Giant thoracic osteophyte: a distinct clinical entity.
Calcified lesions described within the neural axis are classified as either an ossification of the posterior longitudinal ligament, diffuse idiopathic skeletal hyperostosis, or ossification of the ligamentum flavum. We aim to describe a unique pathologic entity: the giant thoracic osteophyte. We identified four patients who were surgically treated at the Massachusetts General Hospital from 2006 to 2012 with unusual calcified lesions in the ventral aspect of the spinal canal. In order to differentiate giant thoracic osteophytes from calcified extruded disc material, disc volumetrics were performed on actual and simulated disc spaces. All patients underwent operative resection of the calcific lesion as they had signs and/or symptoms of spinal cord compression. The lesions were found to be isolated, large calcific masses that originated from the posterior aspect of adjacent thoracic vertebral bodies. Pathological examination was negative for tumor. Adjacent disc volumes were not significantly different from the index disc (p=0.91). A simulated calculation hypothesizing that the calcific mass was extruded disc material demonstrated a significant difference (p=0.01), making this scenario unlikely. In conclusion, giant thoracic osteophyte is a unique and rare entity that can be found in the thoracic spine. The central tenant of surgical treatment is resection to relieve spinal cord compression.
Department of Neurosurgery, Massachusetts General Hospital & Harvard Medical School, 55 Fruit Street, White Building Room 502, Boston, MA 02114, USA.
Jean-Valery C E
JV
Coumans
Department of Neurosurgery, Massachusetts General Hospital & Harvard Medical School, 55 Fruit Street, White Building Room 502, Boston, MA 02114, USA.
Jonathan B
JB
Neal
Department of Orthopedic Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA.
Brian E
BE
Grottkau
Department of Neurosurgery, Massachusetts General Hospital & Harvard Medical School, 55 Fruit Street, White Building Room 502, Boston, MA 02114, USA.
Brian V
BV
Nahed
Department of Neurosurgery, Massachusetts General Hospital & Harvard Medical School, 55 Fruit Street, White Building Room 502, Boston, MA 02114, USA.
John H
JH
Shin
Department of Neurosurgery, Massachusetts General Hospital & Harvard Medical School, 55 Fruit Street, White Building Room 502, Boston, MA 02114, USA. Electronic address: walcott.brian@mgh.harvard.edu.
Brian P
BP
Walcott
D000328:Adult; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007403:Intervertebral Disc / Q000473:pathology; D008875:Middle Aged; D054850:Osteophyte / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery; D013904:Thoracic Vertebrae / Q000473:pathology; D014057:Tomography, X-Ray Computed
Arthrodesis; Degenerative disease; Fusion; Myelopathy; Osteophyte; Spine; Thoracic