scholarly journals Simple and Reliable Magnetic Resonance Imaging Parameter to Predict Postoperative Ambulatory Function in Patients With Metastatic Epidural Spinal Cord Compression

2021 ◽  
pp. 219256822110003
Author(s):  
Young-Hoon Kim ◽  
Kee-Yong Ha ◽  
Hyung-Youl Park ◽  
Chang-Hee Cho ◽  
Hun-Chul Kim ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Compression Ratio ◽  
Signal Intensity ◽  
Cord Compression ◽  
Imaging Features ◽  
Characteristic Analysis ◽  
Retrospective Case ◽  
Ambulatory Status ◽  
Imaging Parameter

Study Design: Retrospective case-control study. Objectives: The aim of this study was to develop a simple and reliable imaging parameter to predict postoperative ambulatory status in patients with metastatic epidural spinal cord compression (MESCC). Methods: Sixty-three patients with MESCC underwent spine surgery because of neurologic deficits were included. On preoperative axial MRI, the cord compression ratio was analyzed for postoperative ambulatory status. The relationship between other imaging features, such as fracture of the affected vertebra and increased T2 signal intensity of the spinal cord at the compression level, and the postoperative ambulatory status were also analyzed. Results: Cord compression ratio and increased T2 signal change of the spinal cord were significantly different between the postoperative ambulatory group and the non-ambulatory group. Receiver operating characteristic analysis showed that the optimal cut-off value was 0.84. In the multivariate regression analysis, only a cord compression ratio of more than 0.84 was significantly associated with postoperative ambulatory status (odds ratio = 10.80; 95% confidence interval = 2.79-41.86; P = .001). Interobserver/intraobserver agreements were strong for the cord compression ratio, however those agreements were weak for increased T2 signal intensity. Conclusions: On preoperative MRI, the cord compression ratio may predict postoperative ambulatory status in patients with MESCC. The measurement of this imaging parameter was simple and reliable. This imaging predictor may be helpful for both clinicians and patients.

scholarly journals Assessing structure and function of myelin in cervical spondylotic myelopathy

Neurology ◽  
2017 ◽  
Vol 89 (6) ◽  
pp. 602-610 ◽  
Author(s):  
Hanwen Liu ◽  
Erin L. MacMillian ◽  
Catherine R. Jutzeler ◽  
Emil Ljungberg ◽  
Alex L. MacKay ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Compression Ratio ◽  
Signal Intensity ◽  
Cervical Spondylotic Myelopathy ◽  
Cord Compression ◽  
Whole Body ◽  
Healthy Controls ◽  
Conventional Mri ◽  
Intensity Compression

Purpose:To assess the extent of demyelination in cervical spondylotic myelopathy (CSM) using myelin water imaging (MWI) and electrophysiologic techniques.Methods:Somatosensory evoked potentials (SSEPs) and MWI were acquired in 14 patients with CSM and 18 age-matched healthy controls. MWI was performed on a 3.0T whole body magnetic resonance scanner. Myelin water fraction (MWF) was extracted for the dorsal columns and whole cord. SSEPs and MWF were also compared with conventional MRI outcomes, including T2 signal intensity, compression ratio, maximum spinal cord compression (MSCC), and maximum canal compromise (MCC).Results:Group analysis showed marked differences in T2 signal intensity, compression ratio, MSCC, and MCC between healthy controls and patients with CSM. There were no group differences in MWF and SSEP latencies. However, patients with CSM with pathologic SSEPs exhibited reduction in MWF (p < 0.05). MWF was also correlated with SSEP latencies.Conclusion:Our findings provide evidence of decreased myelin content in the spinal cord associated with impaired spinal cord conduction in patients with CSM. While conventional MRI are of great value to define the extent of cord compression, they show a limited correlation with functional deficits (i.e., delayed SSEPs). MWI provides independent and complementary readouts to spinal cord compression, with a high specificity to detect impaired conduction.

scholarly journals Comparison of 5 × 5 Gy and 10 × 3 Gy for metastatic spinal cord compression using data from three prospective trials

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Dirk Rades ◽  
Jon Cacicedo ◽  
Antonio J. Conde-Moreno ◽  
Barbara Segedin ◽  
Darejan Lomidze ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Motor Function ◽  
Spinal Cord Compression ◽  
Treatment Time ◽  
Cord Compression ◽  
Metastatic Spinal Cord Compression ◽  
Motor Deficits ◽  
Tumor Type ◽  
Ambulatory Status ◽  
Local Progression

Abstract Background In a palliative situation like metastatic spinal cord compression (MSCC), overall treatment time of radiotherapy should be as short as possible. This study compared 5 × 5 Gy in 1 week to 10 × 3 Gy in 2 weeks in a prospective cohort. Methods Forty patients receiving 5 × 5 Gy in a phase II trial were matched 1:2 to 213 patients receiving 10 × 3 Gy in two previous prospective studies for tumor type, ambulatory status, time developing motor deficits, interval between tumor diagnosis and MSCC and visceral metastases. These factors were consistent in all three patients (triple) used for each 1:2 matching. Groups were compared for local progression-free survival (LPFS), motor function, ambulatory status, and overall survival (OS). Results After matching, 32 triples remained for analyses (N = 96 in total). Six-month LPFS-rates were 94% after 5 × 5 Gy and 87% after 10 × 3 Gy (p = 0.36), 6-month OS-rates 43% and 35% (p = 0.74). Improvement of motor function was achieved in 59% and 34% of patients (p = 0.028); overall response rates (improvement or no further progression of motor deficits) were 94% and 89% (p = 0.71). Post-treatment ambulatory rates were 81% after 5 × 5 Gy and 85% after 10 × 3 Gy (p = 0.61). Of non-ambulatory patients, 50% (6/12) and 46% (11/24) regained the ability to walk (p = 1.00). Conclusions 5 × 5 Gy in 1 week appeared similarly effective as 10 × 3 Gy in 2 weeks. These results may not be applicable to long-term survivors and should be confirmed in a randomized trial directly comparing 5 × 5 Gy and 10 × 3 Gy. Trial registration clinicaltrials.gov NCT03070431. Registered 27 February 2017.

12. Angiotensin-II type-1 receptor blockade decreased T2 signal intensity in spinal cord compression in symptomatic cervical spondylotic myelopathy

2019 ◽  
Vol 19 (9) ◽  
pp. S6
Author(s):  
Alexander Perdomo-Pantoja ◽  
Alejandro Chara ◽  
Joshua Casaos ◽  
Samuel Kalb ◽  
Corinna Zygourakis ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Angiotensin Ii ◽  
Spinal Cord Compression ◽  
Signal Intensity ◽  
Cervical Spondylotic Myelopathy ◽  
Cord Compression ◽  
Receptor Blockade

scholarly journals Spinal extradural arachnoid cysts

2013 ◽  
Vol 12 (2) ◽  
pp. 112-118 ◽  
Author(s):  
Abolfazl Rahimizadeh ◽  
Mahmud Kaghazchi ◽  
Majid Shariati ◽  
Eidi Abdolkhani ◽  
Enayatolah Abbasnejad ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Single Case ◽  
Case Reports ◽  
Cauda Equina ◽  
Cord Compression ◽  
Arachnoid Cysts ◽  
Imaging Features ◽  
Benign Lesions ◽  
Characteristic Imaging

OBJECTIVE: Extradural arachnoid cysts (EACs) are rare causes of spinal cord compression and cauda equina. These benign lesions appear in the literature mainly as single case reports. In this article, we present the largest series found in literature, with four new cases of spinal extradural arachnoid cysts. The characteristic imaging features, details of surgical steps and strategies to prevent postoperative kyphosis in this cystic pathology will be discussed.

Anterior and posterior decompressive surgery for progressive amyotrophy associated with cervical spondylosis: a retrospective study of 51 patients

2009 ◽  
Vol 11 (3) ◽  
pp. 330-337 ◽  
Author(s):  
Kenzo Uchida ◽  
Hideaki Nakajima ◽  
Takafumi Yayama ◽  
Ryuichiro Sato ◽  
Shigeru Kobayashi ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Mr Imaging ◽  
Muscle Atrophy ◽  
Spinal Cord Compression ◽  
Signal Intensity ◽  
Cervical Spondylosis ◽  
Muscle Power ◽  
Cord Compression ◽  
Distal Muscle

Object The aims of this study were to review the clinicoradiological findings in patients who underwent decompressive surgery for proximal and distal types of muscle atrophy caused by cervical spondylosis and to discuss the outcome and techniques of surgical intervention. Methods Fifty-one patients (43 men and 8 women) with proximal (37, with arm drop) and distal muscle atrophy (14, with wrist drop) underwent cervical decompression (39 anterior decompressions and 12 open-door C3–7 laminoplasties with microsurgical foraminotomy) for muscle weakness in the upper extremities. The clinical course, type of spinal cord compression, abnormal signal intensity on high-resolution MR imaging, and postdecompression improvement in muscle power were reviewed at a mean follow-up of 2.6 years (range 0.8–9.4 years). Results The most commonly affected vertebrae were C4–5 and C5–6, and C5–6 and C6–7 in patients with proximal or distal muscle atrophy, respectively; the respective numbers of affected vertebrae were 1.5 and 2.2. Transaxial MR imaging showed medial compression of the spinal cord in 20 patients (in 12 with proximal and 8 with distal muscle atrophy), paramedial compression in 22 (17 and 5 patients, respectively), and foraminal compression in 9 (8 and 1 patient, respectively). Increased signal intensity on MR imaging was observed in 85.0, 22.7, and 11.1% of cases of medial, paramedial, and foraminal compression, respectively. Increased signal intensity at the affected muscle segment level was observed in 52.9, 40.0, and 0% of cases, respectively. Sixty-two percent of patients with proximal muscle atrophy gained 1 or more grades of muscle power on manual muscle testing (MMT), whereas 64.3% with distal muscle atrophy failed to gain even 1 grade of improvement. The recovery of muscle power correlated with disease duration and the percent voltage of Erb point or wrist-stimulated muscle evoked potentials but not with preoperative MMT, longitudinal range of spinal cord compression, signal change on T2-weighted MR imaging, or surgical procedure. Conclusions Surgical outcome in patients with distal muscle atrophy was inferior to that in patients with proximal atrophy. The distal type was characterized by a long preoperative period, a greater number of cervical spine misalignments, a narrow spinal canal, and increased signal intensity on T2-weighted MR imaging. It is essential to perform a careful neurological evaluation, including sensory examination of the lower limbs, as well as neuroradiological and neurophysiological assessments to avoid confusion with motor neuron disease and to detect the coexistence of amyotrophic lateral sclerosis, especially when surgical treatment of cervical spondylosis is planned. The results of careful physical examination, MR imaging studies, and electromyography studies should be comprehensively evaluated to ascertain the pathophysiology of the muscle atrophy. It is very important to distinguish the pathophysiology caused by nerve root impingements from anterior horn dysfunction when making decisions about treatment strategy. Surgical treatment—with or without foraminotomy—for amyotrophy in cervical spondylosis requires urgent action with regard to human neuroanatomy and neural innervation of the paralyzed muscles.

VERTEBRAL COMPRESSION FRACTURES IN PATIENTS PRESENTING WITH METASTATIC EPIDURAL SPINAL CORD COMPRESSION

Neurosurgery ◽  
2009 ◽  
Vol 65 (2) ◽  
pp. 267-275 ◽  
Author(s):  
Kaisorn L. Chaichana ◽  
Courtney Pendleton ◽  
Jean-Paul Wolinsky ◽  
Ziya L. Gokaslan ◽  
Daniel M. Sciubba
Keyword(s):  
Spinal Cord ◽  
Regression Analysis ◽  
Vertebral Body ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Motor Deficit ◽  
Pathological Fractures ◽  
Compression Fractures ◽  
Ambulatory Status ◽  
Vertebral Body Fractures

Abstract OBJECTIVE Metastatic epidural spinal cord compression (MESCC) is a relatively common and debilitating complication of metastatic disease that often results in neurological deficits. Pathological fractures of the vertebral body in patients with MESCC are not uncommon. The goals of this study were to evaluate the effects of compression fractures on long-term neurological function, as well as understand the factors that predict the development of pathological fractures for patients with MESCC. METHODS One hundred sixty-two patients undergoing decompressive surgery for MESCC at an academic tertiary care institution from 1995 to 2007 were retrospectively reviewed. Multivariate proportional hazards regression analysis was used to assess the effects of pathological vertebral body fractures on ambulatory outcome, whereas multivariate logistical regression analysis was used to identify factors associated with preoperative compression fractures. RESULTS Sixty and 102 patients presented with and without pathological vertebral body fractures, respectively, and MESCC. Patients were followed for a mean of 9.7 ± 2.6 months. The presence of preoperative compression fractures was independently associated with decreased postoperative ambulatory status (odds ratio, 2.106; 95% confidence interval, 1.123–4.355; P = 0.03). This was independent of age, preoperative ambulatory status, preoperative motor deficit, duration of preoperative symptoms, immediate postoperative motor deficit, and lytic tumor appearance. The factors strongly associated with preoperative compression fractures in this study include lack of sensory deficits (P = 0.01), primary breast cancer (P = 0.008), anterior spine metastases (P = 0.005), thoracic spine involvement (P = 0.01), preoperative chemotherapy (P = 0.03), and, possibly, preoperative radiation therapy (P = 0.16). CONCLUSION The findings of this study may provide insight into risk stratifying as well as guiding surgical management for patients with MESCC.

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