title: Vertebral osteonecrosis associated with sarcoidosis. Case report.
abstract: Sarcoidosis is a systemic disease commonly affecting lung, skin, or eye. Sarcoidosis involved with osseous structures occurs in approximately 5% of patients, usually involving small bones. Spinal sarcoidosis is extremely rare. The authors report on a man in whom examination of a subclavicular lymph node biopsy specimen and its spinal involvement had established a diagnosis of sarcoidosis and who had undergone steroid therapy. Despite intensive conservative treatment, the authors observed progressive collapse of L-2 requiring spinal decompressive and reconstructive surgeries. Histological evaluation of the collapsed vertebra did not show the typical noncaseating granuloma; rather, the authors observed osteonecrosis of the entire L-2 structure without reactive cellular activities. Other potential diagnoses including infectious disease, metastatic spinal tumor, and osteoporotic vertebral collapse were excluded based on laboratory data, imaging studies, and pathological findings. Complete necrosis of the entire L-2 vertebra in this case can be considered as a rare clinical manifestation of spinal sarcoidosis. Because of osteopenia and systemic bone fragility, combined anterior-posterior spinal reconstructive surgery was performed to restabilize the severely damaged spine.
authors.affiliation: Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. maito@med.hokudai.ac.jp
authors.forename: Manabu
authors.initials: M
authors.lastname: Ito
authors.forename: Makoto
authors.initials: M
authors.lastname: Motomiya
authors.forename: Kuniyoshi
authors.initials: K
authors.lastname: Abumi
authors.forename: Osamu
authors.initials: O
authors.lastname: Shirado
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kotani
authors.forename: Ken
authors.initials: K
authors.lastname: Kadoya
authors.forename: Eihiro
authors.initials: E
authors.lastname: Murota
authors.forename: Akio
authors.initials: A
authors.lastname: Minami
mesh_terms: D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010020:Osteonecrosis / Q000175:diagnosis / Q000601:surgery*; D012086:Reoperation; D012507:Sarcoidosis / Q000175:diagnosis / Q000601:surgery*; D013117:Spinal Cord Compression / Q000473:pathology / Q000601:surgery*; D013122:Spinal Diseases / Q000175:diagnosis / Q000601:surgery*; D013123:Spinal Fusion; D014057:Tomography, X-Ray Computed