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27-APRIL-2004 RAAFAT ASSAD HUSSEIN 27 YEARS
MASS OF C4 WITH RIGHT SIDED EXPANSION AND PATHOLOGICAL FRACTURE.
Anamnesis
The patient came to the
clinic 25-April-2004 complaining of neck pain
for one month. The last week got right upper
limb pain. MRI cervical spine performed
22-April-2004 showing extruded mass of the C4
with pathologic fracture and severe compression
of the spinal cord and the mass extending
paravertebral right side up and down.
On examination, the patient
in agonizing pain, having neck pain when turning
the head to all directions. There is severe weak
grip and extension both hands 3/5 and both
triceps muscle 3/5. There is hypalgesia of the
right hand. There is weak dorsiflexion both feet
4/5.
Using the C-arm, the level of
C3-4 was identified and discectomy of C3-4 and
C5-6 was
performed and corporectomy of C4 was achieved
with removal of all the tumorous tissue until the dura was seen at the
bottom of the removed structures. The mass
involving the right side was removed also. Fresh
frozen section gave the answer of giant cell
tumor of the bone. Using fibular graft with
miniplate, fusion of C3-5 was achieved. Check by
C-arm showed acceptable graft and screws
position. Routine closure
of the wound.
Smooth postoperative recovery. The power of the
four limbs dramatically improved.
FOLLOW UP
The patient
came to the clinic 17-May-2004 with clean wound
with still having weak both triceps muscles 4/5. He
was advised to follow the oncologist for further
treatment options.
Comments
The tumor can be
radically removed, but treatment with radio and
chemotherapy is mandatory.
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