Synovial chondromatosis of the lumbar spine with compressive myelopathy: a case report with review of the literature
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CASE REPORT
Synovial chondromatosis of the lumbar spine with compressive myelopathy: a case report with review of the literature Ibrahim Fikry Abdelwahab & Daniel Contractor & Stefano Bianchi & George Hermann & Benjamin Hoch
Received: 17 March 2008 / Revised: 8 April 2008 / Accepted: 21 April 2008 / Published online: 2 July 2008 # ISS 2008
Abstract Synovial chondromatosis has been rarely reported to occur in the spine with only one case found in the lumbar spine. We describe another case of synovial chondromatosis in the lumbar spine in a 41-year-old man who presented with compressive myelopathy. The tumor was located in the left ventrolateral corner of the epidural space just below the L4–L5 intervertebral space. Besides being extremely rare, our case was unusual in that the juxtaposed facet joint was radiologically normal. Keywords Chondromatosis . Synovial . Facet joint . Lumbar spine
I. F. Abdelwahab (*) : D. Contractor Department of Radiology, Coney Island Hospital affiliated to Down State School of Medicine, CUNY, 2601 Ocean Pkwy, Brooklyn, NY 11235, USA e-mail: [email protected] S. Bianchi Institut de Radiologie, Clinique et Fondation des Grangettes, Geneva, Switzerland G. Hermann Department of Radiology, Mount Sinai School of Medicine, CUNY, 1 Gustave Levy Place, New York, NY 10029, USA B. Hoch Department of Pathology, Mount Sinai School of Medicine, CUNY, 1 Gustave Levy Place, New York, NY 10029, USA
Introduction Synovial chondromatosis (SC) is an uncommon disorder characterized by cartilaginous proliferation within the synovium. The areas of proliferation may calcify or ossify and may be extruded from the synovium and become loose bodies in the joint space. The loose bodies may cause pressure erosion of the bone cortex. It is a monoarthritic disease that affects the large joints with the knee most commonly affected [1–6]. SC may be primary, or secondary to variety of conditions, the most common of which is osteoarthritis [3, 7, 8]. Only eight cases of SC involving the spine have been reported in the English language literature [5, 6, 9–13]. We report a new case of SC involving the lumbar spine.
Case history A 41-year-old man, with a long history of HIV infection, presented with left buttock pain. For 10 months, he suffered low back and left leg pain. In the last 2 months, the pain had markedly progressed and had radiated intermittently in the lateral gluteal region, hip, posterolateral thigh and leg, dorsum of the foot, and large toe. Clinical examination revealed a man walking in an antalgic gait with pain when bending back. Palpation of the back disclosed paravertebral muscle spasm and mild tenderness. Weak dorsiflexion was experienced in the foot and large toe. The left calf diameter was smaller than the right. Sensory examination produced uncertain differences between the left and right legs. Magnetic resonance (MR) imaging of the lumbar spine revealed a small mass lesion in the left ventrolateral corner of the spinal canal just below the L4–L5 intervertebral space with signal intensities consiste
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