scholarly journals Surgical outcome and prognostic factors in spinal cord ependymoma: a single-center, long-term follow-up study

2021 ◽  
Vol 14 ◽  
pp. 175628642110556
Author(s):  
Oliver Gembruch ◽  
Mehdi Chihi ◽  
Merle Haarmann ◽  
Ahmet Parlak ◽  
Marvin Darkwah Oppong ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Prognostic Factors ◽  
Cervical Spine ◽  
Thoracic Spine ◽  
Neurological Outcome ◽  
Neurological Deterioration ◽  
Tumor Extension ◽  
Poor Neurological Outcome ◽  
Spinal Cord Ependymoma

Objective: Spinal cord ependymomas account for 3–6% of all central nervous system tumors and around 60% of all intramedullary tumors. The aim of this study was to analyze the neurological outcome after surgery and to determine prognostic factors for functional outcome. Patients and Methods: Patients treated surgically due to a spinal cord ependymoma between 1990 and 2018 were retrospectively included. Demographics, neurological symptoms, radiological parameters, histopathology, and neurological outcome (using McCormick Score [MCS]) were analyzed. Possible prognostic factors for neurological outcome were evaluated. Results: In total, 148 patients were included (76 males, 51.4%). The mean age was 46.7 ± 15.3 years. The median follow-up period was 6.8 ± 5.4 years. The prevalence was mostly in the lumbar spine (45.9%), followed by the thoracic spine (28.4%) and cervical spine (25.7%). Gross-total resection was achieved in 129 patients (87.2%). The recurrence rate was 8.1% and depended on the extent of tumor resection ( p = 0.001). Postoperative temporary neurological deterioration was observed in 63.2% of patients with ependymomas of the cervical spine, 50.0% of patients with ependymomas of the thoracic spine, and 7.4% of patients with ependymomas of the lumbosacral region. MCS 1–2 was detected in nearly two-thirds of patients with cervical and thoracic spinal cord ependymoma 36 months after surgery. Neurological recovery was superior in thoracic spine ependymomas compared with cervical spine ependymomas. Poor preoperative functional condition (MCS >2), cervical and thoracic spine location, and tumor extension >2 vertebrae were independent predictors of poor neurological outcome. Conclusion: Neurological deterioration was seen in the majority of cervical and thoracic spine ependymomas. Postoperative improvement was less in thoracic cervical spine ependymomas compared with thoracic spine ependymomas. Poor preoperative status and especially tumor extension >2 vertebrae are predictors of poor neurological outcome (MCS >2).

Calcifying pseudoneoplasms of the spine with myelopathy

2000 ◽  
Vol 93 (2) ◽  
pp. 291-293 ◽  
Author(s):  
Matthew T. Mayr ◽  
Stephen Hunter ◽  
Scott C. Erwood ◽  
Regis W. Haid
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Thoracic Spine ◽  
Radiological Evaluation ◽  
Pathological Findings ◽  
Content Type ◽  
Progressive Myelopathy ◽  
Fine Print

✓ The authors describe two cases of calcifying pseudoneoplasms, rare degenerative lesions that mimic tumor or infection. One case involved the cervical spine and the second the thoracic spine. Both patients experienced progressive myelopathy from extradural compression of the spinal cord. The radiological evaluation, pathological findings in the lesions, treatment, and follow up are described. Total or subtotal excision can relieve symptoms and prevent recurrence of this lesion.

Cervical spine injury from gunshot wounds

2014 ◽  
Vol 21 (3) ◽  
pp. 442-449 ◽  
Author(s):  
Narlin Beaty ◽  
Justin Slavin ◽  
Cara Diaz ◽  
Kyle Zeleznick ◽  
David Ibrahimi ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Neurological Deficit ◽  
Neurological Outcome ◽  
Treatment Algorithm ◽  
Gunshot Wounds ◽  
Neurological Deterioration ◽  
Neurological Deficits ◽  
Cervical Instability ◽  
Cord Injury

Object Gunshot wounds (GSWs) to the cervical spine have been examined in a limited number of case series, and operative management of this traumatic disease has been sparsely discussed. The current literature supports and the authors hypothesize that patients without neurological deficit need neither surgical fusion nor decompression. Patients with GSWs and neurological deficits, however, pose a greater management challenge. The authors have compiled the experience of the R Adams Cowley Shock Trauma Center in Baltimore, Maryland, over the past 12 years, creating the largest series of such injuries, with a total number of 40 civilian patients needing neurosurgical evaluation. The current analysis examines presenting bone injury, surgical indication, presenting neurological examination, and neurological outcome. In this study, the authors characterize the incidence, severity, and recovery potential of cervical GSWs. The rate of unstable fractures requiring surgical intervention is documented. A detailed discussion of surgical indications with a treatment algorithm for cervical instability is offered. Methods A total of 144 cervical GSWs were retrospectively reviewed. Of these injuries, 40 had documented neurological deficits. No neurosurgical consultation was requested for patients without deficit. Epidemiological and clinical information was collected on patients with neurological deficit, including age, sex, timing, indication, type of surgery, initial examination after resuscitation, follow-up examination, and imaging data. Results Twenty-eight patients (70%) presented with complete neurological deficits and 12 patients (30%) presented with incomplete injuries. Fourteen (35%) of the 40 patients underwent neurosurgical intervention. Twelve patients (30%) required intervention for cervical instability. Seven patients required internal fixation involving 4 anterior fusions, 2 posterior fusions, and 1 combined approach. Five patients were managed with halo immobilization. Two patients underwent decompression alone for neurological deterioration and persistent compressive injury, both of whom experienced marked neurological recovery. Follow-up was obtained in 92% of cases. Three patients undergoing stabilization converted at least 1 American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade and the remaining operative cases experienced small ASIA motor score improvement. Eighteen patients underwent inpatient MRI. No patient suffered complications or neurological deterioration related to retained metal. Three of 28 patients presenting with AIS Grade A improved to Grade B. For those 12 patients with incomplete injury, 1 improved from AIS Grade C to D, and 3 improved from Grade D to E. Conclusions Spinal cord injury from GSWs often results in severe neurological deficits. In this series, 30% of these patients with deficits required intervention for instability. This is the first series that thoroughly documents AIS improvement in this patient population. Adherence to the proposed treatment algorithm may optimize neurological outcome and spine stability.

Occipitocervicothoracic stabilization in pediatric patients

2011 ◽  
Vol 8 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Kyle M. Fargen ◽  
Richard C. E. Anderson ◽  
David H. Harter ◽  
Peter D. Angevine ◽  
Valerie C. Coon ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Thoracic Spine ◽  
Pediatric Patients ◽  
Pathological Condition ◽  
Case Series ◽  
Neurological Function ◽  
Spinal Reconstruction ◽  
Spine Deformities ◽  
Distal Fixation

Object Although rarely encountered, pediatric patients with severe cervical spine deformities and instability may occasionally require occipitocervicothoracic instrumentation and fusion. This case series reports the experience of 4 pediatric centers in managing this condition. Occipitocervical fixation is the treatment of choice for craniocervical instability that is symptomatic or threatens neurological function. In children, the most common distal fixation level with modern techniques is C-2. Treated patients maintain a significant amount of neck motion due to the flexibility of the subaxial cervical spine. Distal fixation to the thoracic spine has been reported in adult case series. This procedure is to be avoided due to the morbidity of complete loss of head and neck motion. Unfortunately, in rare cases, the pathological condition or highly aberrant anatomy may require occipitocervical constructs to include the thoracic spine. Methods The authors identified 13 patients who underwent occipitocervicothoracic fixation. Demographic, radiological, and clinical data were gathered through retrospective review of patient records from 4 institutions. Results Patients ranged from 1 to 14 years of age. There were 7 girls and 6 boys. Diagnoses included Klippel-Feil, Larsen, Morquio, and VATER syndromes as well as postlaminectomy kyphosis and severe skeletal dysplasia. Four patients were neurologically intact and 9 had myelopathy. Five children were treated with preoperative traction prior to instrumentation; 5 underwent both anterior and posterior spinal reconstruction. Two patients underwent instrumentation beyond the thoracic spine. Allograft was used anteriorly, and autologous rib grafts were used in the majority for posterior arthrodesis. Follow-up ranged from 0 to 43 months. Computed tomography confirmed fusion in 9 patients; the remaining patients were lost to follow-up or had not undergone repeat imaging at the time of writing. Patients with myelopathy either improved or stabilized. One child had mild postoperative unilateral upper-extremity weakness, and a second child died due to a tracheostomy infection. All patients had severe movement restriction as expected. Conclusions Occipitocervicothoracic stabilization may be employed to stabilize and reconstruct complex pediatric spinal deformities. Neurological function can be maintained or improved. The long-term morbidity of loss of cervical motion remains to be elucidated.

Utility of modified transarticular screw in the middle and lower cervical spine as intermediate fixation in posterior long fusion surgery

2009 ◽  
Vol 11 (5) ◽  
pp. 555-561 ◽  
Author(s):  
Hiroshi Miyamoto ◽  
Masatoshi Sumi ◽  
Koki Uno
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Cobb Angle ◽  
Nerve Root ◽  
Japanese Orthopaedic Association ◽  
Transarticular Screw ◽  
Fusion Surgery ◽  
Nerve Root Injury ◽  
A New Technique

Object The use of a pedicle screw (PS) in the cervical spine ensures strong fixation. However, 6.7–29% of such screws appear to be malpositioned using manual insertion techniques, especially at C-3 to C-6 where the pedicle diameter is smaller, potentially causing catastrophic complications such as vertebral artery (VA) and spinal cord or nerve root injuries. To optimize safety, the authors use a new technique: cephalad and/or caudad ends at C-2 and C-7/T-1, respectively, are fixed with PSs, and intermediate points around C3–6 are fixed using a modified transarticular screw technique that captures 3 dorsal cortices and preserves the ventral cortex of the facet in posterior long fusion surgery involving occipitospinal fixation. The purpose of the present study was to demonstrate this technique and evaluate the clinical and radiological outcomes. Methods Thirty-nine patients, 8 men and 31 women, with a mean age of 61.7 ± 11.0 years at surgery, were included in the study. Twenty-eight occipitospinal fusions and 11 posterior long fusions were performed. Patients were divided into 2 groups: a rheumatoid arthritis (RA) group consisting of 26 patients and a non-RA group of 13 patients including 7 with athetoid cerebral palsy. Clinical outcomes were evaluated according to the Japanese Orthopaedic Association (JOA) score. For radiological evaluation, the Cobb angle on lateral radiographs was measured preoperatively, postoperatively, and at the final follow-up, and the degree of realignment from pre- to postoperation and the loss of correction from postoperation to the follow-up were compared between the 2 patient groups. Results The recovery rate of the JOA score was 50.6 ± 20.7% in the RA group and 37.3 ± 24.3% in the non-RA group. Neither VA injury nor spinal cord or nerve root injury occurred among this series. The degree of realignment was greater in the non-RA group (9.2 ± 13.9°) than the RA group (1.4 ± 12.7°) as the Cobb angle was more kyphotic preoperatively in the non-RA group (2.9 ± 18.6°) than in the RA group (17.4 ± 15.7°). However, 38.5% of patients in the non-RA group had a correction loss > 10% compared with 7.7% in the RA group; this difference was statistically significant. Conclusions The featured transarticular screw technique, which preserves the ventral cortex of the facet, as intermediate fixation in long fusion is a safe and easy procedure with few complications. It ensures acceptable clinical and radiological outcomes, especially in patients with RA.

Laminectomy and Posterior Cervical Plating for Multilevel Cervical Spondylotic Myelopathy and Ossification of the Posterior Longitudinal Ligament: Effects on Cervical Alignment, Spinal Cord Compression, and Neurological Outcome

Neurosurgery ◽  
2003 ◽  
Vol 52 (5) ◽  
pp. 1081-1088 ◽  
Author(s):  
John K. Houten ◽  
Paul R. Cooper
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Neurological Outcome ◽  
Cervical Spondylotic Myelopathy ◽  
Posterior Longitudinal Ligament ◽  
X Rays ◽  
Lateral Mass ◽  
Japanese Orthopedic Association ◽  
Curvature Index ◽  
Muscle Groups

Abstract OBJECTIVE Multilevel anterior decompressive procedures for cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament may be associated with a high incidence of neurological morbidity, construct failure, and pseudoarthrosis. We theorized that laminectomy and stabilization of the cervical spine with lateral mass plates would obviate the disadvantages of anterior decompression, prevent the development of kyphotic deformity frequently seen after uninstrumented laminectomy, decompress the spinal cord, and produce neurological results equal or superior to those achieved by multilevel anterior procedures. METHODS We retrospectively reviewed the records of 38 patients who underwent laminectomy and lateral mass plating for cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament between January 1994 and November 2001. Seventy-six percent of patients had spondylosis, 18% had ossification of the posterior longitudinal ligament, and 5% had both. Clinical presentation included upper extremity sensory complaints (89%), gait difficulty (70%), and hand use deterioration (67%). Spasticity was present in 83%, and weakness of one or more muscle groups was seen in 79%. Spinal cord signal abnormality on sagittal T2-weighted magnetic resonance imaging (MRI) was seen in 68%. Neurological evaluation was performed using a modification of the Japanese Orthopedic Association Scale for functional assessment of myelopathy, the Cooper Scale for separate evaluation of upper and lower extremity motor function, and a five-point scale for evaluation of strength in individual muscle groups. Lateral cervical spine x-rays were analyzed using a curvature index to determine maintenance of alignment. Each surgically decompressed level was graded on a four-point scale using axial MRI to assess the adequacy of decompression. Late follow-up was conducted by telephone interview. RESULTS Laminectomy was performed at a mean 4.6 levels. Follow-up was obtained at a mean of 30.2 months after the procedure. The score on the modified Japanese Orthopedic Association scale improved in 97% of patients from a mean of 12.9 preoperatively to 15.58 postoperatively (P< 0.0001). In the upper extremities, function measured by the Cooper Scale improved from 1.8 to 0.7 (P< 0.0001), and in the lower extremities, function improved from 1.0 to 0.4 (P< 0.0002). There was a statistically significant improvement in strength in the triceps (P< 0.0001), iliopsoas (P< 0.0002), and hand intrinsic muscles (P< 0.0001). X-rays obtained at a mean of 5.9 months after surgery revealed no change in spinal alignment as measured by the curvature index. There was a decrease in the mean preoperative compression grade from 2.46 preoperatively to 0.16 postoperatively (P< 0.0001). There was no correlation between neurological outcome and the presence of spinal cord signal change on T2-weighted MRI scans, patient age, duration of symptoms, or preoperative medical comorbidity. CONCLUSION Multilevel laminectomy and instrumentation with lateral mass plates is associated with minimal morbidity, provides excellent decompression of the spinal cord (as visualized on MRI), produces immediate stability of the cervical spine, prevents kyphotic deformity, and precludes further development of spondylosis at fused levels. Neurological outcome is equal or superior to multilevel anterior procedures and prevents spinal deformity associated with laminoplasty or noninstrumented laminectomy.

scholarly journals Intramedullary Arachnoid Cyst of the Cervical Spine: Case Report and Literature Review

2017 ◽  
Vol 36 (04) ◽  
pp. 256-259 ◽  
Author(s):  
Saleh Baeesa ◽  
Abdalrahman Aljameely
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Arachnoid Cyst ◽  
Arachnoid Cysts ◽  
Magnetic Resonance Imaging Scan ◽  
Resonance Imaging ◽  
Benign Lesions ◽  
Clinical And Radiological Results

AbstractIntramedullary arachnoid cysts of the spinal cord are extremely rare benign lesions of unclear pathogenesis. To our knowledge, only 21 cases were reported in the literature, 10 of which involved the cervical spine. We report the case of a 47-year-old female who presented with a symptomatic spinal intramedullary arachnoid cyst (SIAC). Magnetic resonance imaging scan of the cervical spine demonstrated an intramedullary arachnoid cyst at C3-C5 level. The patient had a cervical laminectomy and cysto-subarachnoid shunt with rapid and excellent clinical recovery and no recurrence at 2-year follow-up.Intramedullary arachnoid cysts should be considered in the differential diagnosis of intramedullary cystic lesions of the spinal cord. Their pathogenesis and natural history are not well defined in the literature. However, a cysto-subarachnoid shunt can be performed with excellent long-term clinical and radiological results.

scholarly journals Cervical Spine Myelopathy from Metalloma Association with Chronic Retention of a Bullet

2021 ◽  
Author(s):  
Piyawat Bintachitt ◽  
Ratanaphorn Chamnan ◽  
Weera Chaiyamongkol ◽  
Wongthawat Liawrungrueawng
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Gunshot Wound ◽  
Foreign Bodies ◽  
Surgical Removal ◽  
History Of ◽  
Spine Fixation ◽  
Cervical Spine Fixation ◽  
Cervical Spine Myelopathy

     A Civilian gunshot wound associated with metallosis in the cervical spine region was an extremely rare case; hence, the clinician had difficulty with diagnosis and surgical treatment.      A 57–year-old gentleman had a history of a gunshot wound injury going back 30 years. He presented with neck pain, progress of paresthesia of upper extremities and progressively difficult ambulation for 3 months. Radiographic and pathological diagnosis from tissue of the 7th paravertebral of the cervical spine showed foreign bodies consistent with metallosis. The patient showed improvement of symptoms after posterior cervical spine fixation and decompression. He had full recovery at 1 year follow up.      Metallosis can occur in cases of chronic exposure to lead and metals. The results of this chronic process of metallosis will develop to metalloma, which then compresses the spinal cord and develops into myelopathy. The patient had a bullet, or piece of metal at the cervical spine, so surgical removal was performed to prevent further compression of the spinal cord from metalloma.

Spinal cord herniation after multilevel anterior cervical corpectomy and fusion for ossification of the posterior longitudinal ligament of the cervical spine

2009 ◽  
Vol 10 (3) ◽  
pp. 240-243 ◽  
Author(s):  
Jun-Hong Min ◽  
Byung-Joo Jung ◽  
Jee-Soo Jang ◽  
Seok-Kang Kim ◽  
Dae-Jin Jung ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Anterior Approach ◽  
Posterior Longitudinal Ligament ◽  
Neurological Deterioration ◽  
Dural Defect ◽  
Cervical Corpectomy ◽  
Spinal Cord Herniation ◽  
Ossified Posterior Longitudinal Ligament ◽  
Anterior Cervical Corpectomy

The authors report the case of a 52-year-old man who had undergone resection of an ossified posterior longitudinal ligament via the anterior approach. The patient experienced postoperative neurological deterioration that may have been caused by a massive cord herniation associated with a dural defect at the corpectomy site. Spinal cord herniation may develop as a complication of anterior cervical decompression. Surgeons should be alert to this condition when planning to treat cervical ossification of the ossified posterior longitudinal ligament via the anterior approach.

scholarly journals Successful surgical repair and recovery in a 2-week-old infant after birth-related cervical fracture dislocation

2018 ◽  
Vol 21 (1) ◽  
pp. 16-20
Author(s):  
Sara Saleh ◽  
Kyle I. Swanson ◽  
Taryn Bragg
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spine ◽  
Fracture Dislocation ◽  
Interdisciplinary Management ◽  
Cervical Fracture ◽  
Spine Stabilization ◽  
Cord Injury ◽  
Spine Injuries

Cervical spine injuries are the most common spine injuries in the pediatric population. The authors present the youngest known patient who underwent cervical spine fusion to repair birth trauma–induced cervical fracture dislocation, resulting in spondyloptosis and spinal cord injury. A 2-week-old boy was found to have spondyloptosis and spinal cord injury after concerns arose from reduced movement of the extremities. The patient’s birth was complicated by undiagnosed abdominal dystocia, which led to cervical distraction injury. At 15 days of age, the boy underwent successful C-5 corpectomy, with anterior C4–6 and posterior C2–7 arthrodesis, using an autologous rib graft for a C-5 fracture dislocation. MRI performed 2 weeks postoperatively revealed significant improvement in the alignment of the spinal canal. The patient was discharged from the hospital in a custom Minerva brace and underwent close follow-up in addition to occupational therapy and physical therapy. At the latest follow-up 4.5 years later, the patient was able to walk and ride a tricycle by himself. The authors describe the patient’s surgery and the challenges faced in achieving successful repair and cervical spine stabilization in such a young patient. The authors suggest that significant neurological recovery after spinal cord injury in infants is possible with appropriate, timely, and interdisciplinary management.

Surgical management of cervical spine manifestations of neurofibromatosis Type 1: long-term clinical and radiological follow-up in 22 cases

2011 ◽  
Vol 14 (3) ◽  
pp. 356-366 ◽  
Author(s):  
Faisal S. Taleb ◽  
Abhijit Guha ◽  
Paul M. Arnold ◽  
Michael G. Fehlings ◽  
Eric M. Massicotte
Keyword(s):  
Cervical Spine ◽  
Tumor Progression ◽  
Neurofibromatosis Type 1 ◽  
Neurofibromatosis Type ◽  
Neurological Deterioration ◽  
Specific Group ◽  
Instrumented Fusion ◽  
Second Surgery

Object Patients with neurofibromatosis Type 1 (NF-1) at the cervical spine present significant surgical challenges due to neural compression, multiplicity of tumors, and complex spinal deformities. Iatrogenic instability following resection of tumors is underappreciated in the literature. The focus of this study was to understand the indications for stabilization in this specific group of patients. Methods The authors performed a retrospective review of 20 cases involving NF-1 patients with symptomatic cervical spine neurofibromas who underwent surgical decompression and tumor resection, with or without instrumentation, between 1991 and 2008. They also included 2 additional cases involving patients treated before 1991. Imaging findings and data pertaining to clinical presentation, intraoperative management, and postoperative assessment were compiled to clarify the indications for stabilization. An ordinal pain scale based on patient self-assessment was used. Neurological function was evaluated using American Spinal Injury Association Impairment Scale scores. Results The patient group comprised 13 men and 9 women. Their median age at presentation was 42.5 years; their median age at initial diagnosis of NF-1 was 30 years (range 8–74 years). The median duration of follow-up (since presentation) was 7 years (range 1–32 years). Progressive myelopathy was the main presenting symptom. Spinal cord compression was identified in 13 patients on presentation. Complete removal of the symptomatic tumors was performed in 11 patients. Ten patients underwent instrumented fusion during their first surgery. Six of these 10 required a second surgery—with fixation in 4 cases and without in 2. Of the 12 patients who did not receive instrumented fusion in their first surgery, 8 required a second surgery—with fixation in 5 cases and without in 3. Neurological deterioration due to progressive deformity was the indication for the second surgery in 3 of the 5 patients who required instrumented fusion only in their second surgery; the other 2 patients presented with neurological deterioration secondary to tumor progression. Four patients needed a third operation and instrumented fusion: 3 for deformity-related deficit and 1 for tumor progression. Based on the latest follow-up, 21 patients were stable clinically and radiologically, and 1 patient had died. Conclusions This specific group of patients represents a significant surgical challenge. In this retrospective analysis, emphasis is placed on early stabilization of the cervical spine to prevent late deformity as part of the comprehensive management of patients with NF-1.

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