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PubMed1994

Spinal cord compression in homozygous beta-thalassemia intermedia.

Symptomatic spinal cord compression caused by an epidural mass of extramedullary hematopoietic tissue in patients with beta-thalassemia is a rare occurrence, that becomes exceptional in childhood and adolescence. The literature is not uniform about the optimal treatment of these patients and different modes of therapy have been proposed so far, including surgical excision or decompressing laminectomy followed by local irradiation and/or hypertransfusional regimens. We report the successful treatment of such a complication in an adolescent with homozygous beta-thalassemia by surgery followed by repeated blood transfusions aimed at maintaining hematocrit at normal levels.

Adolescent↗
PubMed1986

Combination chemotherapy and radiation therapy. The medical management of epidural spinal cord compression from testicular cancer.

Radiation and surgery are the mainstays of treatment for epidural spinal cord compression. There are reports in the literature, however, in which the use of chemotherapy alone or in combination with radiation and surgery has resulted in improved patient response. We present two patients with spinal cord compression from testicular cancer who developed progressive paraplegias that were successfully reversed with combination chemotherapy, steroids, and radiotherapy. In one case, the patient was unable to receive more than 600 rad (6 Gy) of radiation and his improvement was clearly related to the chemotherapy he received. In treating tumors causing spinal cord compression that are thought to be chemosensitive, one should consider adding chemotherapy to radiation or using chemotherapy alone if the options of surgery or radiation are not available.

Adrenal Cortex Hormones↗
PubMed1978

Epidural spinal cord compression from metastatic tumor: diagnosis and treatment.

The clinical findings in 130 conseucutive cases of spinal cord compression by metastatic extradural tumors were analyzed. These 130 patients were combined with a previous survey of 105 patients to compare the effectiveness of radiation therapy (RT) alone with that of surgical decompression followed by RT. Ambulation after treatment was considered a successful outcome. The most common primary tumors producing spinal cord compression were (in order) breast, lung, prostate, and kidney. In 68% of these tumors the thoracic region was involved. Pain was the primary symptom of 96% of the patients, while motor or sensory deficits (or both) were found in 82% of them. Therapy consisted of surgery and RT in 65 patients and RT alone in 170 patients. There were no differences in outcome between those treated by surgery combined with RT and those managed by RT alone. Patients with radiosensitive tumors and those ambulatory at the onset of treatment benefited whether treated by surgery or by RT. Seventy-five percent of living patients who improved from treatment remained ambulatory at 6 months, and approximately 50% of living patients were ambulatory at 1 year. We conclude that RT without decompressive laminectomy is as effective as decompressive laminectomy in treating epidural spinal cord compression from systemic cancer.

Adolescent↗
PubMed2005

Chronic inflammatory demyelinating polyradiculoneuropathy: two cases with cervical spinal cord compression.

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a peripheral nerve disorder probably due to an immunological disturb. It evolves either in a steadily progressive or in a relapsing and fluctuating course. Weakness is mainly in the lower limbs proximally and distally. The electromyography is demyelinating. The cerebral spinal fluid protein is most of times elevated. Sometimes enlarged nerves are found. There are few cases described with spinal cord compression due to hypertrophic spinal nerve roots. Two patients (females, 66 and 67 years old) with diagnosis of a long standing CIDP are described. In the first one, the evolution was characterized by remission and relapsing course. The second patient had a chronic and progressive course. These patients presented after a long evolution a cervical spinal cord compression syndrome due to hypertrophic cervical roots. Neurologists must be aware of the possibility of development of spinal cord compression by enlarged spinal roots in patients with a long standing CIDP.

Aged↗
PubMed1998

Emergency treatment of malignant extradural spinal cord compression: an evidence-based guideline.

PURPOSE: To review the literature for malignant extradural spinal cord compression (MSCC), produce evidence-based recommendations based on the criteria used by the Canadian Task Force on the Periodic Health Examination, and make suggestions regarding future research directives. METHODS: A systematic review of the literature with explicit study selection and evaluation criteria was performed. Primary outcome measure was posttreatment ambulation rate. RESULTS: There is good evidence to support the use of high-dose dexamethasone (96 mg/d), but inconclusive evidence for the use of moderate-dose steroids (16 mg/d) in conjunction with radiotherapy (RT) for the treatment of MSCC. Fair evidence exists for not using steroids in patients who are nonparetic and ambulatory pretreatment, and to give radiation to patients with subclinical spinal cord compression (SCC). The remainder of the recommendations are based on inconclusive evidence: RT alone should be the first-line treatment for ambulatory patients except when there is spinal instability, bony compression, or paraplegia on presentation, in which case surgery should be performed. Either modality can be used for paraparetic patients who are nonambulatory. Postoperative RT should be considered for tumor in residua. Ambulatory, undiagnosed patients should have needle biopsy attempted first. Patients should be aggressively screened and educated about SCC. CONCLUSION: In general, there were very few papers of high methodologic quality found in the literature. More studies are needed to satisfy the validity of many of the clinical decisions that are made today with regard to the management of MSCC.

Anti-Inflammatory Agents↗
PubMed1999

Epidural spinal cord compression: a single institution's retrospective experience.

Epidural spinal cord compression (ESCC) is a common metastatic complication occurring in 5% of patients with cancer. We sought to determine retrospectively the frequency of multiple sites of ESCC at presentation and the risk of recurrence of ESCC. Of the cancer patients seen by the University of California San Diego's Neuro-Oncology Service between August 1986 and January 1997, 108 developed ESCC that was documented both clinically and by MRI of the spine. In 77 patients (71%), a single site of ESCC was seen; 31 patients (29%) had multiple sites of ESCC. All sites of ESCC were irradiated. In 7% of patients with single-site ESCC and in 9% of patients with multiple-site ESCC, the disease recurred. Length of survival was similar for patients with single- or multiple-site ESCC (median, 4.5 months) versus patients with recurrent ESCC (median, 7 months). An MRI of the entire spine in patients with suspected ESCC demonstrated multiple sites of ESCC in nearly one-third of patients. In 8% of patients with ESCC, symptomatic ESCC recurred.

Adult↗
PubMed1999

Radiation therapy of metastatic spinal cord compression. Multidisciplinary team diagnosis and treatment.

PURPOSE: To evaluate the effectiveness of a multidisciplinary approach to spinal cord compression (SCC) in accordance with prospective protocol, providing a uniform approach to diagnosis, decision making concerning optimal treatment modality in any particular case of SCC, treatment performance and evaluation of treatment results. The SCC patients treated by radiation therapy are described. MATERIALS AND METHODS: Patients with SCC were examined and treated by a multidisciplinary team consisting of a neurologist, radiologist, oncologist, orthopedic surgeon, and neurosurgeon. Seventy-nine patients for whom radiation was recommended received a 30 Gy radiation dose to a compression-causing mass and course of high dose dexamethasone. Three fractions of 5 Gy and 5 fractions 3 Gy each were delivered by Co60 or 8 MV photon beam in 12 days. Treatment outcome was essentially evaluated by ambulation capabilities which were considered to be the main problem of SCC. Changes in other neurologic motor, sensory and autonomic disturbances were also evaluated. RESULTS: Seventy-two percent of the patients were already non-ambulatory at diagnosis. The first symptom was motor deficiency in only 33% of them while in all other cases it was pain. Ambulation capability was the main prognosticator of treatment outcome; 90% of patients who were ambulatory before treatment remained so while 33% of the non-ambulatory patients regained their ability to walk. The grade of motor disturbance was also an important variable: among the non-ambulatory patients, 50% of the paretic but only 14% of the plegic ones became ambulatory. Overall, 51% of the study patients were ambulatory after undergoing radiation. The ambulatory state after treatment was the main predictor for survival. CONCLUSION: Close cooperation of a multidisciplinary team in diagnosis and treatment according to the above protocol enabled the achievement of good results of radiation treatment in SCC. Early diagnosis and early treatment should further enhance therapeutic outcome.

Adult↗
PubMed2005

[Effectiveness and toxicity of reirradiation (Re-RT) for metastatic spinal cord compression (MSCC)].

BACKGROUND AND PURPOSE: Radiation myelopathy is a serious late toxicity after radiotherapy (RT) of metastatic spinal cord compression (MSCC). The risk of myelopathy depends on the equivalent dose in 2-Gy fractions (EQD2). Many radiation oncologists are concerned about spinal Re-RT, because it may result in a high cumulative EQD2. This study investigates effectiveness and feasibility of Re-RT for in-field recurrence of MSCC. PATIENTS AND METHODS: 74 patients, irradiated between 01/1995 and 12/2003 for MSCC, were reirradiated for in-field recurrence of MSCC (Table 1). Primary RT was performed with 1 x 8 Gy (n = 34), 5 x 4 Gy (n = 28), 10 x 3 Gy (n = 4), 15 x 2.5 Gy (n = 4), or 20 x 2 Gy (n = 4). Recurrence occurred after median 6 months (2-40 months). Re-RT was performed with 1 x 8 Gy (n = 35), 5 x 3 Gy (n = 16), 5 x 4 Gy (n = 13), 10 x 2 Gy (n = 4), 12 x 2 Gy (n = 3), or 17 x 1.8 Gy (n = 3). Cumulative EQD2 (alpha/beta = 2 Gy) was 39-40 Gy (n = 21), 49-50 Gy (n = 41), 56-60 Gy (n = 6), or > 60 Gy (n = 6). Follow-up after Re-RT was median 9 months (2-52 months). RESULTS: Re-RT led to an improvement of motor function in 29/74 patients (39%; Figures 1 to 3). On multivariate analysis, outcome was significantly influenced by type of primary tumor (p = 0.013) and by the time of developing motor deficits before Re-RT (p = 0.037), but not by radiation schedule (p = 0.560), by ambulatory status before Re-RT (p = 0.471), by cumulative EQD2 (p = 0.795), nor by the interval between primary RT and Re-RT (p = 0.420; Table 2). Radiation myelopathy was not observed in the whole series. CONCLUSION: Re-RT is an effective treatment for an in-field recurrence of MSCC. After a cumulative EQD2 < or = 50 Gy, radiation myelopathy appears unlikely.

Adult↗
PubMed1999

Balloon device for experimental graded spinal cord compression in the rat.

We have developed a balloon device that creates reproducible graded compression of the rat spinal cord. It uses a modified Camino intracranial pressure monitor bolt with a small latex balloon attached to the tip. The device is affixed to the spinous processes of two cervicothoracic vertebrae and positioned directly over an exposed segment of spinal cord. Ten compression balloons were tested and revealed reproducible pressure transmission at expansion volumes from 0.12 to 0.34 cc. Reversible graded spinal cord compression was verified by monitoring cortical somatosensory and motor evoked potentials before, during, and after cord compression. The pathophysiologic changes occurring with graded compression and the effect of therapeutic interventions can be studied in a rat model.

Animals↗
PubMed1998

Spinal cord compression: histologic spectrum of lesions.

Histologic diagnosis ultimately determines the prognosis and treatment of lesions causing spinal cord compression. Modern imaging techniques have revolutionized the procedure of localizing lesions presenting with signs and symptoms of spinal cord compression. As a result, these lesions are more accessible for fine needle aspiration and biopsy. A quick diagnosis is possible if cytologic preparation is made. Similarly, intraoperative frozen section facility not only provides rapid diagnosis, but also offers opportunity of appropriate management decision there and then. Histology in many cases needs help of special stains and immunocytochemistry. This study looks at the histologic spectrum of these lesions, gender distribution and age range in Pakistani population.

Adenocarcinoma↗
PubMedDate not supplied

[The neuroprotector effect of a new taurine derivative on a model of compression spinal cord trauma in rats].

The neuroprotector effect of a new taurine derivative, 2-(1-phenylethyl)-aminoethanesulfonyl-2-propylamide hydrochloride, has been studied in rats with model compression spinal cord trauma. The drug favored restoration of the motor function of posterior extremities in rats with the model spinal cord trauma and significantly decreased the lethality in test animals. The taurine derivative normalized the energy metabolism, lipid peroxidation and antioxidant system in animals with spinal cord trauma. The neuroprotector effect of the new taurine derivative significantly exceeds the action of cerebrolysine.

Amino Acids↗
PubMed1992

Ataxia in epidural spinal cord compression.

Nine patients presented with ataxia as the primary manifestation of epidural spinal cord compression. Eight had known cancer, the ninth an epidural abscess. Lower-extremity dysmetria, gait ataxia, or both, were the only neurologic signs in five patients. An incorrect initial diagnosis led to delay in treatment and subsequent neurologic deterioration in six patients. Failure to recognize isolated, painless ataxia as the initial manifestation of spinal cord compression and appropriately treat the disorder can result in irreversible spinal cord deterioration.

Abscess↗
PubMed2002

[Thoracic spinal cord compression by radiation-induced exostosis: a case report and review of the literature].

A 38-year old man developed compressive myelopathy due to radiation-induced osteochondroma at T7. The patient had been given radiotherapy at the age of 7 years for a lymphosarcoma situated at the lower part of the neck. Radiation is an exceptional cause of spinal compression which can be avoided by regular surveillance of patients given radiotherapy in the spinal area as children.

Adult↗
PubMed1998

Study of spinal cord evoked injury potential by use of computer modeling and in dogs with naturally acquired thoracolumbar spinal cord compression.

OBJECTIVE: To add objective measurements of the characteristics of evoked injury potentials (EIP) and their relations to clinical severity in dogs with thoracolumbar spinal cord damage. ANIMALS: 25 dogs with naturally acquired spinal cord compression attributable to disk extrusion or vertebral fracture at the level of the thoracolumbar junction and with various degrees of paresis/paralysis. PROCEDURE: Spinal cord potentials evoked by tibial nerve stimulation were recorded every 5 to 10 mm at the lamina level in the vicinity of the cord compression. This allowed an EIP to be recorded even in the least handicapped dogs. A computer model yielded information about the waveform changes of the EIP in the vicinity of conduction blocks. RESULTS: The EIP waveform changed from biphasic to monophasic a short distance caudad to the location of spinal cord compression. Location of a maximal conduction block was measured in relation to position of the electrodes recording this waveform change. The distance between the assumed conduction block and the actual spinal cord compression was larger in the most affected dogs. The amplitude of the EIP was not related to severity of the clinical picture; however, the proximity of the recording electrode to the spine influenced the amplitude and the waveform of the EIP. CONCLUSION AND CLINICAL RELEVANCE: Change in the EIP waveform from biphasic to monophasic makes it possible to estimate the conduction block location along the spinal cord. A large distance between the assumed conduction block and site of actual cord compression could be an objective argument to confirm severity of a lesion.

Animals↗