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PubMed1984

[Spinal cord compression in malignant plasmacytic diseases. Apropos of 6 cases].

Myeloma may be complicated or revealed by spinal cord compression. Out of 105 cases of myeloma admitted to this Department, 6 cases of spinal cord compression were observed, with a favourable outcome after treatment by laminectomy combined with radiotherapy. In 5 cases out of 6, spinal cord compression was either the presenting sign or occurred within the first months after diagnosis. Compression occurred in the thoracic cord in 5 cases, and in the lumbar cord in 1 case. The interval between the first symptom and diagnosis varied greatly (from a few hours to 1 year), as did the degree of paraplegia, which ranged from paraparesis to flaccid paraplegia. A favourable outcome occurs in most other reported cases, in contrast with spinal cord compression from metastases. Treatment (laminectomy-radiotherapy or both) remains controversial.

Adult↗
PubMed1990

Magnetic resonance imaging of malignant extradural tumors with acute spinal cord compression.

Thirty-six cancer patients with extradural spinal metastatic disease and acute symptoms of spinal cord compression underwent magnetic resonance (MR) imaging at 1.5 T. Cord involvement was found in all 36, 7 of whom had lesions at 2 different sites. Vertebral metastases in addition to those corresponding to the cord compressions were detected in 27 patients, and 18 of these had widespread deposits. MR displayed the extent of the tumors in the craniocaudal and lateral directions. The ability to identify multiple sites of cord and vertebral involvement and to delineate tumor accurately makes MR the examination of choice in cancer patients with suspected spinal cord compression. It obviates the need for myelography and postmyelography CT in this group of patients.

Adult↗
PubMed1997

Infarction of a vertebral pedicle causing acute spinal cord compression.

We present a case of acute spinal cord compression due to haemorrhage following recurrent infarction of the right pedicle of the second lumbar vertebra. Such a case has not previously been reported and we describe the radiological and operative findings. Magnetic resonance imaging was particularly helpful in precisely localizing the lesion and planning surgery. The most likely diagnosis remained a solitary neoplastic deposit until confirmation of recurrent infarction was made on histological examination of the operative specimen. The histological findings were also in keeping with the episodic progression of the patients symptoms.

Acute Disease↗
PubMed1985

[Vertebral osteonecrosis. Apropos of 3 cases, 1 complicated by spinal cord compression and 2 associated with another necrotic localization].

The authors report three cases of vertebral osteonecrosis which presented the phenomenon of intra-vertebral space. These patients had osteoporosis with vertebral compression. Two received steroid therapy. One case progressively developed spinal cord compression and the two other cases had an associated osteonecrosis (femoral head and talus). After reviewing the literature, the authors stress the relative frequency of neurological complications, in particular spinal cord compression (7 per cent).

Adrenal Cortex Hormones↗
PubMed1995

[A chronic spinal cord compression model in a rat with a 354A tumor].

A posterior spinal cord compression model was produced in a rat with a 354 A tumor. Here we report the compression process using MRI (at 2.11 tesla), the progression of paralysis in the posterior limbs, the pathological changes in the neural tissues, and the spinal evoked potentials (SpEPs). A relatively flat spinal cord compression model was established by the interposition of free fatty tissue between the tumor and dura mater. The anteroposterior diameter of the compressed cord (AP), the width of the compressed cord (W), the cross-sectional areas of the spine (A), the mean of the anteroposterior diameters of the cord at the levels of the adjacent cephalic and caudal vertebral bodies (AP), and the mean of the cross-sectional areas of the cord at the levels of the adjacent cephalic and caudal vertebral bodies (A) were measured on axial views from MRI. Paralysis of the posterior limbs occurred in this model when A/A became less than 60%, AP/AP became less than 35% and AP/W became less than 20%. Pathological changes became apparent in the neural tissues when A/A became less than 50-60%, AP/AP became less than 25-30% and AP/W became less than 15%. Polyphasic wave-forms were noted when A/A became less than 60%, AP/AP became less than 35% and AP/W became less than 20%. When the A/A became less than 40%, the histopathological changes became marked. SpEPs could no longer be detected at this degree of compression, indicating that all neural conduction had been blocked.

Animals↗
PubMed1988

[Radiological diagnosis of chronic spinal cord compressive lesion at thoraco-lumbar junction].

Radiological findings in five cases with chronic spinal cord compressive lesion at thoraco-lumbar junction were reported. Three cases had spondylosis and two cases had ossification of yellow ligament (OYL). The levels of the lesions were T12/L1 in three cases and T11/12 in two cases. Two out of three spondylotic patients had also OYL at the same level. The five cases consisted of three men and two women. The ages ranged from 42 to 60 years old with a mean age of 53 years old. Neurologically, every patient showed flaccid paresis and sensory disturbance of the legs. Two cases had sensory disturbance of stocking type. The intervals from the onset of the symptoms to the final diagnosis were 6 months, 7 years, 8 years, 11 years and 12 years. Myelography showed anterior spinal cord compression by bony spur in spondylotic patients, and posterior compression by OYL in other cases. Myelography in flexion posture disclosed the cord compression by bony spur more clearly in two out of three spondylotic patients. Delayed CT-myelography showed intramedullary filling of contrast material in two cases, which indicated degenerative change or microcavitation due to long term compression of the spinal cord. MRI was taken in three spondylotic patients and could directly show compression of the spinal cord. Difficulty in detecting abnormality at thoraco-lumbar junction on plain roentgenogram, and similarity of the symptoms to peripheral nerve disease often lead to a delay in diagnosis. The significance of dynamic myelography and delayed CT-myelography when dealing with such a lesion was discussed here.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

Extraosseous extension of vertebral hemangioma, a rare cause of spinal cord compression.

STUDY DESIGN: Case report. OBJECTIVE: To illustrate a rare cause of thoracic spinal cord compression, its diagnosis, and its management. SUMMARY OF BACKGROUND DATA: Asymptomatic vertebral hemangiomas are common, but extraosseous extension causing spinal cord compression with neurologic symptoms is rare, and few cases appear in the English-language literature. METHOD: A previously asymptomatic 63-year-old man sought medical attention for acute back pain and thoracic myelopathy of 6 week's duration. Magnetic resonance imaging confirmed the presence of a mass in the T10 vertebral body with paravertebral and intracanalicular extension contributing to cord compression. Decompression and reconstructive surgery were performed and radiotherapy administered after surgery. Preoperative angiography was not performed because of the patient's rapidly progressive neurologic deterioration and the consideration that the differential diagnosis of vertebral hemangioma was less likely. RESULTS: The diagnosis of benign capillary hemangioma was made histologically. Neurologic recovery was complete except for minor residual sensory changes in the legs. At follow-up 10 months after surgery the patient had returned to his usual active life and motor mower repairing business. CONCLUSION: Extraosseous extension of vertebral hemangiomas is a rare cause of thoracic spinal cord compression. As such, the available data are derived from reports based on series involving only a small number of cases, rather than on results of randomized controlled trials. Those causing progressive neurologic symptoms should be surgically decompressed, with the specific procedure determined by the extent and site of the lesion. Preoperative angiography is recommended, but embolization is not always necessary or even possible. Postoperative radiotherapy is recommended when tumor removal is subtotal.

Angiography↗
PubMed1984

Spinal cord compression secondary to Gaucher's disease.

A case of compression of the spinal cord and cauda equina secondary to collapse of the T-12 and L-3 vertebral bodies in a patient with type 1 Gaucher's disease is presented. Decompressive laminectomies were done at both the T-12 and L-3 levels with moderate improvement of the patient's neurologic findings. Histologic examinations confirmed the presence of Gaucher's cells in the bone. Review of the literature revealed only one previous report.

Cauda Equina↗
PubMed1989

Spinal cord blood flow measured by 14C-iodoantipyrine autoradiography during and after graded spinal cord compression in rats.

The relations between degree of thoracic spinal cord compression causing myelographic block, reversible paraparesis, and extinction of the sensory evoked potential on one hand, and spinal cord blood flow on the other, were investigated. This was done in rats using the blocking weight-technique and 14C-iodoantipyrine autoradiography. A load of 9 g caused myelographic block. Five minutes of compression with that load caused a reduction of spinal cord blood flow to about 25%, but 5 and 60 minutes after the compression spinal cord blood flow was restored to 60% of the pretrauma value. A load of 35 g for 5 minutes caused transient paraparesis. Recovery to about 30% was observed 5 and 60 minutes thereafter. During compression at a load of 55 g, which caused almost total extinction of sensory evoked potential and irreversible paraplegia, spinal cord blood flow under the load ceased. The results indicate that myelographic block occurs at a load which does not cause irreversible paraparesis and that a load which permits sensory evoked potential to be elicited results in potentially salvageable damage.

Animals↗
PubMed1988

[Role of endogenous norepinephrine and effects of alpha- and beta-blockers in experimental spinal cord compression injury].

The changes in spinal cord micro-circulation were investigated after administering alpha- and beta-blockers to rabbits with acute spinal cord injury. Immediately after the 8th thoracic spinal cord was injured by applying pressure with a weight (50 g) for 1 minute, an alpha or beta-blocker was injected into the subarachnoid space of the injured region of the spinal cord. Spinal cord edema, blood flow, vascular permeability, and the mean arterial pressure were compared between the groups treated with each agent and the control group. One hour after the injury, the water content of the spinal cord was significantly lower in the phenoxybenzamine-treated group than in the control group. After 6 hours, however, no significant difference was observed between these two groups. The spinal cord blood flow was higher in the phenoxybenzamine-treated group than in the control group until 6 hours after the injury. These results suggest involvement of norepinephrine in the formation of edema at the early stage of spinal cord injury.

Adrenergic alpha-Antagonists↗
PubMed2000

Aggressive thoracic actinomycosis complicated by vertebral osteomyelitis and epidural abscess leading to spinal cord compression.

STUDY DESIGN: Report of a successfully diagnosed and treated case of spinal cord compression due to epidural actinomycosis. OBJECTIVE: To illustrate that proper use of imaging strategy can greatly facilitate diagnosis and management of this rare condition. SUMMARY OF BACKGROUND DATA: Spinal actinomycosis causing epidural abscess and significant spinal cord compression is an uncommon condition. Although diagnosis is difficult, favorable results are widely reported when specific therapy is instituted. METHODS: A 32-year-old Chinese man had extensive dorsal thoracic soft tissue swelling and lower limb weakness. Collapse of the T5 vertebral body was found on plain radiographs with mediastinal infiltrates on chest radiograph. It took magnetic resonance imaging (MRI) to fully delineate the epidural abscess and dorsal muscular abscesses, which were not depicted by computed tomographic (CT) scan. Diagnosis was made by examination of CT-guided aspirate and tissue recovered during surgery by a microbiologist. The patient received high-dose intravenous penicillin and prompt spinal decompression once diagnosis of actinomycosis was confirmed. RESULTS: The dorsal muscular abscesses and upper thoracic epidural abscess resolved rapidly after intravenous antibiotics and surgical drainage. This was well documented by follow-up MRI and the full recovery of motor power and lower limb sensation in the patient. CONCLUSIONS: High clinical suspicion and proper use of imaging data led to timely diagnosis of this rare case of mediastinal, epidural, and intramuscular thoracic actinomycosis. Specific antibiotic therapy and timely, well-targeted surgical intervention greatly improve the outcome of this condition.

Actinomycosis↗
PubMed1993

[Vitamin-resistant hypophosphatemic rickets and spinal cord compression. Apropos of 2 cases].

Adults with X-linked vitamin-resistant hypophosphatemic rickets can develop spinal cord compression as a result of spinal canal stenosis due to involvement of the spine with the increased periosteal and ligamentary calcification which is typical of the disease. Two cases are reported. In both patients, spinal cord compression manifested as rapidly progressive spastic paraplegia due to compression at T9 and T5, respectively. Decompressive laminectomy ensured full recovery in one case but was ineffective in the other. In both cases, paraplegia developed approximately one year after initiation of therapy combining a metabolite of vitamin D and phosphorus in high doses. Current imaging techniques (CT scan, magnetic resonance imaging) provide highly accurate information on the anatomic mechanism of the stenosis, its often multiple locations, and its course. Three factors are involved in the stenosis, in variable degrees: thickening of the laminae, hypertrophy of the facet joints, thickening and calcification of the yellow ligament. Magnetic resonance imaging is the investigation of choice in these patients. A deleterious effect vitamin D-phosphorus treatment cannot be outruled. The appropriateness of initiating this treatment should be prudently discussed and treated patients should be closely monitored.

Follow-Up Studies↗
PubMedDate not supplied

Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial.

BACKGROUND: The standard treatment for spinal cord compression caused by metastatic cancer is corticosteroids and radiotherapy. The role of surgery has not been established. We assessed the efficacy of direct decompressive surgery. METHODS: In this randomised, multi-institutional, non-blinded trial, we randomly assigned patients with spinal cord compression caused by metastatic cancer to either surgery followed by radiotherapy (n=50) or radiotherapy alone (n=51). Radiotherapy for both treatment groups was given in ten 3 Gy fractions. The primary endpoint was the ability to walk. Secondary endpoints were urinary continence, muscle strength and functional status, the need for corticosteroids and opioid analgesics, and survival time. All analyses were by intention to treat. FINDINGS: After an interim analysis the study was stopped because the criterion of a predetermined early stopping rule was met. Thus, 123 patients were assessed for eligibility before the study closed and 101 were randomised. Significantly more patients in the surgery group (42/50, 84%) than in the radiotherapy group (29/51, 57%) were able to walk after treatment (odds ratio 6.2 [95% CI 2.0-19.8] p=0.001). Patients treated with surgery also retained the ability to walk significantly longer than did those with radiotherapy alone (median 122 days vs 13 days, p=0.003). 32 patients entered the study unable to walk; significantly more patients in the surgery group regained the ability to walk than patients in the radiation group (10/16 [62%] vs 3/16 [19%], p=0.01). The need for corticosteroids and opioid analgesics was significantly reduced in the surgical group. INTERPRETATION: Direct decompressive surgery plus postoperative radiotherapy is superior to treatment with radiotherapy alone for patients with spinal cord compression caused by metastatic cancer.

Combined Modality Therapy↗
PubMed2002

Surgery and permanent 125I seed paraspinal brachytherapy for malignant tumors with spinal cord compression.

PURPOSE: To evaluate the functional outcome, predictors of response, and toxicity from spinal surgery and 125I brachytherapy in patients with malignant tumors resulting in spinal cord compression. METHODS AND MATERIALS: Between July 1985 and September 2001, after surgical resection, 30 patients underwent 31 intraoperative paraspinal brachytherapy procedures at Barrow Neurological Institute. Twenty-four (with 25 procedures) had follow-up at our clinic and form the basis for this report. Surgical procedures were based on the location of the impinging lesion: corpectomy or spondylectomy in 13 cases and laminectomy in 12. Permanent 125I seeds in absorbable suture were placed with open exposure after resection. RESULTS: Spinal cord compression was cervical in 4 (16%), thoracic in 14 (56%), and lumbar in 7 (28%) of the 25 cases. One patient underwent two separate procedures at different spinal sites. Of the 25 brachytherapy sites, 22 also received external beam radiotherapy (EBRT): 5, EBRT with a planned brachytherapy boost; 4, brachytherapy and prompt EBRT after recovery; and 13, brachytherapy as salvage for local failure after prior EBRT. Three had no EBRT: 1 had lymphoma treated with chemotherapy, 1 had remote previous EBRT for a childhood tumor, and 1 refused EBRT. The mean follow-up was 19.8 months. The 2- and 3-year actuarial local control rate was 87.4% and 72.9%, respectively. Four sites (16.0%) experienced local failure. The mean time to recurrence for these 4 patients was 20.3 months. Three of the four had failed prior EBRT, with surgery and brachytherapy used for salvage. The 2- and 3-year actuarial overall survival rates were 24.0% and 16.0%, mean 19.2 months. An ambulatory function score was assigned pre- and postoperatively: I, normal ambulation; II, abnormal not requiring assistance; III, abnormal requiring assistance; and IV, unable to ambulate. All patients with score I, 91% of those with score II, 67% of those with score III, and 67% of those with score IV were ambulatory after the procedure; 84% had either normal or improved ambulation postoperatively. Morbidity was restricted to four postoperative events: one cerebrospinal fluid leak, two wound infections treated in situ without removal of seeds or instrumentation, and one pulmonary embolus. No myelopathies or other neurologic sequelae were encountered. CONCLUSION: This is the largest series in the literature exploring surgery and 125I brachytherapy in the treatment of malignant spinal cord compression. We found this to be well tolerated and to result in durable local control and ambulatory function. Our results suggest a benefit to aggressive local therapy in selected patients with spinal cord compression.

Adult↗