Dr saeid safaei Orthopedic Spine Surgeon Milad Hospital

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Dr saeid safaei Orthopedic Spine Surgeon Milad Hospital Tumor Symposium ESFAHAN 1/13/2011

Dr saeid safaei Orthopedic Spine Surgeon Milad Hospital Tumor Symposium ESFAHAN 1/13/2011

CASE 1 • 41 y old man • Intractable back pain no response to

CASE 1 • 41 y old man • Intractable back pain no response to conservative treatment. • No neurologic deficit • Referred to me after 1 month 1/13/2011

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Chemistry • • • CBC Ca Ph Alkalin pho UA analysis T 3/ T

Chemistry • • • CBC Ca Ph Alkalin pho UA analysis T 3/ T 4/ TSH PTH Immunoelectrophoresis Bensjon’s of 24 h Urine 1/13/2011 • ALL NORMAL

Do you want more information ? 1/13/2011

Do you want more information ? 1/13/2011

Needle Biopsy 1/13/2011

Needle Biopsy 1/13/2011

What is your Diagnosis ? • • • Primary tumor ? Benign ? Malignant

What is your Diagnosis ? • • • Primary tumor ? Benign ? Malignant ? Hyper para ? Infection ? Others ? 1/13/2011 • Metastatic ? • Myeloma ?

Needle Biopsy 1/13/2011 Salitory myeloma

Needle Biopsy 1/13/2011 Salitory myeloma

Are you agree with this diagnosis ? ? 1/13/2011 ?

Are you agree with this diagnosis ? ? 1/13/2011 ?

What is your approach Now ? • • • Bracing & Radio Chemotherapy ?

What is your approach Now ? • • • Bracing & Radio Chemotherapy ? • ASF only ? • PSF only ? • ASF + PSF ? • PSF + ASF ? • Radiofrquency &Vertebroplasty ? • PVCR ? Bracing with medical treatment ? 1/13/2011 • Do you recommend Embolisation • TO prevent bleeding ? • DO you recommend Recurrent Embolisation as a definite treatment ?

My approach was PVCR BUT No embolisation chance was available on that time &

My approach was PVCR BUT No embolisation chance was available on that time & beginning paraparesis AND bleeding during operation changed to PSF and Radio chemotherap and if need, Anterior Reconstruction in future. 1/13/2011

Post op 1/13/2011

Post op 1/13/2011

3 month post radiotherapy 1/13/2011

3 month post radiotherapy 1/13/2011

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What do you do now ? • Wait and see ? 1/13/2011 • Anterior

What do you do now ? • Wait and see ? 1/13/2011 • Anterior recounstraction ?

Thank you for your attention 1/13/2011

Thank you for your attention 1/13/2011

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