Treatment of neoplastic epidural cord compression by vertebral body resection and stabilization

1985 ◽  
Vol 63 (5) ◽  
pp. 676-684 ◽  
Author(s):  
Narayan Sundaresan ◽  
Joseph H. Galicich ◽  
Joseph M. Lane ◽  
Manjit S. Bains ◽  
Patricia McCormack
Keyword(s):  
Vertebral Body ◽  
De Novo ◽  
Cord Compression ◽  
Cervical Region ◽  
Lumbar Region ◽  
Content Type ◽  
Prior Therapy ◽  
Results Of Treatment ◽  
Experienced Pain

✓ The results of treatment of neoplastic spinal cord compression by vertebral body resection and immediate stabilization in 101 consecutive patients over a 5-year period have been analyzed. Sites of primary cancer included the lung (25 patients), kidney (15 patients), breast (14 patients), connective tissue (12 patients), and a variety of others (35 patients). Of the 101 patients, 23 received surgery de novo; the remaining 78 patients had undergone previous therapy. Sites of involvement included the cervical region in 13 patients, the thoracic region in 68 patients, and the lumbar region in 20 patients. Prior to surgery, severe pain was noted in 90% of the patients, and 45% were non-ambulatory. Using an anterolateral surgical exposure, the vertebral body was resected along with all epidural tumor. Immediate stabilization was achieved with methyl methacrylate and Steinmann pins. Following surgery, the overall ambulation rate was 78%, and 85% of patients experienced pain relief. Of the 23 patients who had received no prior therapy, 90% continued to be ambulatory at their last follow-up examination or until death. The authors believe that surgery prior to irradiation is indicated in selected patients with neoplastic cord compression. In patients with solitary osseous metastasis to the spine, potentially curative resection can be undertaken if surgery is performed when the tumor is still confined to the vertebral body.

Chondroblastoma of the lumbar spine

2005 ◽  
Vol 2 (5) ◽  
pp. 596-600 ◽  
Author(s):  
Raphaël Vialle ◽  
Antoine Feydy ◽  
Ludovic Rillardon ◽  
Carla Tohme-Noun ◽  
Philippe Anract ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Local Recurrence ◽  
Osteolytic Lesion ◽  
Radicular Pain ◽  
Appendicular Skeleton ◽  
Lumbar Region ◽  
Content Type ◽  
Anterior Posterior ◽  
Fine Print

✓ Chondroblastoma is a benign cartilaginous neoplasm that generally affects the appendicular skeleton. Twenty-six cases of spinal chondroblastoma have been reported in the past 50 years, only six of which were located in the lumbar region. The authors report two cases involving this exceptional location. In both patients, low-back pain, in the absence of radicular pain, was the presenting symptom. In both cases, plain radiography and computerized tomography scanning revealed an osteolytic lesion surrounded by marginal sclerosis. Magnetic resonance imaging allowed the authors to study the tumor's local extension. Examination of a percutaneous fluoroscopy-guided biopsy sample revealed the following typical histological features of chondroblastoma: chondroid tissue, focally alternating with cellular areas, and no nuclear atypia or pleomorphism. To reduce the risk of local recurrence, vertebrectomy and anterior—posterior fusion were performed in both cases. In one case, a structural lumbar scoliosis was corrected during the posterior procedure. There was no postoperative complication. No recurrence was observed during the 3- to 6-year follow-up period. The surgery-related results were deemed successful. Although exceptional, the diagnosis of chondroblastoma is possible in lesions involving the lumbar spine. Other spinal locations are described in the literature, and frequency of recurrence is stressed. A vertebrectomy is advised to reduce the risk of local recurrence.

Surgical treatment for cervical spondylitic myelopathy

1995 ◽  
Vol 82 (5) ◽  
pp. 745-751 ◽  
Author(s):  
Michael J. Ebersold ◽  
Michel C. Pare ◽  
Lynn M. Quast
Keyword(s):  
Cord Compression ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Content Type ◽  
Posterior Laminectomy ◽  
Anterior Decompression And Fusion ◽  
Anterior Group ◽  
Fine Print

✓ The long-term outcome of cervical spondylitic myelopathy after surgical treatment was retrospectively reviewed and critically evaluated in 100 patients with documented cervical myelopathy treated between 1978 and 1988 at our institution. Eighty-four patients were available for long-term study. The median duration of follow up was 7.35 years (range 3 to 9.5 years). There were 67 men and 17 women; their ages ranged from 27 to 86 years. The duration of preoperative symptoms ranged from 1 month to 10 years. Preoperative functional grade as evaluated with the Nurick Scale for the group was 2.1. Thirty-three patients with primarily anterior cord compression, one- or two-level disease, or a kyphotic neck deformity were treated by anterior decompression and fusion. Fifty-one patients with primarily posterior cord compression and multiple-level disease were treated by posterior laminectomy. There was no difference in the preoperative functional grade in these two groups. The patients in the posterior treatment group were older (59 vs 55 years). There was no surgical mortality from the operative procedures; morbidity was 3.6%. Of the 33 patients undergoing anterior decompression and fusion, 24 showed immediate functional improvement and nine were unchanged. Of the 51 patients who underwent posterior laminectomy, 35 demonstrated improvement, 11 were unchanged, and five were worse. Six patients, one in the anterior group and five in the posterior group, demonstrated early deterioration. Late deterioration occurred from 2 to 68 months postoperatively. Four (12%) patients who had undergone anterior procedures had additional posterior procedures, and seven (13.7%) patients who had undergone posterior procedures had additional decompressive surgery. The final functional status at last follow-up examination for the 33 patients in the anterior group was improved in 18, unchanged in nine, and deteriorated in six. Of the 51 patients who underwent posterior decompression, 19 benefited from the surgery, 13 were unchanged, and 19 were worse at last follow up than before their initial surgical procedure. Age, severity of disease, number of levels operated, and preoperative grade were not predictive of outcome. The only factor related to potential deterioration was the duration of symptoms preoperatively. The results indicate that with anterior or posterior decompression, long-term outcome is variable, and a subgroup of patients, even after adequate decompression and initial improvement, will have late functional deterioration.

Microsurgical C-2 ganglionectomy for chronic intractable occipital pain

1998 ◽  
Vol 89 (3) ◽  
pp. 359-365 ◽  
Author(s):  
Andres M. Lozano ◽  
Graham Vanderlinden ◽  
Robert Bachoo ◽  
Peter Rothbart
Keyword(s):  
Axonal Regeneration ◽  
Excellent Result ◽  
Spontaneous Pain ◽  
Content Type ◽  
Group I ◽  
Experienced Pain ◽  
Pain Outcome ◽  
Group Ii ◽  
Fine Print

Object. The authors evaluated the effectiveness of microsurgical C-2 ganglionectomy in 39 patients with medically refractory chronic occipital pain. In this procedure the neurons transmitting sensory inputs from the occiput are removed and, unlike peripheral nerve ablation, axonal regeneration is not possible. Methods. The patients in this series had symptoms for 1 to 43 years. In 22 patients the occipital pain was caused by trauma; in 17 patients the pain was spontaneous. Pain relief failed in 17 patients who had undergone a previous occipital neurectomy or C-2 rhizolysis. Twenty-three patients experienced pain that was described as shocklike, electric, shooting, jabbing, stabbing, sharp, or exploding (Group I). Eight patients described their pain as dull, pounding, aching, throbbing, or pressurelike (Group II). The patients underwent unilateral or bilateral C-2 open microsurgical ganglionectomies. The postoperative follow-up period ranged from 19 to 48 months. Nineteen patients experienced an excellent result (> 90% reduction in pain). Pain caused by trauma or that described using Group I terms responded best to ganglionectomy (80% good or excellent response). In contrast, the majority of the patients with nontraumatic pain or those described using Group II descriptors did not achieve favorable results. Conclusions. The authors conclude that: 1) patients who suffer from chronic occipital pain after having sustained injury obtain worthwhile benefit from microsurgical C-2 ganglionectomy; 2) patients suffering from migraine, tension, and vascular headaches involving the occipital area are most often not helped by this operation; and 3) terms such as “shock,” “electric,” “shooting,” “jabbing,” and “sharp” used to describe occipital pain predict a favorable pain outcome following a C-2 ganglionectomy.

Atlantoaxial instability in Dyggve-Melchior-Clausen syndrome

2002 ◽  
Vol 96 (1) ◽  
pp. 112-117 ◽  
Author(s):  
Frank Kandziora ◽  
Luitgard Neumann ◽  
Klaus John Schnake ◽  
Cyrus Khodadadyan-Klostermann ◽  
Stefan Rehart ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Cord Compression ◽  
Atlantoaxial Instability ◽  
Posterior Fixation ◽  
Content Type ◽  
First Case ◽  
Solid Fusion ◽  
Specific Care ◽  
Preventable Complication

✓ Dyggve-Melchior-Clausen (DMC) syndrome is a very rare disease. Only 58 cases have been reported in the literature. The syndrome is probably an autosomal recessive inherited disorder, one that is characterized by mental retardation, the short-spine type of dwarfism, and skeletal abnormalities, especially of the spine, hands, and pelvis. Atlantoaxial instability— induced spinal cord compression is a serious and preventable complication. The purpose of this report is to describe the first case of DMC syndrome in which anterior transarticular atlantoaxial screw fixation was used to treat atlantoaxial instability. The authors report on a 17-year-old man with DMC syndrome and concomitant severe atlantoaxial instability. Computerized tomography scanning and magnetic resonance angiography demonstrated an irregular course of the vertebral artery (VA) at C-2, which made a posterior fixation procedure impossible. Additionally, transoral fusion was impossible because the patient was unable to open his mouth sufficiently. Therefore, the patient underwent anterior transarticular screw fixation. Follow-up examination 36 weeks after surgery showed solid fusion without implant failure. In conclusion, treatment of atlantoaxial instability in DMC syndrome must be considered. Specific care must be taken to determine the course of the VA. If posterior and transoral fusion are impossible, anterior transarticular atlantoaxial screw fixation might be the only alternative.

Syrinx shunt to posterior fossa cisterns (syringocisternostomy) for bypassing obstructions of upper cervical theca

1992 ◽  
Vol 77 (6) ◽  
pp. 871-874 ◽  
Author(s):  
Thomas H. Milhorat ◽  
Walter D. Johnson ◽  
John I. Miller
Keyword(s):  
Posterior Fossa ◽  
Symptomatic Improvement ◽  
Foramen Magnum ◽  
Content Type ◽  
Results Of Treatment ◽  
Spinal Subarachnoid Space ◽  
Upper Cervical ◽  
Spinal Arachnoiditis ◽  
Chiari I

✓ Syrinx shunts to the spinal subarachnoid space are likely to fail if the cerebrospinal fluid pathways rostral to the syrinx are blocked. To bypass obstructions at or below the level of the foramen magnum, a technique was developed for shunting the syrinx to the posterior fossa cisterns, termed “syringocisternostomy.” Syrinxes were shunted to the cisterna magna in two patients with spinal arachnoiditis and to the cerebellopontine angle cistern in four patients with Chiari I malformations. There was symptomatic improvement and collapse of the syrinx in each case, with no complications or recurrences over a follow-up interval of 14 to 27 months (average 20.3 months). The surgical technique and results of treatment are described.

Sequentially Staged Resection and 2-Column Reconstruction for C2 Tumors Through a Combined Anterior Retropharyngeal–Posterior: Approach Surgical Technique and Results in 11 Patients

2011 ◽  
Vol 69 (suppl_2) ◽  
pp. ons184-ons194 ◽  
Author(s):  
Xinghai Yang ◽  
Zhipeng Wu ◽  
Jianru Xiao ◽  
Honglin Teng ◽  
Dapeng Feng ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Posterior Approach ◽  
Tumor Resection ◽  
The Other ◽  
Neurological Improvement ◽  
Experienced Pain ◽  
Alive With Disease ◽  
Solid Fusion ◽  
Deep Location

Abstract BACKGROUND Surgical treatment of C2 tumors remains challenging. Because of the deep location and unique anatomical complexity, anterior exposure in this region is considered difficult and dangerous, and few reports concerning anterior tumor resection and reconstruction exist. OBJECTIVE To describe a technique of sequentially staged resection and 2-column reconstruction for C2 tumors through a combined anterior retropharyngeal–posterior approach. METHODS Eleven patients with C2 tumors underwent sequentially staged tumor resection and 2-column reconstruction in our institute. Eight primary lesions and 3 metastases were involved. Tumor resections and anterior reconstructions with conventional constructs were accomplished by an anterior retropharyngeal approach, and occipitocervical fusions through posterior access were performed in the same anesthesia. RESULTS No operative mortality occurred in this series. All patients experienced pain relief and neurological improvement after surgery. Except for 1 incidence of screw pullout, which was corrected by revision surgery, solid fusion was achieved in all patients. A follow-up period of 12 to 37 months was available for this study. Two patients with chordoma relapsed; 1 died of disease, and the other was alive with disease. Two patients with metastasis died of multiple remote metastases. No evidence of local recurrence was found in the other patients. CONCLUSION The anterior retropharyngeal approach is a favorable route to treat tumor lesions of the C2 vertebral body that allows tumor resection and placement of anterior constructs between C1 and the subaxial vertebral body. Tumor resection and 2-column reconstruction could safely be accomplished simultaneously through the combined anterior retropharyngeal–posterior approach.

De novo formation and rupture of an azygos pericallosal artery aneurysm

2000 ◽  
Vol 93 (6) ◽  
pp. 1062-1064 ◽  
Author(s):  
Wolfgang Dietrich ◽  
Andrea Reinprecht ◽  
Andreas Gruber ◽  
Thomas Czech
Keyword(s):  
De Novo ◽  
Artery Aneurysm ◽  
Vascular Anomaly ◽  
Content Type ◽  
Pericallosal Artery ◽  
Bifurcation Aneurysm ◽  
Anterior Cerebral Artery Aneurysm ◽  
Cerebral Artery Aneurysm ◽  
Familial Aneurysms

✓ An azygos pericallosal artery (APCA) aneurysm is a rare anomaly that is closely associated with saccular aneurysms. This is the earliest report to document de novo formation and rupture of an aneurysm at the bifurcation of an unpaired pericallosal trunk. The authors report the case of a woman who presented at the age of 52 years with subarachnoid hemorrhage (SAH) from the rupture of a newly formed APCA bifurcation aneurysm, 7 years after she had undergone surgery to clip a ruptured anterior cerebral artery aneurysm. De novo formation of aneurysms after SAH rarely occurs and certain risk factors like multiple and familial aneurysms, arterial hypertension, or smoking have been postulated. Late follow-up examination with angiography to detect de novo aneurysms should be considered in patients with this vascular anomaly after SAH.

scholarly journals Magneticresonance imaging in the diagnosis of vertebral haemangiomas

1998 ◽  
Vol 4 (1) ◽  
pp. 149-155
Author(s):  
Asem Hiari ◽  
Bassam Nawaiseh ◽  
Hesham Jaber
Keyword(s):  
Retrospective Analysis ◽  
Vertebral Body ◽  
Cervical Region ◽  
Lumbar Region ◽  
Thoracic Region ◽  
Vertebral Haemangioma ◽  
Frequent Site

A retrospective analysis of 600 [238 females, 362 males] spine examinations was carried out. Vertebral haemangioma was observed in 160 patients [27%], 74 females [31%] and 86 males [24%]. The majority were over 35 years. The most frequent site was the lumbar region, 64 patients [40%], then the thoracic region, 32 patients [20%], cervical region, 26 patients [16%], predominantly in the dense complex of the axis, and 38 patients [24%] were found to have multiple haemangiomas. Characteristically all vertebral haemangiomas abutted or included the basivertebral veins in the vertebral body

A pilot study of influence of pedicle screw instrumentation on immature vertebra: a minimal 5-year follow-up in children younger than 5 years

2019 ◽  
Vol 23 (6) ◽  
pp. 680-687
Author(s):  
Yanbin Zhang ◽  
Qifeng Peng ◽  
Shengru Wang ◽  
Yang Yang ◽  
Guanfeng Lin ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Vertebral Body ◽  
Spinal Canal ◽  
Shape Change ◽  
Lumbar Region ◽  
Pedicle Screw Instrumentation ◽  
Anteroposterior Diameter ◽  
Pedicle Length ◽  
Immature Spine

OBJECTIVEConcerns remain over the influence of pedicle screw instrumentation on the growth potential of an immature spine. Previous studies have reported discrepancies between animal experiments and clinical studies. The authors’ objective was to explore the influence of pedicle screw instrumentation on the growth of an immature spine at a very young age.METHODSIndividuals who met the authors’ criteria were included. Anteroposterior diameter of the vertebral body; pedicle length on both sides; and anteroposterior diameter, transverse diameter, and area of the spinal canal were measured on CT images before surgery and at the final follow-up. Parameters of instrumented vertebrae and adjacent noninstrumented vertebrae were compared. The growth value and growth percentage of each parameter were calculated. Subgroup comparisons were made in thoracic vertebrae and lumbar vertebrae. Statistical analyses were performed.RESULTSThirteen patients with a congenital spinal deformity were included in the study. The average age at surgery was 3.4 (range 2–5) years, and the average follow-up was 7.2 (range 5–11) years. Osteotomy and short instrumentation with pedicle screws were performed in each case. A total of 69 segments were measured, including 43 instrumented vertebrae and 26 immediately adjacent noninstrumented vertebrae. Significant increases in all parameters were noted at the final follow-up. In instrumented vertebrae, growth of the pedicle length and the anteroposterior diameter and area of the spinal canal increased significantly, while growth of the anteroposterior diameter of the vertebral body decreased significantly compared with noninstrumented vertebrae. Similar results were noted in the lumbar region. The shape-change phenomenon was found in noninstrumented vertebrae but was not apparent in instrumented vertebrae.CONCLUSIONSPedicle screw instrumentation may slow down growth of the vertebral body, indirectly speed up growth of the spinal canal, and hinder the shape-change phenomenon of the lumbar spinal canal. However, the influences were quite slight, and significant development did occur in instrumented vertebrae. Therefore, pedicle screw instrumentation may not have much effect on the growth of immature vertebrae in children younger than 5 years.

Early decompression and neurological outcome in acute cervical spinal cord injuries

1982 ◽  
Vol 56 (5) ◽  
pp. 699-705 ◽  
Author(s):  
Franklin C. Wagner ◽  
Bahram Chehrazi
Keyword(s):  
Spinal Cord ◽  
Neurological Outcome ◽  
Cervical Spinal Cord ◽  
Cord Compression ◽  
Content Type ◽  
Percent Recovery ◽  
Significant Difference ◽  
Admission Status ◽  
Fine Print

✓ To evaluate the effect on neurological outcome of spinal cord compression persisting after a closed injury, the authors reviewed 44 of 62 consecutively managed cases of cervical spinal cord and spine injuries at C3–7, inclusive. Decompression within 48 hours of injury was confirmed by myelography or open reduction. Neurological status, graded numerically on a spinal trauma scale at admission and at follow-up review (an average of 1 year ± 2 months after admission), and percent recovery of neurological deficit were compared to canal narrowing (22 severe, ≥ 30%; versus 22 moderate, 11% to 29%; or mild, ≤ 10%) and to delay before treatment (30 within 8 hours of injury versus 14 treated 9 to 48 hours after injury). Severe narrowing was equated with compression. Status at admission and at follow-up review was positively correlated. Patients with admission scores of less than 2 recovered a mean of 15% of their deficit, while those with scores more than 2 recovered a mean of 77%. Admission status correlated significantly with spinal canal narrowing but not with vertebral body displacement. Time of treatment had no significant effect upon admission status and percent recovery. No significant difference in the percent of recovery was noted, whether decompression was early (up to 8 hours) or late (9 to 48 hours) after injury. Surgery did not significantly alter the percent of recovery. The findings indicate that the initial injury to the cervical spinal cord and spine remains the primary determinant of neurological outcome. Severe canal narrowing with cord compression thereafter appears to have comparatively little effect. The conclusion that decompression is without effect is not possible without comparison with a group of patients whose spinal canals remained narrowed at follow-up review.

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