Impact of morphological restoration of the spinal cord from the preoperative to early postoperative periods on C5 palsy development

2021 ◽  
pp. 1-9
Author(s):  
Masahiro Mizutani ◽  
Takashi Fujishiro ◽  
Takuya Obo ◽  
Atsushi Nakano ◽  
Yoshiharu Nakaya ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Intervertebral Disc ◽  
Spinal Cord Compression ◽  
Postoperative Period ◽  
Morphological Changes ◽  
Cord Compression ◽  
Early Postoperative Period ◽  
Decompression Surgery ◽  
Transverse Diameter ◽  
C5 Palsy

OBJECTIVE C5 palsy (C5P) is a known complication of cervical decompression surgery. The tethering effect of the C5 nerve root following the posterior shift of the spinal cord is the most accepted pathologic mechanism for C5P development; however, this mechanism cannot fully explain C5P by itself in clinical practice. Separately, some studies have suggested that preoperative severe spinal cord compression and postoperative morphological changes in the spinal cord affect C5P development; however, no previous study has quantitatively addressed these possibilities. The aim of this study was to examine whether spinal cord morphology and morphological restoration after surgery affect C5P development. METHODS The authors reviewed consecutive patients with degenerative cervical myelopathy who underwent laminoplasty including the C3–4 and C4–5 intervertebral disc levels. All participants underwent MRI both preoperatively and within 4 weeks postoperatively. To assess the severity of spinal cord compression, the compression ratio (CR; spinal cord sagittal diameter/transverse diameter) was calculated. As an index of morphological changes in the spinal cord during the early postoperative period, the change rate of CR (CrCR, %) was calculated as CRwithin 4 weeks postoperatively/CRpreoperatively × 100. These measurements were performed at both the C3–4 and C4–5 intervertebral disc levels. The study cohort was divided into C5P and non-C5P (NC5P) groups; then, CR and CrCR, in addition to other radiographic variables associated with C5P development, were compared between the groups. RESULTS A total of 114 patients (mean age 67.6 years, 58.8% men) were included in the study, with 5 and 109 patients in the C5P and NC5P groups, respectively. Preoperative CR at both the C3–4 and C4–5 levels was significantly lower in the C5P group than in the NC5P group (0.35 vs 0.44, p = 0.042 and 0.27 vs 0.39, p = 0.021, respectively). Patients with C5P exhibited significantly higher CrCR at the C3–4 level than those without (139.3% vs 119.0%, p = 0.046), but the same finding was not noted for CrCR at the C4–5 level. There were no significant differences in other variables between the groups. CONCLUSIONS This study reveals that severe compression of the spinal cord and its greater morphological restoration during the early postoperative period affect C5P development. These findings could support the involvement of segmental cord disorder theory, characterized as the reperfusion phenomenon, in the pathomechanism of C5P, in addition to the tethering effect.

Repeat decompression surgery for recurrent spinal metastases

2010 ◽  
Vol 13 (1) ◽  
pp. 109-115 ◽  
Author(s):  
Ilya Laufer ◽  
Andrew Hanover ◽  
Eric Lis ◽  
Yoshiya Yamada ◽  
Mark Bilsky
Keyword(s):  
Spinal Cord ◽  
Survival Time ◽  
Median Survival ◽  
Spinal Cord Compression ◽  
Median Survival Time ◽  
Eastern Cooperative Oncology Group ◽  
Cord Compression ◽  
Decompression Surgery ◽  
High Grade

Object In this paper, the authors' goal was to determine the outcome of reoperation for recurrent epidural spinal cord compression in patients with metastatic spine disease. Methods A retrospective chart review was conducted of all patients who underwent spine surgery at the Memorial Sloan-Kettering Cancer Center between 1996 and 2007. Thirty-nine patients who underwent reoperation of the spine at the level previously treated with surgery were identified. Only patients whose reoperation was performed because of tumor recurrence leading to high-grade epidural spinal cord compression or recurrence with no further radiation options were included in the study. Patients who underwent reoperations exclusively for instrumentation failure were excluded. All patients underwent additional decompression via a posterolateral approach without removal of the spinal instrumentation. Results Patients underwent 1–4 reoperations at the same level. A median survival time of 12.4 months was noted after the first reoperation, and a median survival time of 9.1 months was noted after the last reoperation. At last follow-up 22 (65%) of 34 patients were ambulatory at the time of last follow-up or death, and the median time between loss-of-ambulation and death was 1 month. Functional status was maintained or improved by one Eastern Cooperative Oncology Group grade in 97% of patients. A major surgical complication rate of 5% was noted. Conclusions Reoperation represents a viable option in patients with high-grade epidural spinal cord compression who have recurrent metastatic tumors at previously operated spinal levels. In carefully selected patients, reoperation can prolong ambulation and result in good functional and neurological outcomes.

Motor network recovery in patients with chronic spinal cord compression: a longitudinal study following decompression surgery

2018 ◽  
Vol 28 (4) ◽  
pp. 379-388 ◽  
Author(s):  
Kayla Ryan ◽  
Sandy Goncalves ◽  
Robert Bartha ◽  
Neil Duggal
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Surgical Intervention ◽  
Blood Oxygen Level Dependent ◽  
Cord Compression ◽  
Decompression Surgery ◽  
Blood Oxygen Level ◽  
Motor Network ◽  
Dependent Signal

OBJECTIVEThe authors used functional MRI to assess cortical reorganization of the motor network after chronic spinal cord compression and to characterize the plasticity that occurs following surgical intervention.METHODSA 3-T MRI scanner was used to acquire functional images of the brain in 22 patients with reversible cervical spinal cord compression and 10 control subjects. Controls performed a finger-tapping task on 3 different occasions (baseline, 6-week follow-up, and 6-month follow-up), whereas patients performed the identical task before surgery and again 6 weeks and 6 months after spinal decompression surgery.RESULTSAfter surgical intervention, an increased percentage blood oxygen level–dependent signal and volume of activation was observed within the contralateral and ipsilateral motor network. The volume of activation of the contralateral primary motor cortex was associated with functional measures both at baseline (r = 0.55, p < 0.01) and 6 months after surgery (r = 0.55, p < 0.01). The percentage blood oxygen level–dependent signal of the ipsilateral supplementary motor area 6 months after surgery was associated with increased function 6 months after surgery (r = 0.48, p < 0.01).CONCLUSIONSPlasticity of the contralateral and ipsilateral motor network plays complementary roles in maintaining neurological function in patients with spinal cord compression and may be critical in the recovery phase following surgery.

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 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.

Single-stage repair of thoracic aortic aneurysm and spinal cord compression

2019 ◽  
Vol 27 (9) ◽  
pp. 754-756
Author(s):  
Akshay Kumar ◽  
Nimisha Shiwalkar ◽  
Purnadeo Narpaul Persaud ◽  
Arun Kumar Haridas
Keyword(s):  
Spinal Cord ◽  
Aortic Aneurysm ◽  
Spinal Cord Compression ◽  
Thoracic Aortic Aneurysm ◽  
Disease Process ◽  
Cord Compression ◽  
Single Stage ◽  
Decompression Surgery ◽  
Permanent Disability ◽  
Descending Thoracic Aortic Aneurysm

A ruptured thoracic aortic aneurysm complicated by spinal cord compression resulting in paraparesis although rare, can be a life-threatening condition. Despite treatment, patients may have a permanent disability due to the disease process itself or as a consequence of the surgical procedure. We describe an unusual case of descending thoracic aortic aneurysm complicated by vertebral erosion and paraparesis from spinal cord compression. The patient was successfully management by an interdisciplinary surgical approach utilizing a single-stage procedure comprising replacement of the aorta with a Dacron graft, spinal decompression surgery, and vertebral reconstruction using a titanium mesh cage.

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