Defining spinal instability and methods of classification to optimise care for patients with malignant spinal cord compression: A systematic review

Radiography ◽  
2016 ◽  
Vol 22 (1) ◽  
pp. 77-83
Author(s):  
C. Sheehan
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Spinal Instability

Systematic Review of the Diagnosis and Management of Malignant Extradural Spinal Cord Compression: The Cancer Care Ontario Practice Guidelines Initiative‘s Neuro-Oncology Disease Site Group

2005 ◽  
Vol 23 (9) ◽  
pp. 2028-2037 ◽  
Author(s):  
D. Andrew Loblaw ◽  
James Perry ◽  
Alexandra Chambers ◽  
Normand J. Laperriere
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Back Pain ◽  
Sensitivity And Specificity ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Cochrane Library ◽  
Spinal Instability ◽  
High Dose ◽  
Diagnosis And Management

Purpose This systematic review describes the diagnosis and management of adult patients with a suspected or confirmed diagnosis of extradural malignant spinal cord compression (MSCC). Methods MEDLINE, CANCERLIT, and the Cochrane Library databases were searched to January 2004 using the following terms: spinal cord compression, nerve compression syndromes, spinal cord neoplasms, clinical trial, meta-analysis, and systematic review. Results Symptoms for MSCC include sensory changes, autonomic dysfunction, and back pain; however, back pain was not predictive of MSCC. The sensitivity and specificity for magnetic resonance imaging (MRI) range from 0.44 to 0.93 and 0.90 to 0.98, respectively, in the diagnosis of MSCC. The sensitivity and specificity for myelography range from 0.71 to 0.97 and 0.88 to 1.00, respectively. A randomized study detected higher ambulation rates in patients with MSCC who received high-dose dexamethasone before radiotherapy (RT) compared with patients who did not receive corticosteroids before RT (81% v 63% at 3 months, respectively; P = .046). There is no direct evidence that supports or refutes the type of surgery patients should have for the treatment of MSCC, whether surgical salvage should be attempted if patient is progressing on or shortly after RT, and whether patients with spinal instability should be treated with surgery. Conclusion Patients with symptoms of MSCC should be managed to minimize treatment delay. MRI is the preferred imaging technique. Treatment for patients with MSCC should consider pretreatment ambulatory status, comorbidities, technical surgical factors, the presence of bony compression and spinal instability, potential surgical complications, potential RT reactions, and patient preferences.

Radiation-Sensitive Spine Tumor

2018 ◽  
pp. 159-174
Author(s):  
Adam M. Robin ◽  
Ilya Laufer
Keyword(s):  
Spinal Cord ◽  
Multiple Myeloma ◽  
Spinal Cord Compression ◽  
Cauda Equina ◽  
Spinal Metastases ◽  
Cord Compression ◽  
External Beam Radiation ◽  
Spinal Instability ◽  
Mechanical Instability

A decision-making framework called NOMS (neurologic, oncologic, mechanical and systemic) facilitates and guides therapeutic decisions for patients with spinal metastases. Patients should be evaluated for signs of myelopathy or cauda equina syndrome. The Epidural Spinal Cord Compression (ESCC) scale facilitates reporting of the degree of radiographic spinal cord compression. A determination of the expected histology-specific tumor response to conventionally fractionated external beam radiation (cEBRT) and systemic therapy should be made. Radiation therapy effectively treats biologic pain for radiosensitive tumors such as multiple myeloma. Patients should undergo a careful evaluation of movement-associated pain as tumor-induced spinal instability is an independent indication for surgery. Determination of tumor-associated mechanical instability can be facilitated by the Spinal Instability Neoplastic Score (SINS). Herein, the authors present a case of spinal multiple myeloma managed using the NOMS framework and in consideration of current evidence and treatment paradigms.

Is Open Surgery for Metastatic Spinal Cord Compression Secondary to Lung Cancer Really Beneficial? A Systematic Review

2020 ◽  
Vol 144 ◽  
pp. e253-e263
Author(s):  
Ming-Kai Hsieh ◽  
Daniel R. Bowles ◽  
Jose A. Canseco ◽  
Matthew B. Sherman ◽  
Gregory D. Schroeder ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Systematic Review ◽  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Open Surgery ◽  
Cord Compression ◽  
Metastatic Spinal Cord Compression

Spine Metastases

2018 ◽  
Author(s):  
Ori Barzilai ◽  
Mark H. Bilsky ◽  
Ilya Laufer
Keyword(s):  
Spinal Cord ◽  
Multiple Myeloma ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
External Beam Radiation ◽  
Current Evidence ◽  
Spinal Instability ◽  
Beam Radiation ◽  
Therapeutic Decisions

A decision-making framework called NOMS (neurologic, oncologic, mechanical, and systemic) facilitates and guides therapeutic decisions for patients with spinal metastases. Patients should be evaluated for signs of myelopathy or cauda equina. The Epidural Spinal Cord Compression scale facilitates reporting of the degree of radiographic spinal cord compression. A determination of the expected histology-specific tumor response to conventionally fractionated external beam radiation and systemic therapy should be made. Radiation therapy effectively treats biologic pain and radiosensitive tumors such as multiple myeloma. Patients should undergo a careful evaluation of movement-associated pain as tumor-induced spinal instability is an independent indication for surgery. Determination of tumor-associated mechanical instability can be facilitated by the Spinal Instability Neoplastic Score. Herein, the authors present a case of spinal multiple myeloma managed using the NOMS framework and in consideration of current evidence and treatment paradigms.

scholarly journals Surgical Decompression of High-Grade Spinal Cord Compression from Hormone Refractory Metastatic Prostate Cancer

Neurosurgery ◽  
2017 ◽  
Vol 82 (5) ◽  
pp. 670-677
Author(s):  
Muhammad Omar Chohan ◽  
Sweena Kahn ◽  
Gustav Cederquist ◽  
Anne S Reiner ◽  
Joseph Schwab ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Median Overall Survival ◽  
Cord Compression ◽  
Spinal Instability ◽  
High Grade ◽  
Hormone Sensitive ◽  
Hormone Refractory ◽  
Spine Disease

Abstract BACKGROUND Spine and nonspine skeletal metastases occur in more than 80% of patients with prostate cancer. OBJECTIVE To examine the characteristics of the patient population undergoing surgery for the treatment of prostate cancer metastatic to the spine. METHODS A retrospective chart review was performed on all patients treated at our institution from June 1993 to August 2014 for surgical management of metastatic spine disease from prostate cancer. RESULTS During the study period, 139 patients with 157 surgical lesions underwent surgery for metastatic spine disease. Decompression for high-grade epidural spinal cord compression was required for 126 patients with 143 lesions. Preoperatively, 69% had a motor deficit and 21% were nonambulatory, with 32% due to motor weakness. At surgery, 87% of patients had hormone-refractory prostate cancer (HRPC) and 61% failed prior radiation. Median overall survival for HRPC patients was 6.6 mo (95% confidence interval [CI]: 5.6-8.6) while the median overall survival for hormone-sensitive patients was 16.3 mo (95% CI: 4.0-26.6). CONCLUSION The majority of patients undergoing surgery for prostate cancer metastases to the spine were refractory to hormone therapy, indicating that patients with hormone-sensitive prostate cancer are unlikely to develop symptomatic spinal cord compression or spinal instability. A significant number of HRPC patients presented with neurological deficits attributable to spinal cord compression. Vigilant monitoring for the development of signs and symptoms of epidural spinal cord compression and spinal instability in hormone-refractory patients is recommended. Surgical decision making may be affected by the much shorter postoperative survival for HRPC patients as compared to patients with hormone-sensitive cancer.

Sign in / Sign up

Export Citation Format

Share Document