Open kyphoplasty for management of metastatic and severe osteoporotic spinal fracture

2007 ◽  
Vol 6 (3) ◽  
pp. 284-288 ◽  
Author(s):  
Stéphane Fuentes ◽  
Phillipe Métellus ◽  
Grégoire Pech-Gourg ◽  
Tarek Adetchessi ◽  
Henri Dufour ◽  
...  
Keyword(s):  
Spinal Cord ◽  
General Health ◽  
Posterior Instrumentation ◽  
Cord Compression ◽  
Spinal Fracture ◽  
Neurological Dysfunction ◽  
Poor General Health ◽  
Vas Score ◽  
Metastatic Lesions ◽  
The Mean

Object Elderly patients in poor general health frequently suffer vertebral body (VB) fractures due to osteoporosis or vertebral metastatic lesions. Kyphoplasty and vertebroplasty have become the standard treatment for these types of fractures. In certain conditions that cause local kyphosis, such as spinal cord compression due to a metastatic epidural tumor or the shortening of the spinal canal secondary to vertebral compression, the surgical treatment should provide decompression and stabilization during a short intervention. In this study the authors evaluated a surgical technique that frequently combines a same-session surgical decompression, such as a laminectomy, and posterior instrumentation-assisted stabilization during the same open intervention in which the VB is stabilized by kyphoplasty. Methods During an 18-month period, the authors treated 18 patients with VB fractures according to this protocol: 14 patients with vertebral metastatic lesions and four with osteoporosis. The patients' mean age was 60 years. All suffered severe pain preoperatively (mean visual analog scale [VAS] score of 7). Fourteen of the 18 patients suffered a neurological deficit. Twenty-three vertebral levels were treated; in 15 patients it was necessary to place posterior instrumentation. The mean duration of the intervention was 90 minutes. Pain in all patients improved 3 days after the intervention, and the mean VAS score decreased to 2. Patients with a neurological dysfunction improved. The mean quantity of injected cement for the kyphoplasty procedure was 7 ml. The mean duration of hospitalization was 7 days. Neuroimaging revealed cement leaks in two cases: one into the disc interspace and one anteriorly into the fractured part of the vertebra. After the intervention, most patients with metastatic lesions underwent radiotherapy. No procedure-related complications occurred. Conclusions This procedure allows decompression of the spinal cord, consolidation of the VB and thus a stabilization of the vertebral column, and may provide an alternative treatment to invasive VB excision in patients in poor general health.

scholarly journals Utilization of laser interstitial thermotherapy guided by real-time thermal MRI as an alternative to separation surgery in the management of spinal metastasis

2015 ◽  
Vol 23 (4) ◽  
pp. 400-411 ◽  
Author(s):  
Claudio E. Tatsui ◽  
R. Jason Stafford ◽  
Jing Li ◽  
Jonathan N. Sellin ◽  
Behrang Amini ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Real Time ◽  
Spinal Cord Compression ◽  
Spinal Metastasis ◽  
Cord Compression ◽  
The Mean ◽  
Interstitial Thermotherapy

OBJECT High-grade malignant spinal cord compression is commonly managed with a combination of surgery aimed at removing the epidural tumor, followed by spinal stereotactic radiosurgery (SSRS) aimed at local tumor control. The authors here introduce the use of spinal laser interstitial thermotherapy (SLITT) as an alternative to surgery prior to SSRS. METHODS Patients with a high degree of epidural malignant compression due to radioresistant tumors were selected for study. Visual analog scale (VAS) scores for pain and quality of life were obtained before and within 30 and 60 days after treatment. A laser probe was percutaneously placed in the epidural space. Real-time thermal MRI was used to monitor tissue damage in the region of interest. All patients received postoperative SSRS. The maximum thickness of the epidural tumor was measured, and the degree of epidural spinal cord compression (ESCC) was scored in pre- and postprocedure MRI. RESULTS In the 11 patients eligible for study, the mean VAS score for pain decreased from 6.18 in the preoperative period to 4.27 within 30 days and 2.8 within 60 days after the procedure. A similar VAS interrogating the percentage of quality of life demonstrated improvement from 60% preoperatively to 70% within both 30 and 60 days after treatment. Imaging follow-up 2 months after the procedure demonstrated a significant reduction in the mean thickness of the epidural tumor from 8.82 mm (95% CI 7.38–10.25) before treatment to 6.36 mm (95% CI 4.65–8.07) after SLITT and SSRS (p = 0.0001). The median preoperative ESCC Grade 2 was scored as 4, which was significantly higher than the score of 2 for Grade 1b (p = 0.04) on imaging follow-up 2 months after the procedure. CONCLUTIONS The authors present the first report on an innovative minimally invasive alternative to surgery in the management of spinal metastasis. In their early experience, SLITT has provided local control with low morbidity and improvement in both pain and the quality of life of patients.

scholarly journals Non-fusion palliative spine surgery without reconstruction is safe and effective in spinal metastasis patients: retrospective study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Siravich Suvithayasiri ◽  
Borriwat Santipas ◽  
Sirichai Wilartratsami ◽  
Monchai Ruangchainikom ◽  
Panya Luksanapruksa
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Survival Data ◽  
Spinal Metastasis ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Survival Duration ◽  
Related Complication ◽  
The Mean ◽  
Anterior Reconstruction

AbstractConsidering the shorter life expectancy and poorer prognosis of metastatic epidural spinal cord compression patients, anterior reconstruction and fusion may be unnecessary. This study aimed to investigate the outcomes of palliative surgery for metastatic epidural spinal cord compression with neurological deficit among patients who underwent posterior decompression and instrumentation without fusion or anterior reconstruction. This single-center retrospective review included all patients aged > 18 years with thoracic or lumbar spinal metastasis who were surgically treated for metastatic spinal cord compression without fusion or anterior reconstruction at the Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during July 2015 to December 2017. Data from preoperation to the 1-year follow-up, including demographic and clinical data, Frankel classification, pain scores, complication, revision surgery, health-related quality-of-life scores, and survival data, were collected and analyzed. A total of 30 patients were included. The mean age was 59.83 ± 11.73 years, and 20 (66.7%) patients were female. The mean operative time was 208.17 ± 58.41 min. At least one Frankel grade improvement was reported in 53.33% of patients. The pain visual analog scale, the EuroQOL five-dimension five-level utility score, and the Oswestry Disability Index were all significantly improved at a minimum of 3 months after surgery. No intraoperative mortality or instrument-related complication was reported. The mean survival duration was 11.4 ± 8.97 months. Palliative non-fusion surgery without anterior reconstruction may be considered as a preferable choice for treating spinal metastasis patients with spinal cord compression with neurological deficits.

Traumatic Paraplegia in Children without Contiguous Spinal Fracture or Dislocation

Neurosurgery ◽  
1983 ◽  
Vol 12 (4) ◽  
pp. 439-445 ◽  
Author(s):  
John W. Walsh ◽  
David B. Stevens ◽  
Byron A. Young
Keyword(s):  
Spinal Cord ◽  
Clinical Presentation ◽  
Motor Vehicle ◽  
Cord Compression ◽  
Spinal Fracture ◽  
Vehicle Accidents ◽  
Thoracic Level ◽  
Vascular Compromise ◽  
Permanent Loss ◽  
Vertebral Subluxation

Abstract Traumatic paraplegia in children is uncommon and, in almost half of these injuries, no contiguous fracture or dislocation of the spine is found. This report presents eight such cases, three in detail. Most of the children were injured in motor vehicle accidents and sustained thoracic level injuries with a permanent loss of neurological function caudal to the injury. The clinical presentation and radiological diagnosis are reviewed. Four mechanisms of injury have been proposed: transient vertebral subluxation, transient disc herniation, traction and stretching of the spinal cord, and vascular compromise with infarction. Unless extramedullary spinal cord compression is present, laminectomy is not useful.

On spinal osteochondromas

1992 ◽  
Vol 77 (2) ◽  
pp. 247-252 ◽  
Author(s):  
Steffen Albrecht ◽  
J. Stewart Crutchfield ◽  
Gary K. SeGall
Keyword(s):  
Spinal Cord ◽  
Residual Disease ◽  
Signs And Symptoms ◽  
Cord Compression ◽  
Spinal Root ◽  
Content Type ◽  
Male Predominance ◽  
Multiple Osteochondromas ◽  
Adjacent Structures ◽  
The Mean

✓ Osteochondromas (or osteocartilaginous exostoses) make up about 30% to 40% of benign bone tumors. Most are solitary lesions but some are multiple, usually with autosomal dominant inheritance. From 1% to 4% of osteochondromas occur in the spine, where they can cause a variety of signs and symptoms, including those of spinal cord or spinal root compression. The authors present five patients with osteochondromas of the spine and review the findings together with those of over 130 cases reported since 1907. The cases were divided into: 1) spinal osteochondromas in patients with multiple osteochondromas, and 2) solitary osteochondromas occurring in the spine. The age (mean ± standard error of the mean) of patients in the first group was 21.6 ± 1.8 years compared to 30.0 ± 2.1 years for those in the second group (p < 0.02). There was a significant male predominance overall (M:F = 2.5:1; p < 0.0005). In both groups, one-half of the lesions involved the cervical spine. Symptoms are caused by pressure on adjacent structures. Spinal cord compression was reported more than twice as frequently in the multiple osteochondroma group as in the single osteochondroma group (77% vs 33%; p < 0.0005). Computerized tomography (CT) is the imaging procedure of choice. In both groups, the majority of surgically treated patients (90% and 88%, respectively) improve, with about three-quarters of the improved patients having no residual disease or only minor deficits.

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.

Serotonergic manipulations in experimental neoplastic spinal cord compression

1993 ◽  
Vol 78 (6) ◽  
pp. 929-937 ◽  
Author(s):  
Tali Siegal ◽  
Tzony Siegal
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Clinical Course ◽  
Fold Increase ◽  
Cord Compression ◽  
Neurological Dysfunction ◽  
Prostaglandin E ◽  
Content Type

✓ The effects of differing strategies of serotonergic manipulation on vascular permeability, prostaglandin E2 (PGE2) synthesis, and the clinical course are evaluated in an experimental model of neoplastic spinal cord compression in rats. Serotonergic manipulations include in vivo inhibition of serotonin (5-HT) synthesis by p-chlorophenylalanine (p-CPA) and in vivo blockage of serotonin type 2 (5-HT2) receptors either by the selective antagonist ketanserin or by cyproheptadine. In paralyzed rats, the ratio of 5-hydroxyindole-3-acetic acid (5-HIAA) to 5-HT is significantly elevated in the compressed segments, suggesting that 5-HT utilization is increased. Treatment with p-CPA attenuates spinal 5-HT levels by 62.8% ± 5.1% (mean ± standard deviation) and reduces the elevated 5-HIAA:5-HT ratio to the normal value. The increased synthesis of PGE2 observed in the compressed cord is unaffected by p-CPA or ketanserin treatment but is markedly attenuated by cyproheptadine. Ketanserin reduces the 10-fold increase in spinal cord permeability observed in paralyzed rats in a clearly dose-related manner. If given at the first sign of neurological dysfunction, ketanserin delays the onset of paraplegia with the 1-mg/kg dose being clearly superior. Cyproheptadine and p-CPA also reduce the increased permeability and protract the course to paraplegia. A comparison of the effect of dexamethasone, indomethacin, cyproheptadine, p-CPA, and ketanserin reveals that they protract the disease course by 48%, 57%, 60%, 64%, and 78%, respectively. These data suggest that 5-HT2 receptors mediate some of the deleterious vascular consequences observed in the compressed spinal cord by a mechanism not coupled with PGE2 synthesis. A potential benefit of serotonergic manipulations for the acute treatment of neoplastic spinal cord compression is suggested.

scholarly journals It’s Never Too Late: Neurological Outcome of Delayed Decompression in Tuberculosis of Spine

2020 ◽  
pp. 219256822092220 ◽  
Author(s):  
Tushar Narayan Rathod ◽  
Ashwin Hemant Sathe ◽  
Nandan Amrit Marathe
Keyword(s):  
Spinal Cord ◽  
Neurological Deficit ◽  
Cord Compression ◽  
Time Interval ◽  
Decompression Surgery ◽  
Neurological Improvement ◽  
Satisfactory Outcome ◽  
Outcome Group ◽  
The Mean ◽  
Tuberculosis Of Spine

Study Design: Retrospective observational study. Objective: To study the neurological recovery in patients with progressive neurological deficit undergoing delayed decompression and fixation in tuberculosis of spine. Methods: Retrospective analysis of 50 cases with thoracolumbar tuberculosis of spine, undergoing posterior decompression and instrumentation was done. Parameters like time interval between appearance of neurological deficit to decompression surgery, maximal spinal cord compression, neurology on admission, presence of drug resistance, and number of vertebrae involved were evaluated. The subjects were divided into 2 groups depending on neurological improvement measured with LEMS (Lower Extremity Motor Score) at the end of 1-year follow-up. Results: The mean LEMS score on admission was 27.72 (SD 12.88), which improved to 40.80 (SD 10.46) at the end of 1 year ( P < .001). A total of 26 (52%) subjects were categorized into “Satisfactory” outcome (LEMS >10) group and remaining 24 subjects formed the “nonsatisfactory” outcome group. The median time interval between the appearance of neurological deficit and decompression surgery was 23.50 days in the satisfactory group and 29.50 days ( P = .110) in the nonsatisfactory group. Maximal spinal cord compression was 0.370 in satisfactory group and 0.357 in nonsatisfactory group ( P = .754). The mean preoperative LEMS score was 34.62 in the satisfactory outcome group while that in the nonsatisfactory outcome group was 20.25 ( P < .001). Conclusion: There is significant scope for neurological improvement even after delayed decompression and fixation in cases of tuberculosis of spine with progressive neurological deficits. Preoperative neurological status was found to be the most significant determinant of postoperative neurological outcome.

Contrast radiographic findings in canine bacterial discospondylitis: a multicenter, retrospective study of 27 cases

2000 ◽  
Vol 36 (1) ◽  
pp. 81-85 ◽  
Author(s):  
MJ Davis ◽  
CW Dewey ◽  
MA Walker ◽  
SC Kerwin ◽  
ML Moon ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Retrospective Study ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Neurological Dysfunction ◽  
Anatomical Site ◽  
Significant Component ◽  
Radiographic Findings ◽  
Ultimate Outcome ◽  
Vertebral Subluxation

A multicenter, retrospective study was undertaken to evaluate contrast radiographic findings in canine bacterial discospondylitis. Records and myelograms or epidurograms of 27 patients were obtained from five colleges of veterinary medicine. Fifteen cases (56%) were evaluated as having some degree of spinal cord compression. The majority (73.3%) of the cases had only soft tissue as the compressive mass. The median compression for all cases was 5% of the vertebral canal. No difference was noted for compression based on anatomical site (i.e., cervical versus thoracolumbar versus lumbosacral). No significant correlation between degree of lesion compression and clinical outcome was noted, but there was a trend toward increased mortality with greater compression. There was no correlation between the ambulatory status and the ultimate outcome. Three of the 15 (20%) cases showed vertebral subluxation. Results of this study indicate that static spinal cord compression is not a significant component of the neurological dysfunction associated with bacterial discospondylitis. Identification of vertebral subluxation in some patients may indicate a dynamic lesion that should be evaluated with stress radiography.

scholarly journals Society of Physicians at Kazan University. Surgical section. Meeting 20/11-29

1929 ◽  
Vol 25 (7-8) ◽  
pp. 852-854
Author(s):  
I. Tsimkhes
Keyword(s):  
Spinal Cord ◽  
Back Pain ◽  
Spinal Cord Compression ◽  
Spinal Injury ◽  
Lumbar Vertebrae ◽  
Cord Compression ◽  
Spinal Fracture ◽  
Lumbar Region ◽  
Urine Retention ◽  
Spinous Processes

Doctor. V. I. Nizner. Demonstration of the patient after laminectomy for a spinal fracture. B-th, a worker, 35 years old, fell from a staircase 372 meters high. Dizziness, vomiting, back pain, stulag and urine retention. Swelling in the area of the spinous processes of the 12th thoracic and 1st lumbar vertebrae. Spinal cord compression and spinal injury in the lumbar region are suspected.

scholarly journals P.132 Post-traumatic spinal pseudomeningocele with delayed neurological deterioration

2016 ◽  
Vol 43 (S2) ◽  
pp. S50-S51
Author(s):  
VA Karapetyan ◽  
MD Staudt ◽  
BC Shettar ◽  
HA Faizal ◽  
NP Wai
Keyword(s):  
Spinal Cord ◽  
Brachial Plexus ◽  
Spinal Cord Compression ◽  
Spinal Canal ◽  
Fluid Collection ◽  
Cord Compression ◽  
Neurological Symptoms ◽  
Neurological Dysfunction ◽  
Avulsion Injury ◽  
Post Traumatic

Background: Post-traumatic spinal pseudomeningoceles are uncommon sequelae of brachial plexus injuries. These cerebrospinal fluid (CSF) collections have rarely been described to occur within the spinal canal with resultant cord compression and neurological deficit. We present the case of an intracanalicular pseudomeningocele causing spinal cord compression and progressive radiculomyelopathic weakness more than a decade after the original injury. Methods: Case report and review of the literature. Results: A 34 year old man presented with progressive cervical radiculomyelopathy 16 years after sustaining a brachial plexus avulsion injury. Magnetic resonance imaging revealed an anterior epidural intracanalicular fluid collection from C3 to L3, with focal compression at the cervicothoracic junction. Surgical intervention involved a C7 to T3 laminectomy and fenestration of the anterior dura to permit communication of CSF between the dural space and pseudomeningocele. His strength and dexterity improved dramatically post-operatively. Conclusions: Spinal pseudomeningoceles following a traumatic brachial avulsion injury are typically found outside the spinal canal and are usually not associated with any neurological symptoms. There are few reported cases of post-avulsion intracanalicular pseudomeningoceles which present with delayed spinal cord compression and neurological dysfunction. Therefore, patients with a history of a traumatic avulsion injury and delayed neurological symptoms should warrant additional investigations.

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