, LA, USA
7
Department of Pediatric Neurosurgery, Our Lady of the Lake Children’s Health, Baton Rouge, LA, USA
Chondroblastoma is a cartilaginous tumor that constitutes less than 1% of all primary bone tumors [1, 2]. Fewer than 20 cases have been reported in the thoracic spine. We present a case of chondroblastoma of the twelfth thoracic vertebra presenting as a non-idiopathic, painful scoliosis. Multiple salient points regarding classic missed radiographic and clinical features are also presented.
Case presentation An 11-year-old, premenarc
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