Unusual spinal manifestation in secondary hyperparathyroidism: a case report.
METHODS
Case report.


OBJECTIVE
To describe an unusual spinal manifestation of secondary hyperparathyroidism in a 29-year-old woman and discuss the pathologic basis of the disease and evaluate the response to treatment.


BACKGROUND
Extraskeletal tumoral calcification (i.e., tumoral calcinosis, tumoral calcinosis-like lesion, calcifying pseudoneoplasms) is an uncommon entity associated with secondary hyperparathyroidism. Involvement of the cervical spine with this tumor causing neural compression is extremely rare. Only a few cases have been reported in literature and none with a concomitant presence of brown tumors.


METHODS
A 29-year-old woman presented with upper back pain with tingling and weakness in the left hand. She had been on dialysis for 5 years following renal failure. She had a partial parathyroidectomy for hyperparathyroidism a year ago. Para vertebral calcification eroding the posterior elements of C6-T2 and abutting the dura and neural foramens was seen on a CT scan. There were numerous lytic defects of the thoracic and lumbar vertebral bodies, most notable at L4, suggesting focal brown tumors. An MRI scan of the spine demonstrated a large heterogeneously hypointense lesion of the cervicothoracic spine, which remained hypointense on T2 images. A cervicothoracic decompression and spinal stabilization from the front and back was performed. A pathologic diagnosis of tumoral calcinosis-like lesion was confirmed.


RESULTS
Following surgery, the patient recovered neurologically and subsequently underwent total parathyroidectomy. Presently, her bone lesions have healed.


CONCLUSIONS
Hyperparathyroidism may cause tumoral calcinosis-like lesions in the spine. An early spinal decompression followed with parathyroidectomy leads to remission of symptoms.
Jackson
Wes
W
Orthopedic Foundation, Houston, TX, USA.
Sethi
Anil
A
Carp
Julia
J
Talpos
Gary
G
Vaidya
Rahul
R
D000328:Adult; D002114:Calcinosis / Q000150:complications / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D002574:Cervical Vertebrae / Q000473:pathology* / Q000601:surgery; D019299:Decompression, Surgical; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000150:complications* / Q000473:pathology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D016105:Parathyroidectomy; D013117:Spinal Cord Compression / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D013123:Spinal Fusion; D013125:Spinal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D013904:Thoracic Vertebrae / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome