Brown tumour in the cervical spine : Case report and review of literature

Background: Brown tumour of the cervical spine is very rare and is formed due to focal altered bone remodelling secondary to persistent and uncontrolled primary or secondary hyperparathyroidism. It is considered an extreme form of osteitis fibrosa cystica that occurs in the settings of persistently elevated parathyroid hormone.Case Report: This a unique lesion presented in a 48 year old male with recurrent bone pain and known End Stage Renal Disease (ESRD) on maintenance haemodialysis. The main clinical complaints were weak and painful legs and the initial presentation was after the patient collapsed at home and fractured spinal level C2. The initial assessment included blood tests and radiological imaging. CT scanning of the spine revealed a destructive lytic lesion with loss of height and architectural changes of the C2 vertebral body and cord compression.  The differentials included an acute fracture, a metastatic lesion and Brown’s tumour.  Further imaging with an MRI of the spine and PET-CT were performed which confirmed the above lesion and excluded metastatic disease and bone marrow infiltration. A CT guided bone biopsy followed. The patient continued to receive medical treatment for secondary hyperparathyroidism and the C2 fracture was managed with orthosis through a protective hard collar.Discussion: An up to date literature review revealed very few cases of Brown tumour of the cervical spine and there was only one previous case with C2 involvement due to primary hyperparathyroidism and one due to secondary hyperparathyroidism.  Clinicians must be aware of the varied presentations of Brown’s tumour to identify and provide the appropriate management.