Metastatic spinal tumors

2001 ◽  
Vol 11 (6) ◽  
pp. 1-9 ◽  
Author(s):  
Robert F. Heary ◽  
Christopher M. Bono
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
External Beam Radiotherapy ◽  
Cord Compression ◽  
Spinal Tumors ◽  
Surgical Approaches ◽  
Vascular Tumors ◽  
Preoperative Embolization ◽  
Intractable Pain ◽  
Primary Malignancy

Metastatic spinal tumors are the most common type of malignant lesions of the spine. Prompt diagnosis and identification of the primary malignancy is crucial to overall treatment. Numerous factors affect outcome including the nature of the primary cancer, the number of lesions, the presence of distant nonskeletal metastases, and the presence and/or severity of spinal cord compression. Initial management consists of chemotherapy, external beam radiotherapy, and external orthoses. Surgical intervention must be carefully considered in each case. Patients expected to live longer than 12 weeks should be considered as candidates for surgery. Indications for surgery include intractable pain, spinal cord compression, and the need for stabilization of impending pathological fractures. Whereas various surgical approaches have been advocated, anterior-approach surgery is the most accepted procedure for spinal cord decompression. Posterior approaches have also been used with success, but they require longer-length fusion. To obtain a stable fixation, the placement of instrumentation, in conjunction with judicious use of polymethylmethacrylate augmentation, is crucial. Preoperative embolization should be considered in patients with extremely vascular tumors such as renal cell carcinoma. Vertebroplasty, a newly described procedure in which the metastatic spinal lesions are treated via a percutaneous approach, may be indicated in selected cases of intractable pain caused by non- or minimally fractured vertebrae.

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.

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.

The surgical management of metastatic spinal tumors based on an Epidural Spinal Cord Compression (ESCC) scale

2015 ◽  
Vol 15 (8) ◽  
pp. 1738-1743 ◽  
Author(s):  
Nasir A. Quraishi ◽  
George Arealis ◽  
Khalid M.I. Salem ◽  
Sanjay Purushothamdas ◽  
Kimberly L. Edwards ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Management ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Spinal Tumors

Spinal Cord Compression Complicating Subarachnoid Infusion of Morphine: Case Report and Laboratory Experience

Neurosurgery ◽  
1991 ◽  
Vol 29 (5) ◽  
pp. 778-784 ◽  
Author(s):  
Richard B. North ◽  
Protagoras N. Cutchis ◽  
Jonathan A. Epstein ◽  
Donlin M. Long
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Laboratory Model ◽  
Intractable Pain ◽  
Pathological Features ◽  
Tissue Mass ◽  
Foreign Body Reactions ◽  
Pump Implantation ◽  
Inflammatory Tissue

Abstract The intraspinal administration of morphine has been employed increasingly in the management of intractable pain of malignant as well as benign origin. We have encountered a previously unreported clinical complication: spinal cord compression by an inflammatory tissue mass surrounding a subarachnoid infusion catheter administering morphine. leading to paraplegia. The patient was referred to our institution after catheter and pump implantation for chronic, intractable pain associated with pre-existing lumbar arachnoid fibrosis, after multiple myelograms and surgeries. The patient may. therefore, have had an underlying propensity to foreign body reactions. We have encountered a similar phenomenon, however, in a canine laboratory model. The pathological features in both our patient and our laboratory preparation, with inflammatory tissue masses around the tip of the catheter but not around proximal subarachnoid segments, suggest an effect related to infusion. as opposed to infection or the presence of the catheter. We review the pathological features in both settings and the pertinent literature.

Reliability analysis of the epidural spinal cord compression scale

2010 ◽  
Vol 13 (3) ◽  
pp. 324-328 ◽  
Author(s):  
Mark H. Bilsky ◽  
Ilya Laufer ◽  
Daryl R. Fourney ◽  
Michael Groff ◽  
Meic H. Schmidt ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Imaging Techniques ◽  
Spinal Metastases ◽  
Cord Compression ◽  
Spinal Tumors ◽  
Mr Images ◽  
Intrarater Reliability ◽  
Thoracic Spinal ◽  
Sagittal Image

Objective The evolution of imaging techniques, along with highly effective radiation options has changed the way metastatic epidural tumors are treated. While high-grade epidural spinal cord compression (ESCC) frequently serves as an indication for surgical decompression, no consensus exists in the literature about the precise definition of this term. The advancement of the treatment paradigms in patients with metastatic tumors for the spine requires a clear grading scheme of ESCC. The degree of ESCC often serves as a major determinant in the decision to operate or irradiate. The purpose of this study was to determine the reliability and validity of a 6-point, MR imaging–based grading system for ESCC. Methods To determine the reliability of the grading scale, a survey was distributed to 7 spine surgeons who participate in the Spine Oncology Study Group. The MR images of 25 cervical or thoracic spinal tumors were distributed consisting of 1 sagittal image and 3 axial images at the identical level including T1-weighted, T2-weighted, and Gd-enhanced T1-weighted images. The survey was administered 3 times at 2-week intervals. The inter- and intrarater reliability was assessed. Results The inter- and intrarater reliability ranged from good to excellent when surgeons were asked to rate the degree of spinal cord compression using T2-weighted axial images. The T2-weighted images were superior indicators of ESCC compared with T1-weighted images with and without Gd. Conclusions The ESCC scale provides a valid and reliable instrument that may be used to describe the degree of ESCC based on T2-weighted MR images. This scale accounts for recent advances in the treatment of spinal metastases and may be used to provide an ESCC classification scheme for multicenter clinical trial and outcome studies.

scholarly journals Immunoglobulin G4-Related Disease Masquerading an Epidural Spinal Cord Tumor

2021 ◽  
Author(s):  
Ebtesam Abdulla ◽  
Harleen Luther ◽  
Tejal Shah ◽  
Nisha Chandran
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Spinal Cord Tumor ◽  
Cord Compression ◽  
Spinal Tumors ◽  
Immunoglobulin G4 ◽  
Related Disease ◽  
First Case ◽  
Unclear Etiology

Background Immunoglobulin G4–related disease (IgG4-RD) is a recently identified multisystemic fibroinflammatory condition of unclear etiology. IgG4-RD of the epidural tissue causing spinal cord compression is extremely rare. Case description Here, we present a 27-year-old male with epidural mass, causing spinal cord compression at the level of D5-D6. The mass proved pathologically to be epidural inflammatory pseudotumor (IPT) related to IgG4. Spinal decompression was done. The patient was started on steroid treatment and reported a complete resolution of his symptoms over a 3 years’ follow-up period. Conclusion To the authors’ knowledge, this is the first case of IgG4-related epidural IPT and spinal cord compression in Bahrain and the Middle East. IgG4-RD should always be considered as a part of the differential diagnosis of spinal tumors.

Impact of spinal cord compression from intradural and epidural spinal tumors on perioperative symptoms—implications for surgical decision making

2016 ◽  
Vol 40 (3) ◽  
pp. 377-387 ◽  
Author(s):  
Malte Mohme ◽  
Klaus Christian Mende ◽  
Theresa Krätzig ◽  
Rosemarie Plaetke ◽  
Kerim Beseoglu ◽  
...  
Keyword(s):  
Decision Making ◽  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Spinal Tumors ◽  
Surgical Decision ◽  
Surgical Decision Making

scholarly journals Limfoma Non-Hodgkin Primer Vertebra Torakalis dengan Kompresi Progresif Medula Spinalis

2016 ◽  
Vol 1 (3) ◽  
pp. 193-203
Author(s):  
Nurhuda Hendra Setyawan ◽  
Lina Choridah ◽  
Yana Supriatna
Keyword(s):  
Spinal Cord ◽  
Hodgkin Lymphoma ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Spinal Tumors ◽  
Clinical Consequence ◽  
Histopathological Analysis ◽  
Systemic Involvement ◽  
Non Hodgkin Lymphoma ◽  
Rare Occasion

Primary vertebral of non-hodgkin lymphoma presented without systemic involvement is extremely rare. Bone is only 1% found as the primary origin of lymphoma. Primary vertebral location is only 1.7% of all primary bone lymphomas. The tumor grows insidiously and may reach considerable size and clinical consequence prior to diagnosis. When the tumor compresses or infltrates the spinal cord, the symptoms may be rapidly progressive, and proper surgical treatment may be needed to preserve function and to maintain the quality of life.We reported a 70-year-old man presented with progressive lower extremities weakness and numbness, back pain, and incontinentia alvi for the last six months. Magnetic resonance imaging demonstrated T1 and T2 hypointense mass that destructed 10th thoracic vertebral body, right laminae, and right pedicle. The mass compressed spinal canal and spinal cord. Histopathological analysis from open biopsy revealed a non-hodgkin lymphoma of the 10th thoracic vertebra.Isolated primary bony lymphoma of the spine is a very rare occasion. In our case, the initial complaints may be the result of progressive spinal cord compression. Thus, radiologists have to be familiar with imaging fndings of various spinal tumors that can cause spinal cord compression.

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