The surgical management of metastatic spinal tumors based on an Epidural Spinal Cord Compression (ESCC) scale

20515 Background: Metastatic spinal tumors often cause spinal cord compression and jeopardize the quality of life of the patients much. To decrease the local symptomatic recurrence rate, we have been adding IORT to decompression surgery. Methods: For those patients whose life expectancy was more than 6 months were eligible for this treatment. Posterior decompression by laminectomy of the involved vertebrae was performed. Following decompression, the patient was irradiated the lesions intraoperatively with electrons generated from Microtron by shielding the spinal cord with lead plate. The central aspects of the vertebrae were irradiated by scattered electrons detouring from the edge of the lead shield up to 40% of the administered dose. Following IORT, posterior instrumentation was performed. External beam radiotherapy might be added pre- and/or postoperatively when considered necessary. Results: 108 patients were treated between 1992–2005. There were 58 males and 50 females. Age ranged from 26 to 85 with a median of 62.5. By primary sites, 26 breast, 24 kidney, 18 colorectum, 17 lung 12 prostate and 11 thyroid cases were included. Irradiated spines were cervical in 6, thoracic in 76, and lumbar/sacral in 27. Overall median follow-up period was 12.7months. Median IORT dose was 20Gy (range 15–26Gy) and median electron energy was 16MeV (range 11–22MeV). There were 37 cases with preoperative RT and 41 cases with postoperative RT. Overall median survival time was 14.5months (breast 15.3, kidney 22.6, colorectum 5.7, lung 6.2, prostate 31.6, thyroid 60.6months). Neurological response rate was 73.1%. Ambulatory rates were 87.0% for success and 80.6% for rescue by Klimo's definition(2005). There were only 8 symptomatic relapses (7%). As for major complications, only one myelopathy has been observed. Conclusions: Decompression surgery and IORT for metastatic spinal tumors with impending spinal cord compression was a promising treatment modality with excellent local control and neurological response rate and with minimal toxicity especially for those patients with long-term prognosis. No significant financial relationships to disclose.

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Thoracic Spinal Angiomyolipoma: Case Report and Literature Review

Neurosurgery ◽

10.1227/00006123-198503000-00023 ◽

1985 ◽

Vol 16 (3) ◽

pp. 406-411 ◽

Cited By ~ 36

Author(s):

Roger von Hanwehr ◽

Michael L. J. Apuzzo ◽

Jamshid Ahmadi ◽

Parakrama Chandrasoma

Keyword(s):

Spinal Cord ◽

Case Report ◽

Literature Review ◽

Surgical Management ◽

Vertebral Body ◽

Spinal Cord Compression ◽

Rare Case ◽

Cord Compression ◽

Biological Behavior ◽

Thoracic Spinal

Abstract A rare case of thoracic spinal angiomyolipoma presenting with evidence of vertebral body infiltration and concurrent epidural spinal cord compression is described. Clinicopathological correlates, aspects of radiological diagnosis, considerations for surgical management, and histopathological features denoting possible unique attributes of biological behavior for this entity are discussed in conjunction with a review of the previous literature on angiolipomas in general.

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Surgical Management of Spinal Cord Compression from Plexiform Neurofibromas in Patients with Neurofibromatosis 1

Neurosurgery ◽

10.1097/00006123-199808000-00038 ◽

1998 ◽

Vol 43 (2) ◽

pp. 248-255 ◽

Cited By ~ 12

Author(s):

Ian F. Pollack ◽

Ahmet Colak ◽

Charles Fitz ◽

Eugene Wiener ◽

Morey Moreland ◽

...

Keyword(s):

Spinal Cord ◽

Surgical Management ◽

Spinal Cord Compression ◽

Cord Compression ◽

Neurofibromatosis 1 ◽

Plexiform Neurofibromas

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The Role of Surgical Management for Symptomatic Spinal Cord Compression in Patients with Metastatic Prostate Cancer

The Journal of Urology ◽

10.1016/s0022-5347(17)38750-5 ◽

1989 ◽

Vol 142 (2 Part 1) ◽

pp. 337-339 ◽

Cited By ~ 36

Author(s):

Daniel A. Shoskes ◽

Richard G. Perrin

Keyword(s):

Prostate Cancer ◽

Spinal Cord ◽

Surgical Management ◽

Spinal Cord Compression ◽

Metastatic Prostate Cancer ◽

Cord Compression

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Metastatic spinal tumors

Neurosurgical FOCUS ◽

10.3171/foc.2001.11.6.2 ◽

2001 ◽

Vol 11 (6) ◽

pp. 1-9 ◽

Cited By ~ 66

Author(s):

Robert F. Heary ◽

Christopher M. Bono

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

External Beam Radiotherapy ◽

Cord Compression ◽

Spinal Tumors ◽

Surgical Approaches ◽

Vascular Tumors ◽

Preoperative Embolization ◽

Intractable Pain ◽

Primary Malignancy

Metastatic spinal tumors are the most common type of malignant lesions of the spine. Prompt diagnosis and identification of the primary malignancy is crucial to overall treatment. Numerous factors affect outcome including the nature of the primary cancer, the number of lesions, the presence of distant nonskeletal metastases, and the presence and/or severity of spinal cord compression. Initial management consists of chemotherapy, external beam radiotherapy, and external orthoses. Surgical intervention must be carefully considered in each case. Patients expected to live longer than 12 weeks should be considered as candidates for surgery. Indications for surgery include intractable pain, spinal cord compression, and the need for stabilization of impending pathological fractures. Whereas various surgical approaches have been advocated, anterior-approach surgery is the most accepted procedure for spinal cord decompression. Posterior approaches have also been used with success, but they require longer-length fusion. To obtain a stable fixation, the placement of instrumentation, in conjunction with judicious use of polymethylmethacrylate augmentation, is crucial. Preoperative embolization should be considered in patients with extremely vascular tumors such as renal cell carcinoma. Vertebroplasty, a newly described procedure in which the metastatic spinal lesions are treated via a percutaneous approach, may be indicated in selected cases of intractable pain caused by non- or minimally fractured vertebrae.

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Reliability analysis of the epidural spinal cord compression scale

Journal of Neurosurgery Spine ◽

10.3171/2010.3.spine09459 ◽

2010 ◽

Vol 13 (3) ◽

pp. 324-328 ◽

Cited By ~ 232

Author(s):

Mark H. Bilsky ◽

Ilya Laufer ◽

Daryl R. Fourney ◽

Michael Groff ◽

Meic H. Schmidt ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Imaging Techniques ◽

Spinal Metastases ◽

Cord Compression ◽

Spinal Tumors ◽

Mr Images ◽

Intrarater Reliability ◽

Thoracic Spinal ◽

Sagittal Image

Objective The evolution of imaging techniques, along with highly effective radiation options has changed the way metastatic epidural tumors are treated. While high-grade epidural spinal cord compression (ESCC) frequently serves as an indication for surgical decompression, no consensus exists in the literature about the precise definition of this term. The advancement of the treatment paradigms in patients with metastatic tumors for the spine requires a clear grading scheme of ESCC. The degree of ESCC often serves as a major determinant in the decision to operate or irradiate. The purpose of this study was to determine the reliability and validity of a 6-point, MR imaging–based grading system for ESCC. Methods To determine the reliability of the grading scale, a survey was distributed to 7 spine surgeons who participate in the Spine Oncology Study Group. The MR images of 25 cervical or thoracic spinal tumors were distributed consisting of 1 sagittal image and 3 axial images at the identical level including T1-weighted, T2-weighted, and Gd-enhanced T1-weighted images. The survey was administered 3 times at 2-week intervals. The inter- and intrarater reliability was assessed. Results The inter- and intrarater reliability ranged from good to excellent when surgeons were asked to rate the degree of spinal cord compression using T2-weighted axial images. The T2-weighted images were superior indicators of ESCC compared with T1-weighted images with and without Gd. Conclusions The ESCC scale provides a valid and reliable instrument that may be used to describe the degree of ESCC based on T2-weighted MR images. This scale accounts for recent advances in the treatment of spinal metastases and may be used to provide an ESCC classification scheme for multicenter clinical trial and outcome studies.

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Immunoglobulin G4-Related Disease Masquerading an Epidural Spinal Cord Tumor

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0041-1722841 ◽

2021 ◽

Author(s):

Ebtesam Abdulla ◽

Harleen Luther ◽

Tejal Shah ◽

Nisha Chandran

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Spinal Cord Tumor ◽

Cord Compression ◽

Spinal Tumors ◽

Immunoglobulin G4 ◽

Related Disease ◽

First Case ◽

Unclear Etiology

Background Immunoglobulin G4–related disease (IgG4-RD) is a recently identified multisystemic fibroinflammatory condition of unclear etiology. IgG4-RD of the epidural tissue causing spinal cord compression is extremely rare. Case description Here, we present a 27-year-old male with epidural mass, causing spinal cord compression at the level of D5-D6. The mass proved pathologically to be epidural inflammatory pseudotumor (IPT) related to IgG4. Spinal decompression was done. The patient was started on steroid treatment and reported a complete resolution of his symptoms over a 3 years’ follow-up period. Conclusion To the authors’ knowledge, this is the first case of IgG4-related epidural IPT and spinal cord compression in Bahrain and the Middle East. IgG4-RD should always be considered as a part of the differential diagnosis of spinal tumors.

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