New imaging characteristics for predicting postoperative neurologic status in patients with metastatic epidural spinal cord compression. A retrospective analysis of 81 cases

Abstract Background: The most commonly encounter tumor of the spine is metastasis, and thoracic spine is the most commonly metastatic spine. Controversy exists regarding the optimal surgical approach for this kind of patient. The author conducted a study to assess the differences between anterior thoracotomy and posterior approach in patients with malignant epidural cord compression in the thoracic spine. Methods: Between January 2003 and December 2015, patients with metastatic thoracic lesion underwent surgery at our department were stratified into two groups according to different approach method to the lesion site. Group A mean anterior thoracotomy, decompression and fixation. Group P represented posterior decompression and fixation. Survival was defined as months since surgery to last tractable times. American Spinal Injury Association grade was used to assess preoperative and postoperative neurologic status. Days at intensive care unit (ICU) were compared. Every complication by surgery or during admission was documented. Results: Group A had 25 patients and Group P had 67 patients. Lung cancer was ther most commonly origin cancer in both groups. The most commonly surgical level was the 9th thoracic vertebrae in Group A and the 10th thoracic vertbrae in Group P. Both gropus had a similar preoperative neurologic (p=0.959). One patients in Group A and two in the Group P sustained neurologic deterioation immediately after surgery. Group A took more operation time (213.0 vs 199.2 minutes, p=0.380) and had more blood loss (912.5 vs 834.4 ml, p=0.571). 6 patients in Group A (24%) and 10 patients in Group P (13.9%) developed complications immediately or postoperatively. Patients in Group A need more days of care at ICU (2.36 vs 0.19 days, p<0.001). The longer survival was seen in the goup P (15.4 vs 11.2 months) but without significant differnce. Conclusion: Patients in Group P required significantly less days of care at ICU. Besides, posterior approach also took a shorter surgical time, and had a less blood loss during surgery, although without statistically significant difference. According to the results, the author would prefer posterior approach by decompression and fixation for those with thoracic metastatic tumor with epidural compression. Keywords: Thoracic spine; metastatic epidural spinal cord compression; anterior thoracotomy; posterior approach; survivorship; neurologic status; complications.

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Neurological manifestations, imaging characteristics, and surgical outcome of intraspinal osteochondroma

Journal of Neurosurgery Spine ◽

10.3171/2009.11.spine0980 ◽

2010 ◽

Vol 12 (5) ◽

pp. 474-489 ◽

Cited By ~ 35

Author(s):

Iraj Lotfinia ◽

Payman Vahedi ◽

R. Shane Tubbs ◽

Mostafa Ghavame ◽

Ali Meshkini

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Surgical Outcome ◽

Posterior Approach ◽

English Literature ◽

Cord Compression ◽

Surgical Removal ◽

Hereditary Multiple Exostoses ◽

Imaging Characteristics ◽

Google Search

ObjectSpinal osteochondromas (OCs) are rare and can originate as solitary lesions or in the context of hereditary multiple exostoses. Concurrent spinal cord compression is a very rare entity. The purpose of this study was to evaluate the authors' 10-year experience with the imaging characteristics and surgical outcome in patients with symptomatic spinal OC.MethodsBetween 1997 and 2007, 8 consecutive cases of symptomatic intraspinal OC with documented spinal cord compression were treated surgically. These patients were analyzed with regard to presentation, imaging, and outcome. The relevant English literature was reviewed using MEDLINE and Google search engines.ResultsThree patients had cervical, 2 had thoracic, and 3 had lumbar lesions. Classic MR imaging characteristics were rarely found. Multiple hereditary exostoses were equally responsible for cervical, thoracic, and lumbar lesions (33%). The origin of the lesion was from the pedicle (25%), lamina (25%), vertebral body (25%), and superior or inferior facets (25%). A posterior approach to the spine was used in 6 patients, and a combined anterior and posterior approach with fusion was performed for 2 thoracic lesions. Surgical outcome was satisfactory in 75% of patients. The prognosis was poor in the patients with thoracic lesions.ConclusionsIn the authors' experience, early detection and surgical removal in cases of symptomatic spinal OC is a key element for the best outcome. Posterior approaches are generally sufficient. The chronicity of symptoms may limit functional recovery postoperatively, especially with cervical and thoracic lesions.

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Time of Developing Motor Deficits before Radiotherapy as a New and Relevant Prognostic Factor in Metastatic Spinal Cord Compression: Final Results of a Retrospective Analysis

European Neurology ◽

10.1159/000052141 ◽

2001 ◽

Vol 45 (4) ◽

pp. 266-269 ◽

Cited By ~ 14

Author(s):

D. Rades ◽

F. Heidenreich ◽

M. Bremer ◽

J.H. Karstens

Keyword(s):

Spinal Cord ◽

Prognostic Factor ◽

Retrospective Analysis ◽

Spinal Cord Compression ◽

Cord Compression ◽

Metastatic Spinal Cord Compression ◽

Motor Deficits ◽

Relevant Prognostic Factor

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Treatment of spinal cord compression: A retrospective analysis

Medical and Pediatric Oncology ◽

10.1002/mpo.2950110511 ◽

1983 ◽

Vol 11 (5) ◽

pp. 347-351 ◽

Cited By ~ 24

Author(s):

Jay S. Loeffler ◽

Arvin S. Glicksman ◽

Melvin Tefft ◽

Melvyn Gelch

Keyword(s):

Spinal Cord ◽

Retrospective Analysis ◽

Spinal Cord Compression ◽

Cord Compression

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An update on hemilaminectomy of the cranial thoracic spine: Review of six cases

Open Veterinary Journal ◽

10.4314/ovj.v10i1.4 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Kathryn Y. Bray ◽

Peter J. Early ◽

Natasha J. Olby ◽

Melissa J. Lewis

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Thoracic Spine ◽

Surgical Approach ◽

Cord Compression ◽

Thoracic Vertebrae ◽

Disc Disease ◽

Thoracic Spinal Cord ◽

Neurologic Status ◽

Thoracic Spinal

Background: The optimal surgical approach to relieve spinal cord compression in the cranial thoracic spine is not well described, and the anatomy of the cranial thoracic vertebrae creates added surgical difficulty.Aim: This study describes the surgical approach, treatment, and outcome of three dogs and three cats that underwent a cranial thoracic hemilaminectomy for the treatment of extradural spinal cord compression. Surgical positioning was tailored to avoid extensive dissection and provide for a restricted, careful approach.Methods: Three dogs and three cats presenting for cranial thoracic spinal cord compression requiring surgical intervention were included.Results: All patients were discharged within 5 days. No patients experienced postoperative deterioration in neurologic status, and four animals had improved neurologic status at discharge.Conclusion: In cases with cranial thoracic spinal cord compression, the spinous processes can be spared, extensive muscle dissection minimized, and successful outcomes achieved with the appropriate positioning and limited approach. Keywords: Hemilaminectomy, Intervertebral Disc Disease, Myelopathy, Thoracic.

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