scholarly journals Non-fusion palliative spine surgery without reconstruction is safe and effective in spinal metastasis patients: retrospective study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Siravich Suvithayasiri ◽  
Borriwat Santipas ◽  
Sirichai Wilartratsami ◽  
Monchai Ruangchainikom ◽  
Panya Luksanapruksa
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Survival Data ◽  
Spinal Metastasis ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Survival Duration ◽  
Related Complication ◽  
The Mean ◽  
Anterior Reconstruction

AbstractConsidering the shorter life expectancy and poorer prognosis of metastatic epidural spinal cord compression patients, anterior reconstruction and fusion may be unnecessary. This study aimed to investigate the outcomes of palliative surgery for metastatic epidural spinal cord compression with neurological deficit among patients who underwent posterior decompression and instrumentation without fusion or anterior reconstruction. This single-center retrospective review included all patients aged > 18 years with thoracic or lumbar spinal metastasis who were surgically treated for metastatic spinal cord compression without fusion or anterior reconstruction at the Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during July 2015 to December 2017. Data from preoperation to the 1-year follow-up, including demographic and clinical data, Frankel classification, pain scores, complication, revision surgery, health-related quality-of-life scores, and survival data, were collected and analyzed. A total of 30 patients were included. The mean age was 59.83 ± 11.73 years, and 20 (66.7%) patients were female. The mean operative time was 208.17 ± 58.41 min. At least one Frankel grade improvement was reported in 53.33% of patients. The pain visual analog scale, the EuroQOL five-dimension five-level utility score, and the Oswestry Disability Index were all significantly improved at a minimum of 3 months after surgery. No intraoperative mortality or instrument-related complication was reported. The mean survival duration was 11.4 ± 8.97 months. Palliative non-fusion surgery without anterior reconstruction may be considered as a preferable choice for treating spinal metastasis patients with spinal cord compression with neurological deficits.

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

2015 ◽  
Vol 23 (4) ◽  
pp. 400-411 ◽  
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.

Relationship Between Paralysis and the Epidural Spinal Cord Compression Scale in Spinal Metastasis

Orthopedics ◽  
2020 ◽  
Vol 43 (6) ◽  
pp. e567-e573
Author(s):  
Hiroshi Uei ◽  
Yasuaki Tokuhashi ◽  
Masafumi Maseda
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Spinal Metastasis ◽  
Cord Compression

scholarly journals Cervical myelopathy due to neurovascular compression syndrome caused by persistent first intersegmental artery: a case report

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Takuro Endo ◽  
Taku Sugawara ◽  
Naoki Higashiyama
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cervical Myelopathy ◽  
Anatomical Variation ◽  
Cord Compression ◽  
Burning Sensation ◽  
Motor Dysfunction ◽  
Neurological Deficits ◽  
Left Shoulder ◽  
Neurovascular Compression

Abstract Background Persistent first intersegmental artery (PFIA) is a rare anatomical variation of vertebral arteries and is an asymptomatic finding in most cases. Here we report a rare case of cervical myelopathy caused by spinal cord compression by the PFIA. Case presentation The patient was a 52-year-old man who complained of numbness and burning sensation around the neck and left shoulder area, partial weakness in the left deltoid muscle, right side thermal hypoalgesia, and disturbance of deep sensation since the past 1 year, and the symptoms had gradually worsened. Magnetic resonance imaging (MRI) and computed tomography (CT) showed spinal cord compression by the left PFIA at the C1/C2 level. Because conservative treatment was ineffective, microvascular decompression (MVD) of the PFIA was performed. The left PFIA was laterally transposed using polytetrafluoroethylene (PTFE) bands and anchored to the dura mater using three PTFE bands. To achieve adequate transposition, the small blood vessels bridging the spinal cord and PFIA and the dorsal root nerve had to be sacrificed. Postoperative T2-weighted MRI showed a small hyperintense region in the lateral funiculus of the spinal cord, but no new neurological deficits were identified. In the early postoperative stage, the patient’s deep sensory impairment and motor dysfunction were improved. His numbness and burning sensation almost disappeared, but slight thermal hypoalgesia remained in the lower limb. Conclusion MVD is an effective treatment for spinal cord compression caused by the PFIA, but further studies are necessary to help address technical difficulties and avoid complications.

scholarly journals IgG4-Related Sclerosing Disease Causing Spinal Cord Compression: The First Reported Case in Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Nooraldin Merza ◽  
Ahmed Taha ◽  
John Lung ◽  
Anthony W. Benderman ◽  
Stephen E. Wright
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cervical Spinal Cord ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Pathological Examination ◽  
Tissue Mass ◽  
Systemic Steroids ◽  
First Case

Immunoglobulin G4-related disease (IgG4-RD) is known for forming soft tissue mass lesions that may have compressive effects. It is an extremely rare disease that most frequently affects the pancreas causing autoimmune pancreatitis. It can also affect the gallbladder, salivary glands, and lacrimal glands causing respective organ-specific complications. In our report, we describe an IgG4-RD case that affected the spinal cord. A 60-year-old female presented with cervical spinal cord compression caused by IgG4-RD leading to several neurological deficits. Pathological examination of the excisional biopsy of the mass revealed dense lymphoplasmacytic cells infiltration and stromal fibrosis with IgG4 and plasma cells. The patient showed a dramatic response to the administration of systemic steroids with almost resolution of her neurological symptoms. This case highlights the first case in literature for IgG4-RD of the extradural tissue causing spinal compression. Hereby, we also demonstrate the dramatic response of IgG4-RD to the administration of systemic steroids as the patient had no recurrence after 5 years of close follow-up, the longest reported period of follow-up reported in the literature to date.

Clinical outcomes of a Dutch prospective observational registry of metastatic castration resistant prostate cancer (mCRPC) patients treated with radium-223 (Ra-223).

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 323-323
Author(s):  
Rebecca Louhanepessy ◽  
Sushil Badrising ◽  
Vincent van der Noort ◽  
Jules L. L. M. Coenen ◽  
Paul Hamberg ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Clinical Outcomes ◽  
Spinal Cord Compression ◽  
Survival Data ◽  
Cord Compression ◽  
Subsequent Treatment ◽  
Castration Resistant Prostate Cancer ◽  
Bone Surgery ◽  
Radium 223 ◽  
Pathologic Fractures

323 Background: In 2012 the ALSYMPCA study established a 3.6 month Overall Survival (OS) benefit of mCRPC patients treated with Ra-223 over placebo. To date clinical outcomes of Ra-223 treatment in a non-study population have not been prospectively evaluated. Methods: The ROTOR registry aimed to include 300 patients in 20 Dutch hospitals prior to Ra-223 treatment at the physician’s discretion. Clinical parameters collected included: positioning of Ra-223, Adverse Events (AE’s; CTCAE v4.03), Skeletal Related Events (SRE) and survival data. SRE was defined as radiotherapy to a bone metastasis, a new pathological fracture, spinal cord compression and/or bone surgery. Progression-Free Survival (PFS) was defined as survival until radiological or clinical progression, subsequent treatment or death. Results: Between April 2014 and September 2017, 305 patients were included of whom 300 were evaluable. The mean age of patients was 72.6 (range 46.3-91.5) years, 255 (85%) had ≥ 6 bone metastases and 197 (65.5%) were pretreated with taxanes and/or abiraterone or enzalutamide (214 (71.3%)). Two-hundred and ninety (96.7%) patients were treated with Ra-223. Twenty-nine (9.7%), 104 (34.7%), 96 (32%) and 66 (22%) patients received Ra-223 as a first, second, third, ≥ fourth mCRPC treatment line, respectively. Patients received an average of 4.6 (SD 1.8) cycles of Ra-223, while 140 (46.7%) completed all six cycles. After a median follow-up of 13.2 months, PFS was 5.1 (CI 4.5-5.8) months and OS 15.2 (CI 12.8-17.6) months. Eighty-two (27.3%) patients were hospitalized during Ra-223 treatment (Serious AE). Grade ≥ 3 anemia, neutropenia and thrombocytopenia was found in 54 (18.0%), 8 (2.7%) and 11 (3.7%) patients, respectively. Other frequent AE’s (all grades) were nausea (90 (30%)), diarrhea (83 (27.7%)) and fatigue (178 (59.3%)). SREs were observed in 46 (15.3%) patients; 22 (7.3%) received radiotherapy, 6 (2%) developed pathologic fractures, 17 (5.6%) spinal cord compression and 1 (0.3%) received bone surgery during Ra-223 therapy. Conclusions: The non-study ROTOR population had characteristics, all grade AEs and OS comparable with the treatment arm of ALSYMPCA. Clinical trial information: NCT03223597.

scholarly journals Spinal Cord Compression Secondary to Extramedullary Hematopoiese in a Patient with a Beta-Thalassemia

2019 ◽  
Vol 4 (5) ◽  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Mass Effect ◽  
Myeloproliferative Disorders ◽  
Extramedullary Hematopoiesis ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Beta Thalassemia ◽  
Spleen And Lymph Nodes ◽  
Upper Thoracic

Extramedullary hematopoiesis (EMH) is a rare cause of spinal cord compression (SCC). EMH represents the growth of blood cells outside of the bone marrow and occurs in a variety of hematologic illnesses, including various types of anemia and myeloproliferative disorders. Although EMH usually occurs in the liver, spleen, and lymph nodes, it may also occur within the spinal canal. When this occurs, the mass effect can compress the spinal cord, potentially leading to the development of neurological deficits. We present a case of SCC secondary to EMH. Our patient is a 26-year-old male with beta-thalassemia who presented with both upper thoracic and lower extremity symptoms of spinal cord compression. This report illustrates the importance of considering EMH in the differential diagnosis of SCC, even in the absence of signs of its most common etiologies.

Caudal cervical arthrodesis using a distractable fusion cage in a dog

2010 ◽  
Vol 23 (03) ◽  
pp. 209-213 ◽  
Author(s):  
F. Bernard ◽  
J.-F. Bardet ◽  
Adrega da Silva
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Cervical Fusion ◽  
Disc Protrusion ◽  
Dynamic Component ◽  
Long Term Outcome ◽  
Fusion Cage

SummaryThis case report describes a cervical fusion cage, surgical technique and the long-term outcome of caudal cervical arthrodesis used to stabilise dynamic spinal cord compression at the sixth and seventh cervical intervertebral disc space (C6, C7) in a dog. A seven-year-old, 41 kg, entire male Dobermann Pinscher was admitted for progressive ataxia of two weeks duration. Neurological examination revealed ambulatory tetraparesis. Computed tomographic myelogram scans in neutral and traction positions of the neck were performed and were used to determine presence of a dynamic component. A C6-C7 surgical distraction and stabilisation using a distractable intervertebral fusion cage was performed. There was not any deterioration of neurological status was observed on postoperative neurological evaluation. Within eight weeks after surgery, gait and postural abilities had returned to normal. Computed tomography evaluation indicated a complete bridging callus within and outside the cage at 15 weeks after surgery. There were not any complications or recurrences of initial neurological deficits observed during the 40 month follow-up period. Based on the follow-up period data, a C6-C7 dynamic spinal cord compression with disc protrusion was successfully treated by a distractable cervical fusion cage.

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