Treatment of spinal epidural metastases

1980 ◽  
Vol 53 (6) ◽  
pp. 741-748 ◽  
Author(s):  
Ronald F. Young ◽  
Elisabeth M. Post ◽  
Gerald A. King
Keyword(s):  
Cauda Equina ◽  
Similar Rate ◽  
Decompressive Laminectomy ◽  
Content Type ◽  
Sphincter Function ◽  
Significant Difference ◽  
Radiotherapy Alone ◽  
Design Defects ◽  
Spinal Epidural ◽  
Myelographic Block

✓ Metastases to the spinal epidural space with compression of the spinal cord or cauda equina are commonly encountered by physicians in a variety of clinical fields. In the recent past, decompressive laminectomy followed by radiotherapy was thought to be the best available treatment. More recently, radiotherapy alone has been advocated as an alternative treatment mode with a similar rate of effectiveness. This study compares laminectomy followed by radiotherapy to radiotherapy alone in the treatment of spinal epidural metastases in a randomized, prospective clinical trial. No significant difference was found in the effectiveness of the two treatment methods in regard to pain relief, improved ambulation, or improved sphincter function. Patients with an incomplete myelographic block fared well regardless of treatment, and those with a complete block fared poorly. Because of the limited size of this study and because of certain unforeseen design defects, the results are suggestive but not conclusive. Suggestions are made for a future randomized, prospective multicenter study that would conclusively answer the perplexing question as to the most efficacious method for treating spinal epidural metastases.

Spinal epidural neoplasia

1980 ◽  
Vol 52 (1) ◽  
pp. 47-51 ◽  
Author(s):  
Robert C. Dunn ◽  
William A. Kelly ◽  
Richard N. W. Wohns ◽  
John F. Howe
Keyword(s):  
Neurological Status ◽  
Successful Outcome ◽  
Indications For Surgery ◽  
Decompressive Laminectomy ◽  
Content Type ◽  
Tumor Histology ◽  
Radiotherapy Alone ◽  
Histological Confirmation ◽  
Spinal Epidural ◽  
Fine Print

✓ The outcome following decompressive laminectomy and spinal irradiation has been evaluated in 104 consecutive patients with epidural metastatic neoplasia, using broad criteria for successful outcome. Of patients so treated, 33% were benefited, while 23% became worse. Both tumor histology and the preoperative neurological status were important factors in determining the response to this therapy. The authors review the surgical and radiotherapeutic literature in the treatment of this condition, and conclude that there is no clearly established superiority of laminectomy followed by irradiation over radiotherapy alone. Specific indications for surgery exist if prior histological confirmation of malignancy is lacking, if there is neurological deterioration during radiotherapy, or if there are recurrent symptoms referable to a previously irradiated metastasis. Surgery is also indicated if facilities for prompt administration of radiotherapy are unavailable.

Extradural spinal depositions of urates producing paraplegia

1973 ◽  
Vol 39 (5) ◽  
pp. 656-658 ◽  
Author(s):  
John Litvak ◽  
Walter Briney
Keyword(s):  
Ligamentum Flavum ◽  
Cauda Equina ◽  
Decompressive Laminectomy ◽  
Content Type ◽  
Fine Print

✓ A case of paraplegia is reported that responded to decompressive laminectomy and removal of a urate-laden ligamentum flavum compromising the cauda equina.

Neurological dysfunction in Paget's disease of the vertebral column

1972 ◽  
Vol 37 (6) ◽  
pp. 661-665 ◽  
Author(s):  
Edward S. Sadar ◽  
Robert J. Walton ◽  
Henry H. Gossman
Keyword(s):  
Neurological Deficit ◽  
Vertebral Column ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Neurological Dysfunction ◽  
Decompressive Laminectomy ◽  
Content Type ◽  
Sarcomatous Degeneration ◽  
Myelographic Block ◽  
Fine Print

✓ The authors report four cases of Paget's disease of the vertebral column causing neurological deficit, one with sarcomatous degeneration and one without compression of the spinal cord, and review 86 reported cases. Most cases responded well to decompressive laminectomy. The paradox of neurological deficit without myelographic block is discussed and the relatively common incidence of sarcomatous degeneration noted.

Chronic spontaneous spinal epidural hematoma

1972 ◽  
Vol 36 (2) ◽  
pp. 239-242 ◽  
Author(s):  
Harry R. Boyd ◽  
Bertram L. Pear
Keyword(s):  
Epidural Hematoma ◽  
Cauda Equina ◽  
Cord Compression ◽  
Spinal Epidural Hematoma ◽  
Content Type ◽  
Spontaneous Spinal Epidural Hematoma ◽  
Epidural Hemorrhage ◽  
Spinal Epidural ◽  
Definite Treatment ◽  
Fine Print

✓ Two cases of spontaneous chronic spinal epidural hematoma are reported. Epidural hematoma in the region of the spinal cord produces dramatic signs of cord compression leading to early diagnosis and treatment, while epidural hemorrhage in the region of the cauda equina is insidious in its onset and tends to become chronic before definite treatment is undertaken.

Symptomatic spinal epidural lipomatosis as a complication of steroid immunosuppression in cardiac transplant patients

1987 ◽  
Vol 67 (5) ◽  
pp. 760-764 ◽  
Author(s):  
Edward J. Zampella ◽  
Ernest R. Duvall ◽  
B. Chandra Sekar ◽  
Keith H. Langford ◽  
Andrew E. Epstein ◽  
...  
Keyword(s):  
Cauda Equina ◽  
Corticosteroid Treatment ◽  
Cardiac Transplant ◽  
Content Type ◽  
Spinal Epidural Lipomatosis ◽  
Epidural Lipomatosis ◽  
Transplant Patients ◽  
Abnormal Accumulation ◽  
Chronic Corticosteroid ◽  
Spinal Epidural

✓ Patients with Cushing's syndrome may develop spinal epidural lipomatosis, an abnormal accumulation of fat in the spinal epidural space. This accumulation of fat may cause compression of the spinal cord or cauda equina with resulting neurological deficit. Two cases of symptomatic spinal lipomatosis are reported in cardiac transplant patients receiving chronic corticosteroid treatment. The literature is reviewed, and diagnostic and therapeutic considerations are discussed.

Idiopathic and glucocorticoid-induced spinal epidural lipomatosis

1991 ◽  
Vol 74 (1) ◽  
pp. 38-42 ◽  
Author(s):  
Souheil F. Haddad ◽  
Patrick W. Hitchon ◽  
John C. Godersky
Keyword(s):  
Age At Onset ◽  
Radicular Pain ◽  
Treatment Modalities ◽  
Neurogenic Claudication ◽  
Adult Males ◽  
Decompressive Laminectomy ◽  
Content Type ◽  
Clinical Disorders ◽  
Epidural Fat ◽  
Spinal Epidural

✓ Pathological overgrowth of the epidural fat in the spine has been described and reported nearly exclusively in patients either with Cushing's syndrome or on chronic intake of glucocorticoids for a variety of clinical disorders. The authors report four patients with documented spinal lipomatosis (three pathologically and one radiologically). Only one of these patients received corticosteroids, and none had an underlying endocrinological abnormality. All four patients were adult males with a mean age at onset of symptoms of 43 years (range from 18 to 60 years). The symptoms ranged from simple neurogenic claudication and radicular pain to frank myelopathy. Myelography followed by computerized tomography were instrumental in the diagnosis of the first three patients; the fourth was diagnosed by magnetic resonance imaging. The thoracic spine was involved in two cases and the lumbosacral area in the other two. The different treatment modalities were tailored according to the symptomatology of the patients. These included weight reduction of an overweight patient with minimal neurological findings in one case and decompressive laminectomy and fat debulking to achieve adequate cord decompression in the remaining three cases. Two patients improved significantly, the condition of one stabilized, and the fourth required a second decompression at other spinal levels. The various modalities of treatment and their potential complications are discussed.

Spinal epidural extramedullary hematopoiesis with cord compression in a patient with refractory sideroblastic anemia

1982 ◽  
Vol 57 (3) ◽  
pp. 399-406 ◽  
Author(s):  
Dan S. Heffez ◽  
Raymond Sawaya ◽  
George B. Udvarhelyi ◽  
Risa Mann
Keyword(s):  
Extramedullary Hematopoiesis ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Sideroblastic Anemia ◽  
Content Type ◽  
Long Duration ◽  
Radiotherapy Alone ◽  
Postoperative Irradiation ◽  
Compressive Myelopathy ◽  
Spinal Epidural

✓ Spinal cord compression by epidural extramedullary hematopoiesis (EMH) is a rare phenomenon. A case of acute compressive myelopathy is reported in a 72-year-old man with EMH secondary to sideroblastic anemia. Technetium colloid scanning was used to document extensive ectopic marrow formation. The patient improved following surgery and radiotherapy. A review of the literature revealed 23 other cases of symptomatic spinal epidural EMH. The underlying hematological disorder varied but was always of long duration. Eighty-eight percent of the patients were males. Symptoms lasted longer than 1 week in 90% of cases, and 91% demonstrated incomplete neurological deficits. Plain x-ray films were rarely helpful in establishing the diagnosis. Technetium sulfur colloid bone marrow scanning has been used successfully to detect EMH and has led to preoperative diagnosis in one case. Decompressive laminectomy with or without postoperative irradiation is the suggested therapy, although there is evidence that radiotherapy alone may be adequate in some cases. Good recovery is the rule despite long-standing neurological deficits.

Pediatric spinal epidural metastases

1991 ◽  
Vol 74 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Steven L. Klein ◽  
Robert A. Sanford ◽  
Michael S. Muhlbauer
Keyword(s):  
Spinal Cord ◽  
Radiation Therapy ◽  
Soft Tissue ◽  
Spinal Cord Compression ◽  
Osteogenic Sarcoma ◽  
Cord Compression ◽  
Decompressive Laminectomy ◽  
Content Type ◽  
Spinal Epidural ◽  
Fine Print

✓ A total of 2259 children with solid malignant tumors were treated at St. Jude Children's Research Hospital between the years 1962 and 1987. Of these, 112 (5%) developed spinal epidural metastasis with spinal cord compression during the course of their disease process. Metastatic epidural spinal cord compression was caused most commonly by Ewing's sarcoma and neuroblastoma, followed by osteogenic sarcoma, rhabdomyosarcoma, Hodgkin's disease, soft-tissue sarcoma, germ-cell tumor, Wilm's tumor, and (rarely) hepatoma. There was no significant difference in outcome between patients with small-cell tumors (neuroblastoma, Hodgkin's disease, and germ-cell tumors) who received only chemotherapy and/or radiation therapy and the patients with similar lesions who received a decompressive laminectomy alone or prior to chemotherapy and/or radiation therapy. Patients with spinal cord compression from metastatic sarcoma (Ewing's sarcoma, soft-tissue sarcoma, osteogenic sarcoma, and rhabdomyosarcoma) showed a significant improvement with decompressive laminectomy alone or before medical therapy, compared to those who received radiation therapy and/or chemotherapy without posterior decompression. Pediatric tumors invade the spinal canal via the neural foramen, compressing the spinal cord in a circumferential manner, allowing decompressive laminectomy (posterior approach) to be an effective surgical approach. Sixty-six percent of children who had no evidence of motor or sensory function below the level of the compression became ambulatory after surgical decompression and medical treatment, regardless of tumor type.

Myelographic block caused by redundant lumbar nerve root

1973 ◽  
Vol 38 (4) ◽  
pp. 504-505 ◽  
Author(s):  
Des Raj Gulati ◽  
Damodar Rout
Keyword(s):  
Nerve Root ◽  
Muscular Atrophy ◽  
Decompressive Laminectomy ◽  
Content Type ◽  
Lumbar Nerve Root ◽  
The Right ◽  
Myelographic Block ◽  
Fine Print ◽  
Degree Of Recovery

✓ A patient with weakness and muscular atrophy of the right leg was shown to have a myelographic block caused by a redundant lumbar nerve loop. Decompressive laminectomy was followed by a marked degree of recovery.

Gamma knife radiosurgery for intracranial metastatic melanoma: a 6-year experience

2002 ◽  
Vol 97 ◽  
pp. 494-498 ◽  
Author(s):  
Jorge Gonzalez-martinez ◽  
Laura Hernandez ◽  
Lucia Zamorano ◽  
Andrew Sloan ◽  
Kenneth Levin ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Brain Metastases ◽  
Metastatic Melanoma ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Karnofsky Performance Scale ◽  
Content Type ◽  
Significant Difference ◽  
The Mean ◽  
Fine Print

Object. The purpose of this study was to evaluate retrospectively the effectiveness of stereotactic radiosurgery for intracranial metastatic melanoma and to identify prognostic factors related to tumor control and survival that might be helpful in determining appropriate therapy. Methods. Twenty-four patients with intracranial metastases (115 lesions) metastatic from melanoma underwent radiosurgery. In 14 patients (58.3%) whole-brain radiotherapy (WBRT) was performed, and in 12 (50%) chemotherapy was conducted before radiosurgery. The median tumor volume was 4 cm3 (range 1–15 cm3). The mean dose was 16.4 Gy (range 13–20 Gy) prescribed to the 50% isodose at the tumor margin. All cases were categorized according to the Recursive Partitioning Analysis classification for brain metastases. Univariate and multivariate analyses of survival were performed to determine significant prognostic factors affecting survival. The mean survival was 5.5 months after radiosurgery. The analyses revealed no difference in terms of survival between patients who underwent WBRT or chemotherapy and those who did not. A significant difference (p < 0.05) in mean survival was observed between patients receiving immunotherapy or those with a Karnofsky Performance Scale (KPS) score of greater than 90. Conclusions. The treatment with systemic immunotherapy and a KPS score greater than 90 were factors associated with a better prognosis. Radiosurgery for melanoma-related brain metastases appears to be an effective treatment associated with few complications.

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