Percutaneous endoscopic posterior decompression for therapy of spinal cord compression due to ossification of the ligamentum flavum:a long-term follow-up

Spinal meningiomas are the most common adult primary spinal tumor, constituting 24–45% of spinal intradural tumors and 2% of all meningiomas. The aim of this study was to assess postoperative complications, long-term outcomes, predictors of functional improvement and differences between elderly (≥70 years) and non-elderly (18–69 years) patients surgically treated for spinal meningiomas. Variables were retrospectively collected from patient charts and magnetic resonance images. Baseline comparisons, paired testing and regression analyses were used. In conclusion, 129 patients were included, with a median follow-up time of 8.2 years. Motor deficit was the most common presenting symptom (66%). The median time between diagnosis and surgery was 1.3 months. A postoperative complication occurred in 10 (7.8%) and tumor growth or recurrence in 6 (4.7%) patients. Surgery was associated with significant improvement of motor and sensory deficit, gait disturbance, bladder dysfunction and pain. Time to surgery, tumor area and the degree of spinal cord compression significantly predicted postoperative improvement in a modified McCormick scale (mMCs) in the univariable regression analysis, and spinal cord compression showed independent risk association in multivariable analysis. There was no difference in improvement, complications or tumor control between elderly and non-elderly patients. We concluded that surgery of spinal meningiomas was associated with significant long-term neurological improvement, which could be predicted by time to surgery, tumor size and spinal cord compression.

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Risk Factors for Ineffectiveness of Posterior Decompression and Dekyphotic Corrective Fusion with Instrumentation for Beak-Type Thoracic Ossification of the Posterior Longitudinal Ligament: A Single Institute Study

Neurosurgery ◽

10.1093/neuros/nyw130 ◽

2017 ◽

Vol 80 (5) ◽

pp. 800-808 ◽

Cited By ~ 17

Author(s):

Shiro Imagama ◽

Kei Ando ◽

Zenya Ito ◽

Kazuyoshi Kobayashi ◽

Tetsuro Hida ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Supine Position ◽

Posterior Longitudinal Ligament ◽

Cord Compression ◽

Intraoperative Ultrasonography ◽

Posterior Decompression ◽

Motor Paralysis ◽

Severe Motor

Abstract BACKGROUND: Thoracic ossification of the posterior longitudinal ligament (T-OPLL) is treated surgically with instrumented posterior decompression and fusion. However, the factors determining the outcome of this approach and the efficacy of additional resection of T-OPLL are unknown. OBJECTIVE: To identify these factors in a prospective study at a single institution. METHODS: The subjects were 70 consecutive patients with beak-type T-OPLL who underwent posterior decompression and dekyphotic fusion and had an average of 4.8 years of follow-up (minimum of 2 years). Of these patients, 4 (6%; group R) had no improvement or aggravation, were not ambulatory for 3 weeks postoperatively, and required additional T-OPLL resection; while 66 (group N) required no further T-OPLL resection. Clinical records, gait status, intraoperative ultrasonography, intraoperative neurophysiological monitoring (IONM), plain radiography, computed tomography and magnetic resonance imaging findings, and Japanese Orthopaedic Association (JOA) score were compared between the groups. RESULTS: Preoperatively, patients in group R had significantly higher rates of severe motor paralysis, nonambulatory status, positive prone and supine position test, no spinal cord floating in intraoperative ultrasonography, and deterioration of IONM at the end of surgery (P < .05). In preoperative radiography, the OPLL spinal cord kyphotic angle difference in fused area, OPLL length, and OPLL canal stenosis were significantly higher in group R (P < .05). At final follow-up, JOA scores improved similarly in both groups. CONCLUSION: Preoperative severe motor paralysis, nonambulatory status, positive prone and supine position test, radiographic spinal cord compression due to beak-type T-OPLL, and intraoperative residual spinal cord compression and deterioration of IONM were associated with ineffectiveness of posterior decompression and fusion with instrumentation. Our 2-stage strategy may be appropriate for beak-type T-OPLL surgery.

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Primary Intradural Extramedullary Spinal Melanoma in the Lower Thoracic Spine

Case Reports in Oncological Medicine ◽

10.1155/2016/3815280 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3

Author(s):

Kathrin Hering ◽

Anke Bresch ◽

Donald Lobsien ◽

Wolf Mueller ◽

Rolf-Dieter Kortmann ◽

...

Keyword(s):

Spinal Cord ◽

Thoracic Spine ◽

Primary Melanoma ◽

Cord Compression ◽

Long Term Follow Up ◽

Intradural Extramedullary ◽

Lower Thoracic Spine ◽

Spinal Cord Decompression

Background Context.Up to date, only four cases of primary intradural extramedullary spinal cord melanoma (PIEM) have been reported. No previous reports have described a case of PIEM located in the lower thoracic spine with long-term follow-up.Purpose. Demonstrating an unusual, extremely rare case of melanoma manifestation.Study Design. Case report.Methods. We report a case of a 57-year-old female suffering from increasing lower extremity pain, left-sided paresis, and paraesthesia due to spinal cord compression caused by PIEM in the lower thoracic spine.Results. Extensive investigation excluded other possible primary melanoma sites and metastases. For spinal cord decompression, the tumor at level T12 was resected, yet incompletely. Adjuvant radiotherapy was administered two weeks after surgery. The patient was recurrence-free at 104 weeks after radiotherapy but presents with unchanged neurological symptoms.Conclusion. Primary intradural extramedullary melanoma (PIEM) is extremely rare and its clinical course is unpredictable.

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Surgical management of aggressive vertebral hemangiomas causing spinal cord compression: long-term clinical follow-up of five cases

Journal of Orthopaedic Science ◽

10.1007/s00776-010-1483-z ◽

2010 ◽

Vol 15 (3) ◽

pp. 350-356 ◽

Cited By ~ 37

Author(s):

Satoshi Kato ◽

Norio Kawahara ◽

Hideki Murakami ◽

Satoru Demura ◽

Katsuhito Yoshioka ◽

...

Keyword(s):

Spinal Cord ◽

Surgical Management ◽

Spinal Cord Compression ◽

Cord Compression ◽

Vertebral Hemangiomas

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Long-Term Follow-Up After Spinal Cord Injury in Canada

PsycEXTRA Dataset ◽

10.1037/e513252007-001 ◽

2006 ◽

Author(s):

Mark I. Tonack ◽

Sander L. Hitzig ◽

B. Catharine Craven ◽

Kent A. Campbell ◽

Kathryn A. Boschen ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cord Injury ◽

Long Term Follow Up

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OPEN HAEMORRHOIDS SURGERY IN SPINAL CORD INJURY PATIENTS

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i11.1532 ◽

2020 ◽

Vol 4 (11) ◽

Author(s):

Khaled Hassan

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Anal Fissure ◽

Open Surgery ◽

Anal Fissures ◽

Cord Injury ◽

Long Term Follow Up ◽

Grade Iii

This Pilot retrospective research conducted on the results of open surgery in patients with Grade III and IV haemorrhoids With SCI. No major complications had arisen at 6 weeks post-operative and all wounds had healed, but 1 patient Anal fissure recurrence. 75% of patients reported a substantial increase in anorectal anorexia during long-term follow-up. With symptoms. Five patients reported recurrences: three haemorrhoids (18 percent) and two anal fissures (25 percent). Keywords: Haemorrhoids, Pilot retrospective research, Anorectal Anorexia.

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Utilization of laser interstitial thermotherapy guided by real-time thermal MRI as an alternative to separation surgery in the management of spinal metastasis

Journal of Neurosurgery Spine ◽

10.3171/2015.2.spine141185 ◽

2015 ◽

Vol 23 (4) ◽

pp. 400-411 ◽

Cited By ~ 48

Author(s):

Claudio E. Tatsui ◽

R. Jason Stafford ◽

Jing Li ◽

Jonathan N. Sellin ◽

Behrang Amini ◽

...

Keyword(s):

Quality Of Life ◽

Spinal Cord ◽

Real Time ◽

Spinal Cord Compression ◽

Spinal Metastasis ◽

Cord Compression ◽

The Mean ◽

Interstitial Thermotherapy

OBJECT High-grade malignant spinal cord compression is commonly managed with a combination of surgery aimed at removing the epidural tumor, followed by spinal stereotactic radiosurgery (SSRS) aimed at local tumor control. The authors here introduce the use of spinal laser interstitial thermotherapy (SLITT) as an alternative to surgery prior to SSRS. METHODS Patients with a high degree of epidural malignant compression due to radioresistant tumors were selected for study. Visual analog scale (VAS) scores for pain and quality of life were obtained before and within 30 and 60 days after treatment. A laser probe was percutaneously placed in the epidural space. Real-time thermal MRI was used to monitor tissue damage in the region of interest. All patients received postoperative SSRS. The maximum thickness of the epidural tumor was measured, and the degree of epidural spinal cord compression (ESCC) was scored in pre- and postprocedure MRI. RESULTS In the 11 patients eligible for study, the mean VAS score for pain decreased from 6.18 in the preoperative period to 4.27 within 30 days and 2.8 within 60 days after the procedure. A similar VAS interrogating the percentage of quality of life demonstrated improvement from 60% preoperatively to 70% within both 30 and 60 days after treatment. Imaging follow-up 2 months after the procedure demonstrated a significant reduction in the mean thickness of the epidural tumor from 8.82 mm (95% CI 7.38–10.25) before treatment to 6.36 mm (95% CI 4.65–8.07) after SLITT and SSRS (p = 0.0001). The median preoperative ESCC Grade 2 was scored as 4, which was significantly higher than the score of 2 for Grade 1b (p = 0.04) on imaging follow-up 2 months after the procedure. CONCLUTIONS The authors present the first report on an innovative minimally invasive alternative to surgery in the management of spinal metastasis. In their early experience, SLITT has provided local control with low morbidity and improvement in both pain and the quality of life of patients.

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