scholarly journals Per-operative glue embolization with surgical decompression: A multimodality treatment for aggressive vertebral haemangioma

2019 ◽  
Vol 25 (5) ◽  
pp. 570-578 ◽  
Author(s):  
AR Prabhuraj ◽  
Ajit Mishra ◽  
Rakesh Kumar Mishra ◽  
Nupur Pruthi ◽  
Jitender Saini ◽  
...  
Keyword(s):  
Transarterial Embolization ◽  
Treatment Options ◽  
Cord Compression ◽  
Surgical Decompression ◽  
Spinal Needle ◽  
Neurological Deficits ◽  
Percutaneous Injection ◽  
Spinal Stabilization ◽  
Vertebral Haemangioma ◽  
Glue Embolization

Objective The aim of this study is to share our experience in per-operative embolization of aggressive vertebral haemangioma and to compare the surgical outcome with existing modalities of management. Background Vertebral haemangioma accounts for 12% of benign lesions of the vertebral column detected incidentally. Rarely they may enlarge, cause pain and neurological deficit because of spinal cord compression, vertebral body or arch expansion, or pathological fracture. Treatment options for symptomatic vertebral haemangioma include pre-operative transarterial embolization, surgical excision, radiotherapy, and percutaneous injection of alcohol or methyl methacrylate. We present our experience of per-operative glue embolization for aggressive (Enneking stage 3) vertebral haemangiomas. Materials and methods We describe five patients with symptomatic vertebral haemangioma at the dorsal level who underwent per-operative glue embolization. After initial laminectomy, a tumorogram was obtained under fluoroscopic guidance through direct contrast injection via spinal needle inserted through the pedicles of vertebra at the involved level. Varied concentration of glue was injected via the same spinal needle. All patients underwent surgical decompression of the intraspinal epidural component in the same sitting along with posterior spinal stabilization of the adjacent levels in two patients. Results In all five patients, complete embolization of the tumour was possible per-operatively through the transpedicular approach along with adjunctive surgical decompression, and the blood loss was significantly less. Clinical follow-up of these patients at 12–48 months showed reduction in size of the epidural component, relief of cord compression, and significant improvement in their neurological deficits with no recurrence. Conclusion We conclude that per-operative embolization is a safe and efficacious adjunctive procedure with surgical decompression with or without spinal stabilization for the treatment of symptomatic vertebral haemangiomas.

scholarly journals Aneurysmal bone cyst in thoracolumbar spine

2020 ◽  
Vol 6 (3) ◽  
pp. 20190133
Author(s):  
Alex Kiu ◽  
Tiffany Fung ◽  
Pranav Chowdhary ◽  
Sungmi Jung ◽  
Tom Powell ◽  
...  
Keyword(s):  
Treatment Options ◽  
Bone Cyst ◽  
Thoracolumbar Spine ◽  
Cord Compression ◽  
Central Canal ◽  
Neurological Deficits ◽  
Primary Bone Tumors ◽  
Canal Stenosis ◽  
Aneurysmal Bone Cysts ◽  
Primary Bone

Aneurysmal bone cysts (ABC) are rare, benign primary bone tumors. Although benign, they can be locally aggressive resulting in erosion of bone and surrounding tissues over time. In later stages, depending on the clinical urgency, immunotherapy or surgical resection remain treatment options. This report illustrates a case of a 32-year-old female who presented with chronic worsening low back pain without neurological deficits. Radiological imaging revealed a large destructive mass arising from the thoracic spine invading into the central canal, causing critical central stenosis and cord compression. Histopathology revealed ABC. This case highlights the importance of including ABCs and other ‘benign’/locally aggressive lesions in the differential of patients with insidious musculoskeletal complaints. This case also demonstrates that one can be neurologically asymptomatic despite having critical central canal stenosis and cord compression if the causative lesion is slow growing. Understanding this allows us to arrange for most appropriate management.

scholarly journals Hemiparesis resulting from an unusual C1 fracture: A case report and literature review

2020 ◽  
Vol 11 ◽  
pp. 449
Author(s):  
Sung-Joo Yuh ◽  
Zhi Wang ◽  
Ghassan Boubez ◽  
Daniel Shedid
Keyword(s):  
Cord Compression ◽  
Surgical Decompression ◽  
Neurological Deficits ◽  
Lateral Mass ◽  
Computed Tomography Scan ◽  
Instrumented Fusion ◽  
Jefferson Fracture ◽  
Type 3 ◽  
Neurologically Intact ◽  
Tomography Scan

Background: Jefferson fractures are burst fractures involving both the anterior and posterior arches of C1. They typically result from axial compression or hyperextension injuries. Most are stable, and neurological deficits are rare. They are often successfully treated with external immobilization, but require surgery (e.g., fusion/ stabilization). Case Description: An 89-year-old male presented with a left-sided hemiplegia following a trivial fall. The cervical computed tomography scan revealed a left-sided displaced comminuted C1 fracture involving the arch and lateral mass. The MR revealed posterior cord compression and focal myelomalacia. Six months following an emergent C1–C3 decompression with occiput to C4 instrumented fusion, the patient was neurologically intact and pain-free. Conclusion: An 89-year-old male presented with a left-sided hemiplegia due to a Type 3/4 C1 Jefferson fracture. Following posterior C1–C3 surgical decompression with C0–C4 instrumented fusion, the patient sustained a complete bilateral motor recovery.

The neurosurgical management of spinal metastases causing cord and cauda equina compression

1978 ◽  
Vol 49 (6) ◽  
pp. 839-843 ◽  
Author(s):  
Kenneth E. Livingston ◽  
Richard G. Perrin
Keyword(s):  
Cauda Equina ◽  
Spinal Metastases ◽  
Cord Compression ◽  
Surgical Decompression ◽  
Content Type ◽  
Spinal Stabilization ◽  
Prominent Symptom ◽  
Average Survival ◽  
Cauda Equina Compression ◽  
Effective Pain Relief

✓ The authors report a series of 100 consecutive patients with spinal metastases causing cord or cauda equina compression, who were treated with surgical decompression. Of these, 30% (all women) had breast cancer. The most common primary neoplasm in man was prostatic carcinoma. Pain was the earliest and most prominent symptom, followed by weakness. Bladder dysfunction was recorded in 40 patients. The thoracic region was the most common site of cord compression (76 patients). Surgical treatment involved urgent and extensive laminectomy decompression. Concomitant spinal stabilization was required in 10 cases, involving posterior rib graft fusion in seven and Harrington rod instrumentation in three. At last follow-up review, 29 of these patients were living with an average postoperative survival of 2.3 years; 71 patients had died with an average survival of 8.8 months. Surgical decompression produced effective pain relief in 70% of the patients. Postoperatively, 58 patients could walk; of these, 40 were walking and continent of urine 6 months following surgery (including five patients who were totally paraplegic on admission). Positive approach and aggressive management in this problem can achieve results superior to those generally reflected in the literature.

scholarly journals Aggressive vertebral hemangioma in paediatric spine with cord compression

2016 ◽  
Vol 15 (1) ◽  
Author(s):  
Ed Simor Khan Mor Japar Khan ◽  
Dzulkarnain Amir ◽  
Manmohan Singh ◽  
Goh Jin Hee ◽  
Nor Azlin Zainal Abidin ◽  
...  
Keyword(s):  
Back Pain ◽  
Chronic Back Pain ◽  
Treatment Options ◽  
Compression Fracture ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Fatty Tissue ◽  
Vertebral Hemangioma ◽  
Hyperintense Signal ◽  
History Of

Vertebral body hemangiomas are benign primary vascular tumours and account for 4% of all spinal tumours. The majority of patients are asymptomatic. They affect male and female equally. The majority has seen in middle age group. An aggressive vertebral hemangioma presenting with neurological deficits are rare, accounting for less than 1% in the general population. A 10 year old girl with a two weeks history of unsteady gait, frequent falls and back pain which was preceded by a history of traumatic compression fracture of T10 vertebrae. Examination revealed upper motor lesion. MRI demonstrated a T10 body and posterior element lesion with cord compression. A CT scan with the typical picture of ‘polka dot’ can be seen on axial cut. Biopsy confirmed the diagnosis of vertebral hemangioma. Preop embollization, decompression, vertebroplasty and posterior stabilization was done. One week post-op, her condition improved significantly. At six weeks post-op her condition was back to normal. Spinal hemangioma may affect all levels of the vertebrae with a predilection towards the thoracic region. MRI plays an important role, especially in looking at the extension of cord compression and presence of extraosseus lesion. An inactive lesion consist mainly of fatty tissue which give a hyperintense signal on both T1 and T2 weighted images. Treatment options range from radiotherapy, embolisation and surgery. Our goal of treatment in this patient was to decompress the spinal cord and achieved a stable spine. Persistent chronic back pain months after a compression fracture should raise our suspicion to pathological cause. Further investigation must be carried out to confirm the diagnosis.

Institutional experience of tuberculosis of craniovertebral junction

2017 ◽  
Vol 5 (4) ◽  
pp. 1294 ◽  
Author(s):  
Ravi Dasari ◽  
Kadali Satyavara Prasad ◽  
Phaneeswar Thota ◽  
Raman B. V. S.
Keyword(s):  
Neck Pain ◽  
Radical Surgery ◽  
Treatment Options ◽  
Craniovertebral Junction ◽  
Cord Compression ◽  
Basilar Invagination ◽  
Neurological Deficits ◽  
Occipitocervical Fusion ◽  
Bony Destruction ◽  
King George Hospital

Background: Craniovertebral junction tuberculosis (CVJ-TB) is a rare entity occurring in only 0.3 to 1% of tuberculous spondylitis. It causes severe instability and neurological deficits. Present study includes 16 cases of CVJ tuberculosis with neck pain and progressive quadriparesis. Radiological evaluation showed wide spread disease around clivus, C1, C2, C3 with extensive bony destruction, cord compression, basilar invagination and atlantoaxial dislocation.Methods: The study included all the cases admitted with cv junction tuberculosis in neurosurgery ward in King George hospital, Visakhapatnam during a period of three years from 2014 to 2016. Four cases were managed conservatively and four cases were treated by only posterior occipitocervical fusion. We performed two stage operation in single sitting i.e. transoral decompression and posterior occipitocervical fusion in 12 cases. The pathological findings confirmed tuberculosis.Results: Postoperatively all the patients had decreased neck pain and two third of the patients (10 of 16 patients) had improvement in motor power.Conclusions: In the available literature, the treatment options offered for cvj-tb have ranged from a purely conservative approach to radical surgery without well-defined guidelines. In this study, we followed a radical approach as the patients included in our study presented with extensive TB cv junction. So, we recommend radical surgery for extensive TB of cv junction.

scholarly journals Aneurysmal bone cyst of thoracic spine with neurological deficit and its recurrence treated with multimodal intervention – A case report

2020 ◽  
Vol 11 ◽  
pp. 274
Author(s):  
B. Yogesh Kumar ◽  
R. Thirumal ◽  
S. G. Chander
Keyword(s):  
Treatment Options ◽  
Bone Cyst ◽  
Arterial Embolization ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Lytic Lesion ◽  
Neurological Involvement ◽  
En Bloc ◽  
Limb Weakness ◽  
Primary Bone Tumors

Background: Aneurysmal bone cysts (ABCs) are rare, representing about 1% of primary bone tumors, and 15% of all primary spine/sacral tumors. Notably, when they are located in poorly accessible regions such as the spine and pelvis, their management may be challenging. Treatment options include selective arterial embolization (SAE), curettage, en bloc excision with reconstruction, and radiotherapy. Case Description: A 16-year-old male presented with 2 months of mid back pain, left-sided thoracic radiculopathy, and left lower limb weakness (MRC – 3/5). MR imaging revealed an expansile, lytic lesion involving the T9 vertebral body, and the left-sided posterior elements resulting in cord compression. He underwent SAE followed by intralesional excision, bone grafting, and a cage – instrumented fusion. ABC was diagnosed from the biopsy sample. Postoperatively, the pain was reduced, and he was neurologically intact. Five months later, he presented with a new lesion that was treated with repeated SAE and three doses of zoledronic acid. At the end of 2 years, the subsequent, MRI and CT studies documented new bone formation in the lytic areas, with healing of lesion; additionally, he clinically demonstrated sustained pain relief. Conclusion: Here, we emphasized the importance of surgery for patients with ABC who develop focal neurological deficits. Treatment options should include SAE with bisphosphonate therapy for lesions that recur without neurological involvement.

Current Strategies in the Management of Spinal Metastatic Disease

Swiss Surgery ◽  
2003 ◽  
Vol 9 (2) ◽  
pp. 55-62 ◽  
Author(s):  
Bartanusz ◽  
Porchet
Keyword(s):  
Spinal Cord ◽  
Surgical Techniques ◽  
Cord Compression ◽  
Treatment Modalities ◽  
Surgical Approaches ◽  
Spinal Stabilization ◽  
Management Algorithm ◽  
Specific Manner ◽  
Extensive Surgery ◽  
Selection Of

The treatment of metastatic spinal cord compression is complex. The three treatment modalities that are currently applied (in a histologically non-specific manner) are surgery, radiotherapy and the administration of steroids. The development of new spinal instrumentations and surgical approaches considerably changed the extent of therapeutic options in this field. These new surgical techniques have made it possible to resect these tumours totally, with subsequent vertebral reconstruction and spinal stabilization. In this respect, it is important to clearly identify those patients who can benefit from such an extensive surgery. We present our management algorithm to help select patients for surgery and at the same time identifying those for whom primary non-surgical therapy would be indicated. The retrospective review of surgically treated patients in our department in the last four years reveals a meagre application of conventional guidelines for the selection of the appropriate operative approach in the surgical management of these patients. The reasons for this discrepancy are discussed.

Posterior circulation stroke: an easily overlooked complication of catheter ablation of atrial fibrillation

2020 ◽  
Vol 13 (8) ◽  
pp. e234661
Author(s):  
Tahir Nazir ◽  
Mohiuddin Sharief ◽  
James Farthing ◽  
Irfan M Ahmed
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Treatment Options ◽  
Posterior Circulation ◽  
Diagnosis And Treatment ◽  
Neurological Deficits ◽  
Cerebellar Infarction ◽  
Af Ablation ◽  
Posterior Circulation Stroke ◽  
Ventricular Response

Catheter ablation of atrial fibrillation (AF) has established itself as a safe and proven rhythm control strategy for selected patients with AF over the past decade. Thromboembolic complications of catheter ablation are becoming rare in anticoagulated patients with a risk of stroke reported as 0.3%. A particular challenge is posed by clinical presentation due to ischaemic stroke involving the posterior circulation following catheter ablation because of its substantial differences from the carotid territory stroke, making the timely diagnosis and treatment very difficult. It is crucial to keep an index of clinical suspicion in patients presenting with neurological deficits related to vertebrobasilar circulation following ablation. We describe the case of a man who presented with dizziness and palpitations after radiofrequency catheter ablation of AF. He was found to be in AF with a rapid ventricular response. His dizziness was initially attributed to the cardiac dysrhythmia. As his symptoms continued despite heart rate control, he underwent further investigations and was eventually diagnosed with a posterior circulation stroke resulting in left cerebellar infarction. He was treated with antiplatelet therapy and improved significantly over the following few days. We review and present an up-to-date brief literature review on the complications of catheter ablation of AF and describe pathophysiology, clinical features, diagnosis and treatment options for posterior circulation stroke after AF ablation. This case aims to raise awareness among clinicians about posterior circulation stroke after AF ablation.

scholarly journals Epidemiology of spinal cord and column tumors

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. i5-i9
Author(s):  
Joshua T Wewel ◽  
John E O’Toole
Keyword(s):  
Spinal Cord ◽  
Treatment Options ◽  
Survival Rates ◽  
Spinal Metastases ◽  
Cord Compression ◽  
Severe Form ◽  
Spinal Instability ◽  
Treatment Cascade ◽  
Tumor Pathology ◽  
Pathologic Fractures

Abstract The spine is a frequent location for metastatic disease. As local control of primary tumor pathology continues to improve, survival rates improve and, by extension, the opportunity for metastasis increases. Breast, lung, and prostate cancer are the leading contributors to spinal metastases. Spinal metastases can manifest as bone pain, pathologic fractures, spinal instability, nerve root compression, and, in its most severe form, spinal cord compression. The global extent of disease, the spinal burden, neurologic status, and life expectancy help to categorize patients as to their candidacy for treatment options. Efficient identification and workup of those with spinal metastases will expedite the treatment cascade and improve quality of life.

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