Partial Costotransversectomy and Corpectomy for Thoracic Spinal Metastatic Disease: Operative Technique and Nuances: 2-Dimensional Operative Video

2018 ◽  
Vol 17 (3) ◽  
pp. E101-E101
Author(s):  
Oluwaseun O Akinduro ◽  
Eric W Nottmeier
Keyword(s):  
Spinal Cord ◽  
Metastatic Disease ◽  
Spinal Metastasis ◽  
Preoperative Evaluation ◽  
Transverse Process ◽  
Radicular Pain ◽  
Medial Aspect ◽  
Lower Back ◽  
Thoracic Spinal ◽  
Postoperative Improvement

Abstract We describe the operative approach and management for thoracic metastatic disease in a 78-yr-old man with worsening mechanical lower back and left-sided thoracic radicular pain. Imaging of the thoracic spine revealed an osteolytic T11 mass with destruction of the left T11 pedicle and transverse process. Biopsy confirmed spinal metastasis from the liver. Preoperative angiogram was completed for localization of the artery of Adamkewicz and microparticle embolization of the left T11 intercostal artery. Surgical resection was supplemented with electrophysiological monitoring and neuronavigation. The corpectomy was approached by resecting the medial aspect of the rib, transverse process, and pedicle, which were all invaded with tumor. The left T11 nerve root was isolated and sacrificed to allow for placement of the expandable corpectomy cage and also resulted in sustained relief of the patient's radicular pain. The patient recovered from surgery well, with postoperative improvement of his pain. This case highlights the complex technical nuances of this procedure, and the importance of a thorough preoperative evaluation, including angiography, as proper identification of the artery of Adamkewitz can prevent severe neurological deficit from a spinal cord stroke. The patient consented to the procedure.

scholarly journals Intramedullary thoracic spinal metastasis from small-cell lung cancer

2013 ◽  
Vol 79 (3-4) ◽  
Author(s):  
S. Katsenos ◽  
M. Nikolopoulou
Keyword(s):  
Lung Cancer ◽  
Spinal Cord ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Spinal Metastasis ◽  
Small Cell ◽  
Mediastinal Lymphadenopathy ◽  
Small Cell Lung ◽  
Intramedullary Spinal Cord ◽  
Thoracic Spinal

Intramedullary thoracic spinal metastasis from small-cell lung cancer. S. Katsenos, M. Nikolopoulou. Lung cancer with intramedullary spinal cord metastasis (ISCM) is a rare event exhibiting dismal prognosis. In the present paper, we describe a 74-year-old male who developed bilateral leg weakness with associated backache and non-productive cough. Chest imaging evaluation demonstrated pronounced bilateral mediastinal lymphadenopathy and a nodular opacity in the right lower lobe. The patient was diagnosed with small cell lung cancer through bronchoscopic procedures. Magnetic resonance imaging of the spinal cord with contrast-enhancement revealed an intramedullary lesion consistent with metastasis at the T5-T6 level. Despite chemotherapy and thoracic spine radiotherapy, he eventually succumbed to the disease 3 months after diagnosis. A brief overview of the current literature is also provided laying emphasis on the therapeutic strategies of this unusual extrathoracic metastatic disease.

scholarly journals Subdural arachnoidal cyst of the spinal cord: etiology, clinical presentation, surgical strategy and results

2012 ◽  
Vol 31 (02) ◽  
pp. 61-67
Author(s):  
Joelton Fonseca ◽  
José Carlos Lynch ◽  
Fabiana Policarpo ◽  
Celestino Esteves ◽  
Cleber Bomfim ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Radicular Pain ◽  
Cervical Region ◽  
Neurosurgical Department ◽  
Complete Excision ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Lumbar Spinal

Abstract Objective: Of this study is identifying the clinical manifestations, discuss the etiology, and present the surgical treatment nuances and outcomes of patients with sub dural arachnoidal cysts (AC). Method: A retrospective study was carried out with 7 consecutives patients with spinal cord subdural AC, diagnosed, evaluated and operated at the Neurosurgical department of Servidores do Estado Hospital, from 1996 to 2010. The radiological studies, patient records, surgical descriptions and surgical videos, were reviewed, creating a database from which information was collected. The follow-up varied from 2 to 168 months (mean, 48 months). All cysts were histopathological verified. Results: Five AC were located on the thoracic spinal cord, one were located anterior in the cervical region, and one at the lumbar spinal level. The complete resection of the cyst was performed in 4 surgeries. Three patients had cysts located ventral to the cord, which precluded complete excision. The symptoms in four patients demonstrated major improvement. There was no operative death in this series, there was no major complications related to surgery. Conclusion: AC should be considered in the differential diagnosis of lesions causing myelopathy and/or a radicular pain syndrome. Microsurgical resection or generous fenestration in cysts effectively ameliorated patients’ symptomatology.

scholarly journals Imaging of Spinal Metastatic Disease

2011 ◽  
Vol 2011 ◽  
pp. 1-12 ◽  
Author(s):  
Lubdha M. Shah ◽  
Karen L. Salzman
Keyword(s):  
Spinal Cord ◽  
Soft Tissue ◽  
Metastatic Disease ◽  
Imaging Techniques ◽  
Spinal Metastasis ◽  
Imaging Modalities ◽  
Common Site ◽  
The Third ◽  
Soft Tissue Involvement ◽  
Mri Sequences

Metastases to the spine can involve the bone, epidural space, leptomeninges, and spinal cord. The spine is the third most common site for metastatic disease, following the lung and the liver. Approximately 60–70% of patients with systemic cancer will have spinal metastasis.Materials/Methods. This is a review of the imaging techniques and typical imaging appearances of spinal metastatic disease.Conclusions. Awareness of the different manifestations of spinal metastatic disease is essential as the spine is the most common site of osseous metastatic disease. Imaging modalities have complimentary roles in the evaluation of spinal metastatic disease. CT best delineates osseous integrity, while MRI is better at assessing soft tissue involvement. Physiologic properties, particularly in treated disease, can be evaluated with other imaging modalities such as FDG PET and advanced MRI sequences. Imaging plays a fundamental role in not only diagnosis but also treatment planning of spinal metastatic disease.

scholarly journals Dose fall-off during the treatment of thoracic spine metastasis with CyberKnife stereotactic body radiation therapy (SBRT)

2018 ◽  
Author(s):  
Zhongjian Ju ◽  
Jingyuan Wang ◽  
Huaiwen Zhang ◽  
Lei Du ◽  
Wei Xu ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Radiation Therapy ◽  
Stereotactic Body Radiation Therapy ◽  
Maximum Dose ◽  
Spinal Metastasis ◽  
Optimal Dose ◽  
Unit Distance ◽  
New Approach ◽  
Stereotactic Body Radiation ◽  
Thoracic Spinal

CyberKnife stereotactic body radiation therapy (SBRT) is becoming increasingly used for cancer treatment and, to maximize its clinical application, it is important to define the dosimetric characteristics, optimal dose and fractionation regimens. The aim of this study was to evaluate the dose fall-off in two fractionated regimens of CyberKnife SBRT during the treatment of thoracic spinal metastasis. Patients with spinal metastasis involving a vertebra and pedicle were treated with 40 Gy in 5 fractions (n = 4), and patients with spinal metastasis involving only a vertebra received 33 Gy in 3 fractions (n = 4). A new approach was used to measure absolute dose fall-off distance, relative dose fall-off distance, and the dose fall-off per unit distance along four reference directions in the axial plane. Patients treated with 33 Gy/3 fractions had a greater absolute dose fall-off distance in direction 1 (from the point with maximum dose [Dmax] towards the spinal cord) and direction 3 (the opposite of the direction 1), a greater relative dose fall-off distance in direction 3, and a lower dose fall-off per unit distance in direction 1 and 3 compared to patients treated with 40 Gy/5 fractions (all p < 0.05). Overall, the dose fall-off towards the spinal cord is rapid during the treatment of thoracic spinal metastasis with CyberKnife SBRT, which allows a higher dose of radiation to be delivered to the tumor and, at the same time, better protection of the spinal cord.

346 The Utility of Posterior Vertebral Column Subtraction Osteotomies for Tethered Cord Syndrome

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 278-278
Author(s):  
Shashank V Gandhi ◽  
Ahmad Latefi
Keyword(s):  
Spinal Cord ◽  
Preoperative Evaluation ◽  
Spinal Column ◽  
Tethered Cord ◽  
Radicular Pain ◽  
Neurological Injury ◽  
Csf Leak ◽  
Wound Breakdown ◽  
Spinal Cord Herniation ◽  
Pain Symptoms

Abstract INTRODUCTION Detethering of the spinal cord has historically been the treatment of choice for TCS in the setting of spinal dysraphisms. Recurrent TCS occurs 5–80% of patients. Risk of neurological injury, CSF leak, and wound breakdown increase with subsequent procedures. Kokubun et al. described using PVCSO without microsurgical detethering to relieve stretch strain on the spinal cord; however, there is a paucity of literature on its success. Here we describe our experience with PVCSO for TCS. METHODS A prospectively collected database patients with TCS who underwent PVCSO or were being monitored for potential surgery was analyzed. A team of two neurosurgeons evaluated each patient for potential benefit from spinal shortening osteotomies. Preoperative evaluation included MRI and upright radiographs to assess for location and type of tethering and presence of deformity. Single stage posterior PVCSO were conducted at a neutral level rostral to the tethering site, shortening by 10–15mm. When present PVCSOs were concurrently utilized to correct deformities. RESULTS >6 patients were assessed. 4 patients had failed previous microsurgical detethering at least once. 4 patients underwent PVCSO due to worsening of symptoms: 2 with history of myelomeningocele repair and 2 with arachnoid adhesions after spinal subdural hematoma. All 4 had resolution of weakness, numbness, and radicular pain of legs. Incontinence improved in the patient with arachnoid adhesions. There was no worsening of neurological function. 1 patient with spinal cord herniation and scoliosis, had improved radiculopathy from detethering. CONCLUSION In this series all patients who underwent PVCSO for TCS experiences improvement in motor, sensory, and pain symptoms. Indirect relief of in-line strain and stretch on the spinal cord is possible through PVCSO by shortening the spinal column, without high risk of recurrence of symptoms or neurological injury as there is no direct manipulation of neural elements. PVCSO can be utilized for both congenital and acquired TCS.

Spontaneous Herniation of the Thoracic Spinal Cord: A Case Report

2001 ◽  
Vol 45 (4) ◽  
pp. 353 ◽  
Author(s):  
Sung Chan Jin ◽  
Seoung Ro Lee ◽  
Dong Woo Park ◽  
Kyung Bin Joo
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Spontaneous Herniation

Lipomeningocele associated with diplomyelia in a dog

2018 ◽  
Vol 46 (05) ◽  
pp. 323-329 ◽  
Author(s):  
Nele Ondreka ◽  
Sara Malberg ◽  
Emma Laws ◽  
Martin Schmidt ◽  
Sabine Schulze
Keyword(s):  
Spinal Cord ◽  
Neurological Status ◽  
Split Cord Malformation ◽  
Lumbar Spinal Cord ◽  
Histopathological Diagnosis ◽  
Type I ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Subcutaneous Mass ◽  
Lumbar Spinal

SummaryA 2-year-old male neutered mixed breed dog with a body weight of 30 kg was presented for evaluation of a soft subcutaneous mass on the dorsal midline at the level of the caudal thoracic spine. A further clinical sign was intermittent pain on palpation of the area of the subcutaneous mass. The owner also described a prolonged phase of urination with repeated interruption and re-initiation of voiding. The findings of the neurological examination were consistent with a lesion localization between the 3rd thoracic and 3rd lumbar spinal cord segments. Magnetic resonance imaging revealed a spina bifida with a lipomeningocele and diplomyelia (split cord malformation type I) at the level of thoracic vertebra 11 and 12 and secondary syringomyelia above the aforementioned defects in the caudal thoracic spinal cord. Surgical resection of the lipomeningocele via a hemilaminectomy was performed. After initial deterioration of the neurological status postsurgery with paraplegia and absent deep pain sensation the dog improved within 2 weeks to non-ambulatory paraparesis with voluntary urination. Six weeks postoperatively the dog was ambulatory, according to the owner. Two years after surgery the owner recorded that the dog showed a normal gait, a normal urination and no pain. Histopathological diagnosis of the biopsied material revealed a lipomeningocele which confirmed the radiological diagnosis.

scholarly journals The Histopathology of Severe Graded Compression in Lower Thoracic Spinal Cord Segment of Rat, Evaluated at Late Post-injury Phase

2021 ◽  
Author(s):  
Fedorova Jana ◽  
Kellerova Erika ◽  
Bimbova Katarina ◽  
Pavel Jaroslav
Keyword(s):  
Spinal Cord ◽  
Spontaneous Recovery ◽  
Traumatic Injury ◽  
Blue Dye ◽  
Post Injury ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Severe Traumatic Injury ◽  
Spinal Cord Segment ◽  
Cord Injury

AbstractSpontaneous recovery of lost motor functions is relative fast in rodent models after inducing a very mild/moderate spinal cord injury (SCI), and this may complicate a reliable evaluation of the effectiveness of potential therapy. Therefore, a severe graded (30 g, 40 g and 50 g) weight-compression SCI at the Th9 spinal segment, involving an acute mechanical impact followed by 15 min of persistent compression, was studied in adult female Wistar rats. Functional parameters, such as spontaneous recovery of motor hind limb and bladder emptying function, and the presence of hematuria were evaluated within 28 days of the post-traumatic period. The disruption of the blood-spinal cord barrier, measured by extravasated Evans Blue dye, was examined 24 h after the SCI, when maximum permeability occurs. At the end of the survival period, the degradation of gray and white matter associated with the formation of cystic cavities, and quantitative changes of glial structural proteins, such as GFAP, and integral components of axonal architecture, such as neurofilaments and myelin basic protein, were evaluated in the lesioned area of the spinal cord. Based on these functional and histological parameters, and taking the animal’s welfare into account, the 40 g weight can be considered as an upper limit for severe traumatic injury in this compression model.

Superficial siderosis due to dural defect with thoracic spinal cord herniation

2012 ◽  
Vol 312 (1-2) ◽  
pp. 170-172 ◽  
Author(s):  
Giorgio B. Boncoraglio ◽  
Elena Ballabio ◽  
Alessandra Erbetta ◽  
Francesco Prada ◽  
Mario Savoiardo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Superficial Siderosis ◽  
Dural Defect ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Spinal Cord Herniation
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