scholarly journals Percutaneous surgery for treatment of epidural spinal cord compression and spinal instability: technical note

2016 ◽  
Vol 41 (4) ◽  
pp. E2 ◽  
Author(s):  
Claudio E. Tatsui ◽  
Telmo A. B. Belsuzarri ◽  
Marilou Oro ◽  
Laurence D. Rhines ◽  
Jing Li ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Hospital Stay ◽  
Scale Score ◽  
Spinal Cord Compression ◽  
Systemic Treatment ◽  
Cord Compression ◽  
Spinal Instability ◽  
Spinal Stabilization ◽  
Oncological Treatment ◽  
Before And After

OBJECTIVE An emerging paradigm for treating patients with epidural spinal cord compression (ESCC) caused by metastatic tumors is surgical decompression and stabilization, followed by stereotactic radiosurgery. In the setting of rapid progressive disease, interruption or delay in return to systemic treatment can lead to a negative impact in overall survival. To overcome this limitation, the authors introduce the use of spinal laser interstitial thermotherapy (sLITT) in association with percutaneous spinal stabilization to facilitate a rapid return to oncological treatment. METHODS The authors retrospectively reviewed a consecutive series of patients with ESCC and spinal instability who were considered to be poor surgical candidates and instead were treated with sLITT and percutaneous spinal stabilization. Demographic data, Spine Instability Neoplastic Scale score, degree of epidural compression before and after the procedure, length of hospital stay, and time to return to oncological treatment were analyzed. RESULTS Eight patients were treated with thermal ablation and percutaneous spinal stabilization. The primary tumors included melanoma (n = 3), lung (n = 3), thyroid (n = 1), and renal cell carcinoma (n = 1). The median Karnofsky Performance Scale score before and after the procedure was 60, and the median hospital stay was 5 days (range 3–18 days). The median Spine Instability Neoplastic Scale score was 13 (range 12–16). The mean modified postoperative ESCC score (2.75 ± 0.37) was significantly lower than the preoperative score (4.5 ± 0.27) (Mann-Whitney test, p = 0.0044). The median time to return to oncological treatment was 5 days (range 3–10 days). CONCLUSIONS The authors present the first cohort of sLITT associated with a percutaneous spinal stabilization for the treatment of ESCC and spinal instability. This minimally invasive technique can allow a faster recovery without prejudice of adjuvant systemic treatment, with adequate local control and spinal stabilization.

scholarly journals A comparison of spinal laser interstitial thermotherapy with open surgery for metastatic thoracic epidural spinal cord compression

2020 ◽  
Vol 32 (5) ◽  
pp. 667-675
Author(s):  
Dhiego Chaves de Almeida Bastos ◽  
Richard George Everson ◽  
Bruno Fernandes de Oliveira Santos ◽  
Ahmed Habib ◽  
Rafael A. Vega ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Local Control ◽  
Spinal Cord Compression ◽  
Open Surgery ◽  
Systemic Treatment ◽  
Cord Compression ◽  
Controlled Study ◽  
Oncological Treatment ◽  
Thoracic Epidural ◽  
Interstitial Thermotherapy

OBJECTIVEThe proximity of the spinal cord to compressive metastatic lesions limits radiosurgical dosing. Open surgery is used to create safe margins around the spinal cord prior to spinal stereotactic radiosurgery (SSRS) but carries the risk of potential surgical morbidity and interruption of systemic oncological treatment. Spinal laser interstitial thermotherapy (SLITT) in conjunction with SSRS provides local control with less morbidity and a shorter interval to resume systemic treatment. The authors present a comparison between SLITT and open surgery in patients with metastatic thoracic epidural spinal cord compression to determine the advantages and disadvantages of each method.METHODSThis is a matched-group design study comprising patients from a single institution with metastatic thoracic epidural spinal cord compression that was treated either with SLITT or open surgery. The two cohorts defined by the surgical treatment comprised patients with epidural spinal cord compression (ESCC) scores of 1c or higher and were deemed suitable for either treatment. Demographics, pre- and postoperative ESCC scores, histology, morbidity, hospital length of stay (LOS), complications, time to radiotherapy, time to resume systemic therapy, progression-free survival (PFS), and overall survival (OS) were compared between groups.RESULTSEighty patients were included in this analysis, 40 in each group. Patients were treated between January 2010 and December 2016. There was no significant difference in demographics or clinical characteristics between the cohorts. The SLITT cohort had a smaller postoperative decrease in the extent of ESCC but a lower estimated blood loss (117 vs 1331 ml, p < 0.001), shorter LOS (3.4 vs 9 days, p < 0.001), lower overall complication rate (5% vs 35%, p = 0.003), fewer days until radiotherapy or SSRS (7.8 vs 35.9, p < 0.001), and systemic treatment (24.7 vs 59 days, p = 0.015). PFS and OS were similar between groups (p = 0.510 and p = 0.868, respectively).CONCLUSIONSThe authors’ results have shown that SLITT plus XRT is not inferior to open decompression surgery plus XRT in regard to local control, with a lower rate of complications and faster resumption of oncological treatment. A prospective randomized controlled study is needed to compare SLITT with open decompressive surgery for ESCC.

Radiation-Sensitive Spine Tumor

2018 ◽  
pp. 159-174
Author(s):  
Adam M. Robin ◽  
Ilya Laufer
Keyword(s):  
Spinal Cord ◽  
Multiple Myeloma ◽  
Spinal Cord Compression ◽  
Cauda Equina ◽  
Spinal Metastases ◽  
Cord Compression ◽  
External Beam Radiation ◽  
Spinal Instability ◽  
Mechanical Instability

A decision-making framework called NOMS (neurologic, oncologic, mechanical and systemic) facilitates and guides therapeutic decisions for patients with spinal metastases. Patients should be evaluated for signs of myelopathy or cauda equina syndrome. The Epidural Spinal Cord Compression (ESCC) scale facilitates reporting of the degree of radiographic spinal cord compression. A determination of the expected histology-specific tumor response to conventionally fractionated external beam radiation (cEBRT) and systemic therapy should be made. Radiation therapy effectively treats biologic pain for radiosensitive tumors such as multiple myeloma. Patients should undergo a careful evaluation of movement-associated pain as tumor-induced spinal instability is an independent indication for surgery. Determination of tumor-associated mechanical instability can be facilitated by the Spinal Instability Neoplastic Score (SINS). Herein, the authors present a case of spinal multiple myeloma managed using the NOMS framework and in consideration of current evidence and treatment paradigms.

Magnetic resonance imaging of spinal cord compression in thalassaemia before and after radiation treatment

1995 ◽  
Vol 50 (7) ◽  
pp. 504-505 ◽  
Author(s):  
A.D. Gouliamos ◽  
G.A. Plataniotis ◽  
E.S. Michalopoulos ◽  
L.J. Vlahos ◽  
C.G. Papavasiliou
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Spinal Cord Compression ◽  
Radiation Treatment ◽  
Cord Compression ◽  
Resonance Imaging ◽  
Before And After

Spine Metastases

2018 ◽  
Author(s):  
Ori Barzilai ◽  
Mark H. Bilsky ◽  
Ilya Laufer
Keyword(s):  
Spinal Cord ◽  
Multiple Myeloma ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
External Beam Radiation ◽  
Current Evidence ◽  
Spinal Instability ◽  
Beam Radiation ◽  
Therapeutic Decisions

A decision-making framework called NOMS (neurologic, oncologic, mechanical, and systemic) facilitates and guides therapeutic decisions for patients with spinal metastases. Patients should be evaluated for signs of myelopathy or cauda equina. The Epidural Spinal Cord Compression scale facilitates reporting of the degree of radiographic spinal cord compression. A determination of the expected histology-specific tumor response to conventionally fractionated external beam radiation and systemic therapy should be made. Radiation therapy effectively treats biologic pain and radiosensitive tumors such as multiple myeloma. Patients should undergo a careful evaluation of movement-associated pain as tumor-induced spinal instability is an independent indication for surgery. Determination of tumor-associated mechanical instability can be facilitated by the Spinal Instability Neoplastic Score. Herein, the authors present a case of spinal multiple myeloma managed using the NOMS framework and in consideration of current evidence and treatment paradigms.

scholarly journals Surgical Decompression of High-Grade Spinal Cord Compression from Hormone Refractory Metastatic Prostate Cancer

Neurosurgery ◽  
2017 ◽  
Vol 82 (5) ◽  
pp. 670-677
Author(s):  
Muhammad Omar Chohan ◽  
Sweena Kahn ◽  
Gustav Cederquist ◽  
Anne S Reiner ◽  
Joseph Schwab ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Median Overall Survival ◽  
Cord Compression ◽  
Spinal Instability ◽  
High Grade ◽  
Hormone Sensitive ◽  
Hormone Refractory ◽  
Spine Disease

Abstract BACKGROUND Spine and nonspine skeletal metastases occur in more than 80% of patients with prostate cancer. OBJECTIVE To examine the characteristics of the patient population undergoing surgery for the treatment of prostate cancer metastatic to the spine. METHODS A retrospective chart review was performed on all patients treated at our institution from June 1993 to August 2014 for surgical management of metastatic spine disease from prostate cancer. RESULTS During the study period, 139 patients with 157 surgical lesions underwent surgery for metastatic spine disease. Decompression for high-grade epidural spinal cord compression was required for 126 patients with 143 lesions. Preoperatively, 69% had a motor deficit and 21% were nonambulatory, with 32% due to motor weakness. At surgery, 87% of patients had hormone-refractory prostate cancer (HRPC) and 61% failed prior radiation. Median overall survival for HRPC patients was 6.6 mo (95% confidence interval [CI]: 5.6-8.6) while the median overall survival for hormone-sensitive patients was 16.3 mo (95% CI: 4.0-26.6). CONCLUSION The majority of patients undergoing surgery for prostate cancer metastases to the spine were refractory to hormone therapy, indicating that patients with hormone-sensitive prostate cancer are unlikely to develop symptomatic spinal cord compression or spinal instability. A significant number of HRPC patients presented with neurological deficits attributable to spinal cord compression. Vigilant monitoring for the development of signs and symptoms of epidural spinal cord compression and spinal instability in hormone-refractory patients is recommended. Surgical decision making may be affected by the much shorter postoperative survival for HRPC patients as compared to patients with hormone-sensitive cancer.

scholarly journals The management of emergency spinal surgery during the COVID-19 pandemic in Italy

2020 ◽  
Vol 102-B (6) ◽  
pp. 671-676 ◽  
Author(s):  
P. D. Giorgi ◽  
F. Villa ◽  
E. Gallazzi ◽  
A. Debernardi ◽  
G. R. Schirò ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Hospital Stay ◽  
Spinal Cord Compression ◽  
Spinal Surgery ◽  
Early Experience ◽  
Cord Compression ◽  
Medical Resources ◽  
Early Management ◽  
Management Protocol ◽  
Integrated Team

Aims The current pandemic caused by COVID-19 is the biggest challenge for national health systems for a century. While most medical resources are allocated to treat COVID-19 patients, several non-COVID-19 medical emergencies still need to be treated, including vertebral fractures and spinal cord compression. The aim of this paper is to report the early experience and an organizational protocol for emergency spinal surgery currently being used in a large metropolitan area by an integrated team of orthopaedic surgeons and neurosurgeons. Methods An organizational model is presented based on case centralization in hub hospitals and early management of surgical cases to reduce hospital stay. Data from all the patients admitted for emergency spinal surgery from the beginning of the outbreak were prospectively collected and compared to data from patients admitted for the same reason in the same time span in the previous year, and treated by the same integrated team. Results A total of 19 patients (11 males and eight females, with a mean age of 49.9 years (14 to 83)) were admitted either for vertebral fracture or spinal cord compression in a 19-day period, compared to the ten admitted in the previous year. No COVID-19 patients were treated. The mean time between admission and surgery was 1.7 days, significantly lower than 6.8 days the previous year (p < 0.001). Conclusion The structural organization and the management protocol we describe allowed us to reduce the time to surgery and ultimately hospital stay, thereby maximizing the already stretched medical resources available. We hope that our early experience can be of value to the medical communities that will soon be in the same emergency situation. Cite this article: Bone Joint J 2020;102-B(6):671–676.

Thoracoscopic transdiaphragmatic approach for ventral decompression and reconstruction of metastatic spine disease

2012 ◽  
Vol 33 (Suppl1) ◽  
pp. 1 ◽  
Author(s):  
Meic H. Schmidt
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Metastatic Spinal Cord Compression ◽  
Vertebral Body Replacement ◽  
Surgical Approaches ◽  
Spinal Stabilization ◽  
Minimal Incision ◽  
Spine Disease ◽  
Treatment Surgery

The management of metastatic spine disease is complex, but usually involves radiation therapy and/or surgical treatment. Surgery followed by radiation has a significant role in select patients presenting with metastatic spinal cord compression. Ventral decompression can be achieved through several surgical approaches including posterior, posterolateral, and anterior surgical approaches. Although open thoracotomy is the most common approach for ventral decompression, it is associated with significant spinal access morbidity. This video illustrates a thoracoscopic transdiaphragmatic approach for symptomatic L-1 metastatic spinal cord compression. This approach allows for a minimal incision in the diaphragm to expose the thoracolumbar junction and allows for corpectomy, spinal canal decompression, vertebral body replacement, and spinal stabilization via four small incisions along the chest wall. The step-by-step technique illustrates operative nuances and surgical pearls to safely perform this approach in a patient with thoracolumbar L-1 metastatic spinal cord compression. The video can be found here: http://youtu.be/w8fanV9bq-E.

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