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Dr. Mihir Bapat

Dr. Mihir Bapat
Director
Institute of Spine Surgery
Minimal Invasive
Spine Surgery
Nanavati Super Speciality
Hospital, Mumbai

Dr. Sandeep Mehta

Dr. Amandeep Gujral
Consultant
Minimal Invasive
Spine Surgery
Nanavati Super Speciality
Hospital, Mumbai









A Big Little Problem

Conquering a Tumour in a minimally invasive way

THE CASE

A 10-year old boy was admitted to Nanavati with complaints of neck pain for the past 7 months with no response to medicines. The child’s mother had also noticed the neck was beginning to tilt sideways and its movements were gradually getting restricted. The severity of the pain had increased in the past couple of weeks, causing the child to have several sleepless nights. Often, he would wake up crying in agony in the middle of night.

Any pain lasting for more than 4 weeks and not responding to medicines warrants further investigations and thus a CT scan was advised. CT scan showed a Tumour measuring 9mm x 12mm x 12mm. It was located under the right lamina of C2 vertebra encroaching into the right lateral mass, pedicle and vertebral artery foramen leaving a thin rim of bone before it.

THE PROCEDURE

A surgical excision of the Tumour was deemed necessary. The Tumour was inconveniently sandwiched between two vital structures – the vertebral artery and the spinal cord leaving a thin zone of safe surgical approach for the surgical team. Even a minor deviation in the approach could have caused a vertebral artery or spinal cord injury rendering the child permanently paralysed.





Taking into account all the prevalent conditions, a minimally invasive posterior midline approach was utilised. After defining C 2/3 joint, canal line, vertebral artery foramen, margins of C2; bone burring was done along with C2 inferior articular facet towards central canal. The vertebral artery foramen was opened and the artery was protected. Thin shell of bone lining the spinal canal was separated with a nerve hook. Cord position was seen and secured. The Tumour along with its central nidus and surrounding zone of reactive bone was successfully excised.

THE RESULT

The patient was able to independently move about next day post surgery. A post operative CT scan confirmed the complete excision of the Tumour ruling out any possibilities of recurrences. The child was discharged on the second day and had an uneventful recovery. He was permitted to start normal activities and resume school in 4 weeks post surgery.

DISCUSSION

Osteoid Osteoma is one of the most common Benign Tumour affecting the human skeleton. These Tumours usually involve the long bones of the appendicular skeleton but involvement of vertebraes is not uncommon.


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