scholarly journals Pigmented epithelioid melanocytoma (PEM) of the spine with compression fracture: case report

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Sarthak Nepal ◽  
Borriwat Santipas ◽  
Wasan Yotchai ◽  
Manasmon Chairatchaneeboon ◽  
Sirichai Wilartratsami ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Back Pain ◽  
Posterior Instrumentation ◽  
Compression Fracture ◽  
Operative Intervention ◽  
Treatment Modalities ◽  
Spinal Tumors ◽  
En Bloc ◽  
Patient Reported ◽  
Complete Tumor

Abstract Background Pigmented epithelioid melanocytoma (PEM) is a sporadic type of pigmented melanocytic tumor with uncertain malignant potential. PEM arises as a solitary neoplasm that predominantly occurs spontaneously in otherwise healthy patients. Due to its rarity, a gold standard treatment regimen does not exist; however, symptomatic cases should be managed with radiotherapy and surgery. Case presentation A 28-year-old Thai female presented with a sudden onset of back pain and weakness of the lower extremities during the postpartum period. Magnetic resonance imaging demonstrated abnormal soft tissue formation from T4 to T7; it extended to the vertebral bodies, left neural foramina, and posterior columns of T6 and T7. The patient underwent complete tumor debulking, decompressive laminectomy from T4 to T8, and posterior instrumentation from T3 to T10. The histopathology and immunohistochemistry suggested PEM. The patient fully resolved back pain after surgery. Nevertheless, as the patient re-presented with a neurological deficit a few months after the operative intervention, it was decided to perform a surgical resection via an en bloc vertebrectomy. At the one-year follow-up, although the patient reported continued improvement of her back pain, there was no motor power improvement. Conclusions Spinal cord compression due to PEM is uncommon, especially in adults. Early diagnosis and treatment provide a good prognosis and help to regain lost neurological functions. Complete tumor removal and decompression of the spinal cord must be considered as a treatment strategy. Perioperative radiotherapy and chemotherapy have also been highlighted as treatment modalities for spinal tumors. With our reported case, early operative intervention coupled with radiotherapy produced satisfying outcomes.

Percutaneous vertebroplasty of a myelomatous compression fracture in the presence of previous posterior instrumentation

2006 ◽  
Vol 5 (2) ◽  
pp. 168-171 ◽  
Author(s):  
Indro Chakrabarti ◽  
Allen W. Burton ◽  
Ganesh Rao ◽  
Iman Feiz-Erfan ◽  
Roman Hlatky ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Back Pain ◽  
Percutaneous Vertebroplasty ◽  
Posterior Instrumentation ◽  
Compression Fracture ◽  
The Other ◽  
Posterior Stabilization ◽  
Patient Reported ◽  
Acute Back Pain ◽  
Effective Analgesia

✓ The authors report the use of percutaneous transpedicular vertebroplasty performed using polymethylmethacrylate (PMMA) in two patients. These men (53 and 57 years old) had previously undergone open surgery and posterior instrumentation to treat myelomatous compression fractures. Both patients presented with acute back pain that manifested after minor activities. Kyphotic wedge fractures were diagnosed at T-11 in one case and at L-1 in the other. Both patients were treated at other hospitals with laminectomy and instrumented fusion; multiple myeloma was diagnosed after surgery. The patients experienced severe, recalcitrant, and progressive pain; on referral, they were found to have persistent kyphosis. Multiple myelomatous lesions of the spine were seen in one case and in the other the L-1 fracture represented the only site of disease. Percutaneous vertebroplasty was performed by injecting PMMA into the anterior third of the compressed vertebral body. Both patients experienced a 50% reduction in pain immediately after treatment; 3 months later both were walking and reported minimal back pain while undergoing treatment for multiple myeloma. Three years after surgery one patient reported no back pain and no progressive instability of the spine. Four years after surgery the other patient remains pain free, ambulatory, and with overall disease remission. Percutaneous vertebroplasty provided effective analgesia in these two patients with progressive back pain despite posterior stabilization. In both cases, the anterior column was effectively stabilized. A much larger operative intervention with its attendant risks of morbidity was avoided. In addition, subsequent aggressive medical treatment was well tolerated.

Decompression surgery and intraoperative radiation therapy (IORT) for metastatic spinal tumors

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 20515-20515
Author(s):  
K. Karasawa ◽  
N. Hanyu ◽  
T. Chang ◽  
G. Kuga ◽  
D. Yoshida ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Response Rate ◽  
Posterior Instrumentation ◽  
Cord Compression ◽  
Intraoperative Radiation Therapy ◽  
Spinal Tumors ◽  
Decompression Surgery ◽  
Intraoperative Radiation ◽  
Neurological Response

20515 Background: Metastatic spinal tumors often cause spinal cord compression and jeopardize the quality of life of the patients much. To decrease the local symptomatic recurrence rate, we have been adding IORT to decompression surgery. Methods: For those patients whose life expectancy was more than 6 months were eligible for this treatment. Posterior decompression by laminectomy of the involved vertebrae was performed. Following decompression, the patient was irradiated the lesions intraoperatively with electrons generated from Microtron by shielding the spinal cord with lead plate. The central aspects of the vertebrae were irradiated by scattered electrons detouring from the edge of the lead shield up to 40% of the administered dose. Following IORT, posterior instrumentation was performed. External beam radiotherapy might be added pre- and/or postoperatively when considered necessary. Results: 108 patients were treated between 1992–2005. There were 58 males and 50 females. Age ranged from 26 to 85 with a median of 62.5. By primary sites, 26 breast, 24 kidney, 18 colorectum, 17 lung 12 prostate and 11 thyroid cases were included. Irradiated spines were cervical in 6, thoracic in 76, and lumbar/sacral in 27. Overall median follow-up period was 12.7months. Median IORT dose was 20Gy (range 15–26Gy) and median electron energy was 16MeV (range 11–22MeV). There were 37 cases with preoperative RT and 41 cases with postoperative RT. Overall median survival time was 14.5months (breast 15.3, kidney 22.6, colorectum 5.7, lung 6.2, prostate 31.6, thyroid 60.6months). Neurological response rate was 73.1%. Ambulatory rates were 87.0% for success and 80.6% for rescue by Klimo's definition(2005). There were only 8 symptomatic relapses (7%). As for major complications, only one myelopathy has been observed. Conclusions: Decompression surgery and IORT for metastatic spinal tumors with impending spinal cord compression was a promising treatment modality with excellent local control and neurological response rate and with minimal toxicity especially for those patients with long-term prognosis. No significant financial relationships to disclose.

scholarly journals Solitary thoracic intramedullary spinal neurofibroma microsurgically extirpated via recapping T-saw laminoplasty

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901769100
Author(s):  
Mamer Soriano Rosario ◽  
Hideki Murakami ◽  
Satoshi Kato ◽  
Moriyuki Fujii ◽  
Noritaka Yonezawa ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Spinal Cord ◽  
Back Pain ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Anatomic Reconstruction ◽  
Resonance Imaging ◽  
En Bloc ◽  
Intramedullary Spinal Cord

We report the case of a 40-year-old female presenting with back pain that was complicated by a solitary intramedullary spinal cord mass at the T10–11 levels, confirmed by magnetic resonance imaging and computed tomography myelography. Microsurgical en bloc extirpation of the tumor approached through a recapping T-saw laminoplasty of T10 was done, and histopathology findings revealed a diagnosis of neurofibroma. Solitary spinal neurofibroma is one of the rarest tumors involving the spinal cord and is very adherent for the lack of a well-defined capsule, requiring careful dissection under microscope magnification for successful en bloc resection. Recapping T-saw laminoplasty affords both maximal exposure and anatomic reconstruction postextirpation, avoiding most postoperative spinal complications.

Patient with Lumbar Spondylosis and Diskogenic Pain

2016 ◽  
Author(s):  
Jianguo Cheng
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Manifestations ◽  
Compression Fracture ◽  
Treatment Modalities ◽  
Low Grade ◽  
Type I ◽  
Low Back ◽  
Positive Effects ◽  
Modic Type

Diskogenic low back pain (LBP), defined as pain that originates from a damaged vertebral disk, is a common cause of LBP. It is characterized by a three-phase cascade of degeneration marked by dysfunction, instability, and stabilization. A distinct pathologic characteristic of the disks from patients with diskogenic LBP has been found to be the formation of the zones of vascularized granulation tissue, with extensive innervation extending from the outer layer of the annulus fibrosus into the nucleus pulposus along a torn fissure. In addition, there appears to be an association between microbial infection and symptomatic disk degeneration. Low-virulence microorganisms, in particular Propionibacterium acnes, might be causing a chronic low-grade infection in the lower intervertebral disks in some patients. The diagnosis of diskogenic pain is primarily based on clinical manifestations, physical examinations, imaging studies, and provocative diskography. Diskogenic pain should be differentiated from other axial back pain conditions, such as facet arthropathy, sacroiliac joint pain, myofascial strain and pain, vertebral compression fracture, and other, less common conditions. Treatment options should be tailored to individual needs. Early and gradual physical and behavioral therapies are encouraged. Pharmacologic therapy, composed primarily of analgesics, nonsteroidal antiinflammatory drugs, muscle relaxants, and antidepressants, may have modest positive effects. A subset of patients with Modic type I changes in magnetic resonance imaging may benefit antibiotic therapy directed at the infected disks by P. acnes and other low-virulence microorganisms. There is evidence that supports the use of epidural steroid injections and intradiskal injections (methylene blue, ozone, steroids) for diskogenic pain. Additional options include intradiskal biacuplasty, gray ramus communicans nerve blocks/radiofrequency ablation, and intradiskal stem cell injections for disk repair/regeneration, all of which have gained support in clinical trials. These treatment modalities have shown promise to provide equal or even better outcomes compared with surgical spinal fusion or total disk replacement with an artificial disk.    This review contains 2 figures and 149 references. Keywords: collagen, diskogenic low back pain (LBP), herniation, intervertebral disk, spondylosis

Minimally Invasive Resection of a Cervical Anterolateral Meningioma: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (4) ◽  
pp. 520-520
Author(s):  
Federico Landriel ◽  
Santiago Hem ◽  
Eduardo Vecchi ◽  
Claudio Yampolsky
Keyword(s):  
Spinal Cord ◽  
Minimally Invasive ◽  
Neck Pain ◽  
Video Recording ◽  
Tumor Resection ◽  
Spinal Tumors ◽  
Minimally Invasive Approach ◽  
En Bloc ◽  
Invasive Approach ◽  
Intradural Extramedullary

Abstract Intradural extramedullary spinal tumors were historically managed through traditional midline approaches. Although conventional laminectomy or laminoplasty provides a wide tumor and spinal cord exposure, they may cause prolonged postoperative neck pain and late kyphosis deformity. Minimally invasive ipsilateral hemilaminectomy preserves midline structures, reduces the paraspinal muscle disruption, and could avoid postoperative kyphosis deformity. A safe tumor resection through this approach could be complicated in large sized or anteromedullary located lesions. We present a surgical video of C3 antero located meningioma removed en bloc through a minimally invasive approach. The patient signed a written consent to publish video, recording, photograph, image, illustration, and/or information about him.

scholarly journals Spinal meningioma in a patient with multiple sclerosis

2020 ◽  
Vol 11 ◽  
pp. 196
Author(s):  
Sricharan Gopakumar ◽  
Marc Daou ◽  
Ron Gadot ◽  
Alexander E. Ropper ◽  
Jacob Mandel
Keyword(s):  
Multiple Sclerosis ◽  
Back Pain ◽  
Demyelinating Disease ◽  
Tumor Resection ◽  
Review Literature ◽  
Spinal Tumors ◽  
Spinal Meningioma ◽  
Lower Extremity Weakness ◽  
Patient Reported

Background: Multiple sclerosis (MS) is the most common immune-mediated inflammatory demyelinating disease of the central nervous system. Multiple brain and spinal tumors have been linked to MS, but a causal relationship between the two has not been determined. Here, we report a case of spinal meningioma in a patient with MS and review literature discussing the possible connection between these two disease entities. Case Description: A 58-year-old female with MS presented with a 1-year history of progressively worsening back pain in conjunction with worsening right upper and lower extremity weakness. The patient was diagnosed with MS 19 months prior and had multiple known demyelinating plaques in her cervical spine. New MRI revealed an intradural extramedullary thoracic tumor with characteristics consistent with meningioma. She underwent T6- T8 laminectomies for tumor resection and pathology confirmed the radiological diagnosis. At 3-month follow- up, the patient reported complete resolution of her back pain and persistence of weakness-related gait issues. Conclusion: CNS neoplasms including meningioma should be considered in MS patients presenting with newly onset neurological symptoms not entirely consistent with demyelinating disease. Both disease processes should be addressed with appropriate long-term follow-up.

Late instrumentation failure after total en bloc spondylectomy

2011 ◽  
Vol 15 (3) ◽  
pp. 320-327 ◽  
Author(s):  
Morio Matsumoto ◽  
Kota Watanabe ◽  
Takashi Tsuji ◽  
Ken Ishii ◽  
Masaya Nakamura ◽  
...  
Keyword(s):  
Back Pain ◽  
Posterior Approach ◽  
Spinal Tumors ◽  
En Bloc ◽  
Total En Bloc Spondylectomy ◽  
En Bloc Spondylectomy ◽  
Spinal Reconstruction ◽  
Bloc Spondylectomy ◽  
Cage Subsidence ◽  
Instrumentation Failure

Object The object of this study was to investigate failures after spinal reconstruction following total en bloc spondylectomy (TES), related factors, and sequelae arising from such failures in patients with malignant spinal tumors. Methods Fifteen patients (12 males and 3 females, with a mean age of 46.5 years) with malignant spinal tumors who underwent TES and survived for more than 1 year were included in this analysis (mean follow-up 41.5 months). Seven patients had primary tumors, including giant cell tumors in 4 patients, chordoma in 2, and Ewing sarcoma in 1. Eight patients had metastatic tumors, including thyroid cancer in 6 and renal cell cancer and malignant fibrous histiocytoma in 1 patient each. Seven patients without prominent paravertebral extension of the tumor were treated using a posterior approach alone, and 8 patients who exhibited prominent anterior or anterolateral extension of the tumors into the thoracic or abdominal cavity were treated using a combined anterior and posterior approach. Spinal reconstruction after tumor resection was performed using a combination of anterior structural support and posterior instrumentation. The relationship between instrumentation failure and clinical and radiographic factors, including age, sex, history of previous surgery, preoperative radiotherapy, tumor histology, tumor level, surgical approach, number of resected vertebrae, rod diameter, number of instrumented vertebrae, and cage subsidence, was investigated. Results Six patients (40%) with spinal instrumentation failure were identified: rod breakage occurred in 3 patients, and breakage of both the rod and the cage, combined cage breakage and screw back-out, and endplate fracture arising from cage subsidence occurred in 1 patient each. All of these patients experienced acute or chronic back pain, but only 1 patient with a tumor recurrence experienced neurological deterioration upon instrumentation failure. Cage subsidence (≥ 5 mm), preoperative irradiation, and the number of instrumented vertebrae (≤ 4 vertebrae) were significantly related to late instrumentation failure. Conclusions Late instrumentation failure was a frequent complication after TES. Although patients with instrumentation failure experienced back pain, the neurological sequelae were not catastrophic. For prevention, meticulous preparation of the graft site and a longer posterior fixation should be considered.

Randomized, Double-Blind Trial of Evoked Compound Action Potential (ECAP)-Controlled Closed-Loop Spinal Cord Stimulation for Patients With Chronic Trunk and/or Limb Pain

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Steven M Falowski
Keyword(s):  
Spinal Cord ◽  
Back Pain ◽  
Spinal Cord Stimulation ◽  
Closed Loop ◽  
Open Loop ◽  
Therapeutic Window ◽  
Double Blind ◽  
Objective Evidence ◽  
Patient Reported ◽  
Compound Action

Abstract INTRODUCTION Spinal cord stimulation (SCS) is a well-established treatment for chronic pain. Advancements in SCS systems have focused on eliminating paresthesias, but long-term success rates remain suboptimal. Variability in spinal cord (SC) activation with open-loop systems results in unpredictable inhibition of pain processing pathways, and may limit the efficacy of SCS. We report the first randomized, double-blind, pivotal study of SCS and the first therapy to measure real-time in Vivo SC neurophysiology using evoked compound action potentials (ECAPs). This study provides comparative efficacy and safety of ECAP-controlled closed-loop (CL) feedback stimulation compared to open-loop (OL) stimulation, and objective evidence of the mechanism of action of SCS. METHODS A total of 134 subjects were randomized into OL or CL. Subjects and the clinical staff were blinded to the treatment assignment. Both groups received the same device. Programming was equivalent with the only difference being that the closed-loop feedback feature was enabled in the Investigational group. A pain assessment and other patient reported outcome measures per IMMPACT were collected. ECAPs were also collected in both groups to compare the magnitude of SC activation and the percentage of time within the therapeutic window. RESULTS The primary composite endpoint demonstrated superior results in overall pain responders (P = .005) for CL-SCS (82.3%) compared to OL-SCS (60.3%). In addition, all prespecified hierarchical endpoints demonstrated better outcomes in the CL group, with both back pain reduction (P = .015) and back pain responders (P = .003) demonstrating superiority. The magnitude of SC activation was 7 times greater for CL-SCS and CL subjects spend 50% more time within the therapeutic window. In both groups, subjects showed improvements across disability, psychological, sleep, quality of life, and satisfaction. CONCLUSION ECAP-controlled closed-loop SCS has demonstrated superior overall pain relief compared to open-loop SCS. The study has just completed the primary outcome data analysis.

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.

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