Early Ambulation Training as Impairment-Driven Rehabilitation in Cancer Patients with Cervical Spine Metastases After Palliative Spine Surgery

Abstract Background Cervical spine metastasis worsens the quality of life (QOL) of patients with cancer. While the beneficial effects of surgery have been reported, the detailed course of functional recovery remains unclear, especially in the acute phase of rehabilitation. We previously reported on impairment-driven rehabilitation in patients with thoracic or lumbar level metastases. The present study assessed the effects of an impairment-driven strategy on the early recovery of ambulatory function in patients with cervical spine metastasis. Methods We retrospectively reviewed 13 consecutive patients with cervical neoplastic spinal compression. The patients were those whose primary impairment with spinal instability identified by a multidisciplinary tumor board who underwent palliative spine surgery. In addition, we examined neurological deficits; ambulation status; pathological fracture, collapse, and postoperative implant failure progress; and Barthel Index (BI). Results The average duration of ambulation was 3.75 ± 3.92 days after surgery. One case showed collapse and two showed progressions of paralysis. However, all patients had early ambulation after surgery, except for one patient who developed postoperative cerebral infarction. The BI scores showed an improving tendency; however, the difference before and after rehabilitation was not statistically significant. Conclusions We reviewed the recovery course of ambulation in patients with cervical spine metastases who underwent impairment-driven rehabilitation. Combined with surgery and early mobilization, this strategy may improve the QOL of patients with cancer and cervical spine metastasis.

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Surgical or Radiation Therapy for the Treatment of Cervical Spine Metastases: Results From the Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO) Cohort

Global Spine Journal ◽

10.1177/2192568219839407 ◽

2019 ◽

Vol 10 (1) ◽

pp. 21-29

Author(s):

Michael R. Bond ◽

Anne L. Versteeg ◽

Arjun Sahgal ◽

Laurence D. Rhines ◽

Daniel M. Sciubba ◽

...

Keyword(s):

Cervical Spine ◽

Study Design ◽

Rating Scale ◽

Surgical Intervention ◽

Numerical Rating Scale ◽

Spinal Instability ◽

Cervical Metastases ◽

Spine Metastases ◽

Radiotherapy Alone ◽

The Impact

Study Design: Ambispective cohort study design. Objectives: Cervical spine metastases have distinct clinical considerations. The aim of this study was to determine the impact of surgical intervention (± radiotherapy) or radiotherapy alone on health-related quality of life (HRQOL) outcomes in patients treated for cervical metastatic spine tumours. Methods: Patients treated with surgery and/or radiotherapy for cervical spine metastases were identified from the Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO) international multicentre prospective observational study. Demographic, diagnostic, treatment, and HRQOL (numerical rating scale [NRS] pain, EQ-5D (3L), SF-36v2, and SOSGOQ) measures were prospectively collected at baseline, 6 weeks, 3 months, and 6 months postintervention. Results: Fifty-five patients treated for cervical metastases were identified: 38 underwent surgery ± radiation and 17 received radiation alone. Surgically treated patients had higher mean spinal instability neoplastic scores compared with the radiation-alone group (13.0 vs 8.0, P < .001) and higher NRS pain scores and lower HRQOL scores compared to the radiation alone group ( P < .05). From baseline to 6 months posttreatment, surgically treated patients demonstrated statistically significant improvements in NRS pain, EQ-5D (5L), and SOSGOQ2.0 scores compared with nonsignificant improvements in the radiotherapy alone group. Conclusions: Surgically treated cervical metastases patients presented with higher levels of instability, worse baseline pain and HRQOL scores compared with patients who underwent radiotherapy alone. Significant improvements in pain and HRQOL were noted for those patients who received surgical intervention. Limited or no improvements were found in those treated with radiotherapy alone.

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S125. Degree of resolution of neuromonitoring alerts predicts the likelihood of neurological deficits in extradural cervical spine surgery: Review of 30,921 procedures

Clinical Neurophysiology ◽

10.1016/j.clinph.2018.04.485 ◽

2018 ◽

Vol 129 ◽

pp. e188

Author(s):

Jeffrey Cohen ◽

Eric Tesdahl ◽

William B. Wilent ◽

Eric Arehart ◽

Adam Juersivich ◽

...

Keyword(s):

Cervical Spine ◽

Spine Surgery ◽

Neurological Deficits ◽

Cervical Spine Surgery

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Predictive value of intraoperative neurophysiological monitoring during cervical spine surgery: a prospective analysis of 1055 consecutive patients

Journal of Neurosurgery Spine ◽

10.3171/spi/2008/8/3/215 ◽

2008 ◽

Vol 8 (3) ◽

pp. 215-221 ◽

Cited By ~ 125

Author(s):

Michael O. Kelleher ◽

Gamaliel Tan ◽

Roger Sarjeant ◽

Michael G. Fehlings

Keyword(s):

Cervical Spine ◽

Spine Surgery ◽

Evoked Potential ◽

Motor Evoked Potential ◽

Neurological Deficits ◽

Prospective Analysis ◽

Predictive Values ◽

Cervical Spine Surgery ◽

Cervical Surgery ◽

Sensitivity Specificity

Object Despite the growing use of multimodal intraoperative monitoring (IOM) in cervical spinal surgery, limited data exist regarding the sensitivity, specificity, and predictive values of such a technique in detecting new neurological deficits in this setting. The authors sought to define the incidence of significant intraoperative electrophysiological changes and new postoperative neurological deficits in a cohort of patients undergoing cervical surgery. Methods The authors conducted a prospective analysis of a consecutive series of patients who had undergone cervical surgery during a 5-year period at a university-based neurosurgical unit, in which multimodal IOM was recorded. Sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) were determined using standard Bayesian techniques. The study population included 1055 patients (614 male and 441 female) with a mean age of 55 years. Results The IOM modalities performed included somatosensory evoked potential (SSEP) recording in 1055 patients, motor evoked potential (MEP) recording in 26, and electromyography (EMG) in 427. Twenty-six patients (2.5%) had significant SSEP changes. Electromyographic activity was transient in 212 patients (49.6%), and 115 patients (26.9%) had sustained burst or train activity. New postoperative neurological deficits occurred in 34 patients (3.2%): 6 had combined sensory and motor deficits, 7 had new sensory deficits, 9 had increased motor weakness, and 12 had new root deficits. Of these 34 patients, 12 had spinal tumors, of which 7 were intramedullary. Overall, of the 34 new postoperative deficits, 21 completely resolved, 9 partially resolved, and 4 had no improvement. The deficits that completely resolved did so on average 3.3 months after surgery. Patients with deficits that did not fully resolve (partial or no improvement) were followed up for an average of 1.8 years after surgery. Somatosensory evoked potentials had a sensitivity of 52%, a specificity of 100%, a PPV of 100%, and an NPV of 97%. Motor evoked potential sensitivity was 100%, specificity 96%, PPV 96%, and NPV 100%. Electromyography had a sensitivity of 46%, specificity of 73%, PPV of 3%, and an NPV of 97%. Conclusions Combined neurophysiological IOM with EMG and SSEP recording and the selective use of MEPs is helpful for predicting and possibly preventing neurological injury during cervical spine surgery.

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Cervical Discogenic Pain Treatment with Percutaneous Jellified Ethanol: Preliminary Experience

BioMed Research International ◽

10.1155/2019/2193436 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Haytham Eloqayli

Keyword(s):

Cervical Spine ◽

Neck Pain ◽

Spine Surgery ◽

Pain Treatment ◽

Neurological Deficits ◽

Cervical Disc ◽

Motor Deficit ◽

Invasive Technique ◽

Lumbar Spine Surgery ◽

Discogenic Pain

Background. Percutaneous DiscoGel® (Gelscom SAS, France), introduced in 2007 as a promising new minimal invasive technique, showed efficacy and safety in lumbar spine surgery, with limited use and scientific reports with regard to the cervical spine. Since the first publication of its use on the cervical spine (2010), less than 100 cases have been published. We introduce an initial experience with this relatively new procedure. We hypothesized that percutaneous DiscoGel® is a safe and effective option for chronic neck pain of cervical discogenic origin. Method. This was a clinical study on 10 patients with chronic discogenic pain operated on for 18 cervical discs with percutaneous DiscoGel®. Inclusion criteria were patients with chronic axial or referred neck pain with MRI showing a cervical disc that is consistent with patient symptoms and failed conservative treatment. Exclusion criteria were clinical myelopathy, motor deficit, severe stenosis or reduced disc height by more than 50%, or previous cervical spine surgery. Results. A total of 10 cases consisting of 6 females and 4 males underwent treatment with percutaneous DiscoGel® for 18 cervical discs. C5/C6 was the most affected level. The mean preoperative VAS score was 8; the postoperative VAS scores at 6 weeks and 3 months were 2.2 and 2.9, respectively. There were no postoperative complications or neurological deficits. Conclusion. The present study has the limitation of the small number of cases; however, with the limited number of studies and less than 100 published cases in the literature, this initial work shows that cervical percutaneous DiscoGel® is an effective minimally invasive bridging option between conservative and open surgical treatment for cervical discogenic pain, with a high success rate. The differentiation of pain types (nociceptive, referred, radicular, and trapezius myalgia) that can coexist is crucial for procedure selection and improving treatment outcome.

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Osteoradionecrosis of the cervical spine resulting from radiotherapy for primary head and neck malignancies: operative and nonoperative management

Journal of Neurosurgery Spine ◽

10.3171/spi.2005.3.2.0159 ◽

2005 ◽

Vol 3 (2) ◽

pp. 159-164 ◽

Cited By ~ 39

Author(s):

Daniel J. Donovan ◽

Thanh V. Huynh ◽

Eric B. Purdom ◽

Robert E. Johnson ◽

Joseph C. Sniezek

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Head And Neck ◽

Hyperbaric Oxygen ◽

Spinal Cord Compression ◽

Cord Compression ◽

Neurological Deficits ◽

Spinal Instability ◽

Spinal Stability ◽

Head And Neck Malignancies

✓ Osteoradionecrosis is a process of dysvascular bone necrosis and fibrous replacement following exposure to high doses of radiation. The poorly vascularized necrotic tissue may cause pain and/or instability, and it cannot resist infection well, which may result in secondary osteomyelitis. When these processes affect the cervical spine, the resulting instability and neurological deficits can be devastating, and immediate reestablishment of spinal stability is paramount. Reconstruction of the cervical spine can be particularly challenging in this subgroup of patients in whom the spine is poorly vascularized after radical surgery, high-dose irradiation, and infection. The authors report three cases of cervical spine osteoradionecrosis following radiotherapy for primary head and neck malignancies. Two patients suffered secondary osteomyelitis, severe spinal deformity, and spinal cord compression. These patients underwent surgery in which a vascularized fibular graft and instrumentation were used to reconstruct the cervical spine; subsequently hyperbaric oxygen (HBO) therapy was instituted. Fusion occurred, spinal stability was restored, and neurological dysfunction resolved at the 2- and 4-year follow-up examinations, respectively. The third patient experienced pain and dysphagia but did not have osteomyelitis, spinal instability, or neurological deficits. He underwent HBO therapy alone, with improved symptoms and imaging findings. Hyperbaric oxygen is an essential part of treatment for osteoradionecrosis and may be sufficient by itself for uncomplicated cases, but surgery is required for patients with spinal instability, spinal cord compression, and/or infection. A vascularized fibular bone graft is a very helpful adjunct in these patients because it adds little morbidity and may increase the rate of spinal fusion.

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Surgical Treatment Outcomes in Metastatic Tumours Located at the Craniocervical Junction

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0011.5836 ◽

2018 ◽

Vol 20 (1) ◽

pp. 5-13

Author(s):

Piotr Biega ◽

Grzegorz Guzik ◽

Tomasz Pitera

Keyword(s):

Cervical Spine ◽

Surgical Treatment ◽

Primary Tumour ◽

Mechanical Damage ◽

Cardiovascular Complications ◽

Craniocervical Junction ◽

Neurological Deficits ◽

Spinal Instability ◽

Upper Cervical Spine ◽

The Mean

Background. Cancer metastases to the upper section of the cervical spine are found in a low percentage of patients. Their conservative treatment consists in radio- and chemotherapy as well as immobilisation in an orthopaedic collar. Surgery is the treatment of choice in patients with lesions causing spinal instability or compressing neural structures. The aim of this study was to assess the outcomes of surgical treatment conducted in patients with metastases located in the upper section of the cervical spine. Material and methods. The study analysed the medical records of 20 patients who underwent surgical treatment at the Department of Oncological Orthopaedics in Brzozów in 2015-2016. The majority of the patients were female (75%). The mean age of the male patients was 58 years and that of the female patients was 68 years. The most common complaints were pain (90%) and neurological deficits (50%; mainly Frankel Grade C). The most common primary tumour was breast cancer (35%). 58% of the patients had slow-growing tumours according to the Tomita system. Surgical procedures lasted a mean of 117 minutes and involved fixation of a mean of 7.5 levels. The treatment reduced the patients’ VAS score for pain by 3.89 points, improved function (Karnofsky scale) by 18 points and produced neurological improvement in 66% of the patients. The overall 2.5-year survival rate was 35%. The mean hospital stay lasted 14.5 days. One patient died on the 8th post-operative day due to cardiovascular complications. There was one case of delayed wound healing due to a haematoma. No mechanical damage to the implants, infections, or cerebrospinal fluid leaks were found. Conclusions. 1. Metastases located in the upper cervical spine are rare and cause significant technical difficulties. 2. Fixation with lateral mass screws and plates fixed with screws to the occipital bone is a safe and effective method. 3. Surgical treatment allows for restoring spinal stability, reducing pain, and improving the patients’ quality of life.

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Reperfusion Injury (RPI)/White Cord Syndrome (WCS) Due to Cervical Spine Surgery: A Diagnosis of Exclusion

Surgical Neurology International ◽

10.25259/sni_555_2020 ◽

2020 ◽

Vol 11 ◽

pp. 320

Author(s):

Nancy E. Epstein

Keyword(s):

Cervical Spine ◽

Reperfusion Injury ◽

Spine Surgery ◽

English Literature ◽

Mr Studies ◽

Neurological Deficits ◽

Cervical Spine Surgery ◽

Additional Surgery ◽

Cervical Surgery ◽

Rule Out

Background: Following acute cervical spinal cord decompression, a subset of patients may develop acute postoperative paralysis due to Reperfusion Injury (RPI)/White Cord Syndrome (WCS). Pathophysiologically, this occurs due to the immediate restoration of normal blood flow to previously markedly compressed, and under-perfused/ischemic cord tissues. On emergent postoperative MR scans, the classical findings for RPI/ WCS include new or expanded, and focal or diffuse intramedullary hyperintense cord signals consistent with edema/ischemia, swelling, and/or intrinsic hematoma. To confirm RPI/WCS, MR studies must exclude extrinsic cord pathology (e.g. extramedullary hematomas, new/residual compressive disease, new graft/vertebral fracture etc.) that may warrant additional cervical surgery to avoid permanent neurological sequelae. Methods: In the English literature (i.e. excluding 2 Japanese studies), 9 patients were identified with postoperative RPI/WCS following cervical surgical procedures. For 7 patients, new acute postoperative neurological deficits were appropriately attributed to MR-documented RPI/WCS syndromes (i.e. hyperintense cord signals). However, for 2 patients who neurologically worsened, MR studies demonstrated residual extrinsic disease (e.g. stenosis and OPLL) warranting additional surgery; therefore, these 2 patients did not meet the criteria for RPI/WCS. Results: The diagnosis of RPI/WCS is one of exclusion. It is critical to rule out residual extrinsic cord compression where secondary surgery may improve/resolve neurological deficits. Conclusions: Patients with acute postoperative neurological deficits following cervical spine surgery must undergo MR studies to rule out extrinsic cord pathology before being diagnosed with RPI/WCS. Notably, 2 of the 9 cases of RPI/WCS reported in the literature required additional surgery to address stenosis and OPLL, and therefore, did not have the RPI/WCS syndromes.

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Application of Smith-Robinson approach for C2/3 cervical spine surgery

Academic Journal of Second Military Medical University ◽

10.3724/sp.j.1008.2012.01199 ◽

2013 ◽

Vol 32 (11) ◽

pp. 1199-1202

Author(s):

Ying ZHANG ◽

Jun MA ◽

Yuan-yuan CHEN ◽

Xin-wei WANG ◽

De-yu CHEN ◽

...

Keyword(s):

Cervical Spine ◽

Spine Surgery ◽

Cervical Spine Surgery

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Impact of Diabetes Mellitus on Cervical Spine Surgery for Ossification of the Posterior Longitudinal Ligament

Journal of Clinical Medicine ◽

10.3390/jcm10153375 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3375

Author(s):

Atsushi Kimura ◽

Katsushi Takeshita ◽

Toshitaka Yoshii ◽

Satoru Egawa ◽

Takashi Hirai ◽

...

Keyword(s):

Diabetes Mellitus ◽

Cervical Spine ◽

Postoperative Complications ◽

Spine Surgery ◽

Posterior Longitudinal Ligament ◽

Lower Extremity Function ◽

Cervical Spine Surgery ◽

The Impact

Ossification of the posterior longitudinal ligament (OPLL) is commonly associated with diabetes mellitus (DM); however, the impact of DM on cervical spine surgery for OPLL remains unclear. This study was performed to evaluate the influence of diabetes DM on the outcomes following cervical spine surgery for OPLL. In total, 478 patients with cervical OPLL who underwent surgical treatment were prospectively recruited from April 2015 to July 2017. Functional measurements were conducted at baseline and at 6 months, 1 year, and 2 years after surgery using JOA and JOACMEQ scores. The incidence of postoperative complications was categorized into early (≤30 days) and late (>30 days), depending on the time from surgery. From the initial group of 478 patients, 402 completed the 2-year follow-up and were included in the analysis. Of the 402 patients, 127 (32%) had DM as a comorbid disease. The overall incidence of postoperative complications was significantly higher in patients with DM than in patients without DM in both the early and late postoperative periods. The patients with DM had a significantly lower JOA score and JOACMEQ scores in the domains of lower extremity function and quality of life than those without DM at the 2-year follow-up.

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