Chronic renal failure causing brown tumors and myelopathy - Case report and review of pathophysiology and treatment

Brown tumors (osteoclastomas) are histologically benign lesions that are ca used by primary or secondary hyperparathyroidism. Secondary hyperparathyroi dism is a frequent complication of chronic renal failure. Skeletal brown tu mors are relatively uncommon, and brown tumors that involve the spine are c onsidered very rare. The authors present the case of a 37-year-old woman wi th systemic lupus erythematosus and hemodialysis-dependent anuric renal fai lure, in whom spinal cord compression developed due to a brown tumor and pa thological fracture at T-9. The patient underwent transthoracic decompressi ve surgery and spinal reconstruction in which cadaveric femoral allograft a nd instrumentation were used. Brown tumors of the vertebral column require surgical treatment if medical therapy and parathyroidectomy fail to halt th eir progression or if acute neurological deterioration occurs. In patients with renal failure bone healing is delayed and there is an increased risk t hat healing will fail because the metabolic derangements can result in seve re osteoporosis. Surgical reconstruction of the spine may require the use o f augmentation with instrumentation and aggressive treatment of hyperparath yroidism to achieve successful outcomes.