Neuroblastoma With Symptomatic Spinal Cord Compression at Diagnosis: Treatment and Results With 76 Cases

2001 ◽  
Vol 19 (1) ◽  
pp. 183-190 ◽  
Author(s):  
Bruno De Bernardi ◽  
Clotilde Pianca ◽  
Paola Pistamiglio ◽  
Edvige Veneselli ◽  
Elisabetta Viscardi ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Response To Treatment ◽  
Sensory Loss ◽  
Motor Deficit ◽  
Neurologic Recovery ◽  
Therapeutic Modalities ◽  
Severe Motor ◽  
Additional Therapy

PURPOSE: To report on the treatment of patients with newly diagnosed neuroblastoma presenting with spinal cord compression (SCC). PATIENTS AND METHODS: Of 1,462 children with neuroblastoma registered between 1979 and 1998, 76 (5.2%) presented with signs/symptoms of SCC, including motor deficit in 75 patients (mild in 43, moderate in 22, severe [ie, paraplegia] in 10), pain in 47, sphincteric deficit in 30, and sensory loss in 11. Treatment of SCC consisted of radiotherapy in 11 patients, laminectomy in 32, and chemotherapy in 33. Laminectomy was more frequently performed in cases with favorable disease stages and in those with severe motor deficit, whereas chemotherapy was preferred in patients with advanced disease. RESULTS: Thirty-three patients achieved full neurologic recovery, 14 improved, 22 remained stable, and eight worsened, including three who become paraplegic. None of the 10 patients with grade 3 motor deficit, eight of whom were treated by laminectomy, recovered or improved. In the other 66 patients, the neurologic response to treatment was comparable for the three therapeutic modalities. All 11 patients treated by radiotherapy and 26 of 32 patients treated by laminectomy, but only two of 33 treated by chemotherapy, received additional therapy for SCC. Fifty-four of 76 patients are alive at time of the analysis, with follow-up of 4 to 209 months (median, 139 months). Twenty-six (44%) of 54 survivors have late sequelae, mainly scoliosis and sphincteric deficit. CONCLUSION: Radiotherapy, laminectomy, and chemotherapy showed comparable ability to relieve or improve SCC. However, patients treated with chemotherapy usually did not require additional therapy, whereas patients treated either with radiotherapy or laminectomy commonly did. No patient presenting with (or developing) severe motor deficit recovered or improved. Sequelae were documented in 44% of surviving patients.

scholarly journals Is there a right time for surgery in paraplegic patients secondary to non traumatic spinal cord compression?

2012 ◽  
Vol 10 (4) ◽  
pp. 508-511 ◽  
Author(s):  
Leonardo Giacomini ◽  
Roger Neves Mathias ◽  
Andrei Fernandes Joaquim ◽  
Mateus Dal Fabbro ◽  
Enrico Ghizoni ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Prognostic Factor ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Lower Limbs ◽  
Motor Deficit ◽  
Indication For Surgery ◽  
Sensory Deficits ◽  
Sensory Involvement ◽  
Spinal Cord Decompression

Paraplegia is a well-defined state of complete motor deficit in lower limbs, regardless of sensory involvement. The cause of paraplegia usually guides treatment, however, some controversies remain about the time and benefits for spinal cord decompression in nontraumatic paraplegic patients, especially after 48 hours of the onset of paraplegia. The objective of this study was to evaluate the benefits of spinal cord decompression in such patients. We describe three patients with paraplegia secondary to non-traumatic spinal cord compression without sensory deficits, and who were surgically treated after more than 48 hours of the onset of symptoms. All patients, even those with paraplegia during more than 48 hours, had benefits from spinal cord decompression like recovery of gait ability. The duration of paraplegia, which influences prognosis, is not a contra-indication for surgery. The preservation of sensitivity in this group of patients should be considered as a positive prognostic factor when surgery is taken into account.

scholarly journals Long-Term Follow-Up and Predictors of Functional Outcome after Surgery for Spinal Meningiomas: A Population-Based Cohort Study

Cancers ◽  
2021 ◽  
Vol 13 (13) ◽  
pp. 3244
Author(s):  
Jenny Pettersson-Segerlind ◽  
Alexander Fletcher-Sandersjöö ◽  
Charles Tatter ◽  
Gustav Burström ◽  
Oscar Persson ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Magnetic Resonance Images ◽  
Motor Deficit ◽  
Tumor Control ◽  
Time To Surgery ◽  
Spinal Meningiomas

Spinal meningiomas are the most common adult primary spinal tumor, constituting 24–45% of spinal intradural tumors and 2% of all meningiomas. The aim of this study was to assess postoperative complications, long-term outcomes, predictors of functional improvement and differences between elderly (≥70 years) and non-elderly (18–69 years) patients surgically treated for spinal meningiomas. Variables were retrospectively collected from patient charts and magnetic resonance images. Baseline comparisons, paired testing and regression analyses were used. In conclusion, 129 patients were included, with a median follow-up time of 8.2 years. Motor deficit was the most common presenting symptom (66%). The median time between diagnosis and surgery was 1.3 months. A postoperative complication occurred in 10 (7.8%) and tumor growth or recurrence in 6 (4.7%) patients. Surgery was associated with significant improvement of motor and sensory deficit, gait disturbance, bladder dysfunction and pain. Time to surgery, tumor area and the degree of spinal cord compression significantly predicted postoperative improvement in a modified McCormick scale (mMCs) in the univariable regression analysis, and spinal cord compression showed independent risk association in multivariable analysis. There was no difference in improvement, complications or tumor control between elderly and non-elderly patients. We concluded that surgery of spinal meningiomas was associated with significant long-term neurological improvement, which could be predicted by time to surgery, tumor size and spinal cord compression.

scholarly journals Spontaneous Spinal Epidural Haematomas and the Prognostic Implications of Interval to Surgical Decompression: A Report of Two Cases

2009 ◽  
Vol 17 (2) ◽  
pp. 216-219 ◽  
Author(s):  
Colin Yi-Loong Woon ◽  
Benedict Chan-Wearn Peng ◽  
John Li-Tat Chen
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Lower Limb ◽  
Cord Compression ◽  
Surgical Decompression ◽  
Neurological Recovery ◽  
Uncontrolled Hypertension ◽  
Motor Deficit ◽  
Mri Features ◽  
Spinal Epidural

Spontaneous spinal epidural haematomas (SSEHs) are rare causes of spinal cord compression. We present 2 cases of thoracic SSEHs with similar magnetic resonance imaging (MRI) features. Patient 1 was on long-term oral anticoagulants and patient 2 had uncontrolled hypertension. Patient 1 presented with a dense motor deficit, whereas patient 2 developed progressive lower limb weakness. Decompression laminectomy and haematoma evacuation was performed 51 hours later for patient 1 and 14 hours later for patient 2. Both had recovered their lower limb power, but neurological recovery was greater for patient 2. In patients with bleeding diatheses or uncontrolled hypertension, acute SSEHs must be suspected when they present with atraumatic back pain and signs of spinal cord compression. The interval to surgical decompression greatly influences the prognosis for neurological recovery.

scholarly journals To cut or not to cut? A case report on pediatric intervertebral disc calcification

2021 ◽  
Vol 12 ◽  
pp. 307
Author(s):  
Hunter J. King ◽  
Rohin Ramchandani ◽  
Christina Maxwell ◽  
Atom Sarkar ◽  
Tina Loven
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Intervertebral Disc ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Sensory Loss ◽  
Common Symptom ◽  
Thoracic Spinal Cord ◽  
Intervertebral Disc Calcification ◽  
Thoracic Spinal

Background: Intervertebral disc calcification (IVDC) is a rare cause of acute spinal pain in pediatric patients. The most common symptom is back or neck pain, but muscle spasm, muscle weakness, and sensory loss also occur. Many patients have an alarming presentation and radiological findings concerning for spinal cord compression. Case Description: A 10-year-old female presented with 2 weeks of worsening back pain and restricted neck flexion with no history of preceding trauma. Magnetic resonance imaging (MRI) showed T4/5 and T5/6 vertebral disc calcification and posterior herniation causing thoracic spinal cord compression. Despite concerning imaging findings, we decided to manage this patient conservatively with nonsteroidal anti-inflammatory drugs, leading to the improvement of symptoms within 9 days, and resolution of all pain within 1 month after hospital discharge. At 6 months follow-up, MRI showed complete resolution of calcification within the spinal canal. Conclusion: This case report emphasizes IVDC as an important differential diagnosis of pediatric disc disease that does not require surgical intervention. X-ray imaging with PA and lateral views is an adequate screening for these patients. Majority of cases resolve within 6 months with conservative therapy.

Chemotherapy as the initial treatment of spinal cord compression due to disseminated neuroblastoma

1989 ◽  
Vol 70 (5) ◽  
pp. 688-690 ◽  
Author(s):  
I. R. Sanderson ◽  
Jon Pritchard ◽  
Henry T. Marsh
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Initial Treatment ◽  
Cord Compression ◽  
Response To Treatment ◽  
Trial Period ◽  
Content Type ◽  
Sick Children ◽  
Spinal Cord Function ◽  
Fine Print

✓ During a 12-month trial period, all children attending the Hospitals for Sick Children, London, England, for management of spinal cord compression due to disseminated neuroblastoma were given chemotherapy as initial treatment rather than radiotherapy or laminectomy. Response to treatment was evaluated by a neurosurgeon as well as by oncologists. Four children were treated in this way and all made a full recovery of spinal cord function.

scholarly journals Management and outcome of spontaneous cervical epidural hematoma: Case report and review of the literature

2021 ◽  
Vol 12 (3) ◽  
pp. 094-097
Author(s):  
Yao Christian Hugues DOKPONOU ◽  
Adil BELHACHMI ◽  
Fernand Nathan IMOUMBY ◽  
Alngar DJIMRABEYE ◽  
Brahim El MOSTARCHID ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cervical Spinal Cord ◽  
Acute Attack ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Sensory Loss ◽  
Neurologic Outcomes ◽  
Cord Injury ◽  
Spinal Cord Compression Syndrome

Spontaneous spinal epidural hematomas are rare and potentially disabling neurological emergencies. Its lead to devastating neurologic outcomes and most patient does not recover completely. The clinical presentation is diverse and includes a severe acute attack, radiating pain at the back, interscapular, or neurological deficits. We report a case of a young woman, 24-year-old, that was admitted to our department for sudden non-traumatic cervical spinal cord compression syndrome (Type A of the American Spinal Cord Injury Association “ASIA A”) including intense cervical back pain, sensory loss, and tetraplegia. Her past medical history was unremarkable. The MRI confirmed a cervical mass responsible for the spinal cord compression and the emergent surgical intervention allow us to evacuate acute C3-C7 hematoma. The patient never recovers from the neurologic deficit despite the emergent management of her case followed by functional musculoskeletal rehabilitation for two years.

scholarly journals A prospective study of patients with impending spinal cord compression treated with palliative radiotherapy alone

2013 ◽  
Vol 12 (3) ◽  
pp. 218-225
Author(s):  
L. O'Sullivan ◽  
A. Clayton-Lea ◽  
O. McArdle ◽  
M. McGarry ◽  
J. Kenny ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Clinical Symptoms ◽  
Performance Status ◽  
Palliative Radiotherapy ◽  
Neurological Status ◽  
Cord Compression ◽  
Response To Treatment ◽  
Similar Data ◽  
A Prospective Study

AbstractImpending malignant spinal cord compression (IMSCC) may be defined as compression of the thecal sac, without any visible pressure on the spinal cord itself. Although there is a perception that IMSCC patients have a better prognosis and less severe clinical symptoms than true malignant spinal cord compression (MSCC) patients, these factors have never been documented in the literature.PurposeTo record the characteristics, management and functional outcome of a group of patients with IMSCC, who were treated with radiotherapy in our institution, and compare these parameters with similar data on MSCC patients.Materials and methodsData (gender, age, primary oncological diagnosis, pain, performance status and neurological status) were prospectively collected for 28 patients. Patients were then followed up post treatment to document their response to treatment and treatment-related toxicity.ResultsThe median survival of our group of IMSCC patients is similar to that of an MSCC patient. In addition, the IMSCC group exhibits significant clinical symptoms including neurological deficit.ConclusionAlthough further studies are necessary, we have found that IMSCC patients in this study share similar prognosis and clinical symptoms with MSCC patients. Clinicians should be aware of this when communicating with IMSCC patients and their families, and short-course radiotherapy should be considered.

Risk Factors for Ineffectiveness of Posterior Decompression and Dekyphotic Corrective Fusion with Instrumentation for Beak-Type Thoracic Ossification of the Posterior Longitudinal Ligament: A Single Institute Study

Neurosurgery ◽  
2017 ◽  
Vol 80 (5) ◽  
pp. 800-808 ◽  
Author(s):  
Shiro Imagama ◽  
Kei Ando ◽  
Zenya Ito ◽  
Kazuyoshi Kobayashi ◽  
Tetsuro Hida ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Supine Position ◽  
Posterior Longitudinal Ligament ◽  
Cord Compression ◽  
Intraoperative Ultrasonography ◽  
Posterior Decompression ◽  
Motor Paralysis ◽  
Severe Motor

Abstract BACKGROUND: Thoracic ossification of the posterior longitudinal ligament (T-OPLL) is treated surgically with instrumented posterior decompression and fusion. However, the factors determining the outcome of this approach and the efficacy of additional resection of T-OPLL are unknown. OBJECTIVE: To identify these factors in a prospective study at a single institution. METHODS: The subjects were 70 consecutive patients with beak-type T-OPLL who underwent posterior decompression and dekyphotic fusion and had an average of 4.8 years of follow-up (minimum of 2 years). Of these patients, 4 (6%; group R) had no improvement or aggravation, were not ambulatory for 3 weeks postoperatively, and required additional T-OPLL resection; while 66 (group N) required no further T-OPLL resection. Clinical records, gait status, intraoperative ultrasonography, intraoperative neurophysiological monitoring (IONM), plain radiography, computed tomography and magnetic resonance imaging findings, and Japanese Orthopaedic Association (JOA) score were compared between the groups. RESULTS: Preoperatively, patients in group R had significantly higher rates of severe motor paralysis, nonambulatory status, positive prone and supine position test, no spinal cord floating in intraoperative ultrasonography, and deterioration of IONM at the end of surgery (P < .05). In preoperative radiography, the OPLL spinal cord kyphotic angle difference in fused area, OPLL length, and OPLL canal stenosis were significantly higher in group R (P < .05). At final follow-up, JOA scores improved similarly in both groups. CONCLUSION: Preoperative severe motor paralysis, nonambulatory status, positive prone and supine position test, radiographic spinal cord compression due to beak-type T-OPLL, and intraoperative residual spinal cord compression and deterioration of IONM were associated with ineffectiveness of posterior decompression and fusion with instrumentation. Our 2-stage strategy may be appropriate for beak-type T-OPLL surgery.

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