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PubMed1994

Pattern of disease in spinal cord compression on MRI scan and implications for treatment.

Recent trends in the management of bone metastases include the use of prophylactic bisphosphonates and low dose single fraction radiotherapy in favour of high dose fractionated radiotherapy. A recent animal model [1] suggests that cord compression is often associated with predominant soft tissue epidural disease, with bone collapse as a late event. In the present study, potential implications were investigated by retrospective evaluation of the pattern of disease on MRI scans of patients with spinal cord compression. The dominant component of spinal cord compression was determined in 62 patients. Two main patterns were identified, 45 (73%) had predominant soft tissue epidural disease and 15 (24%) had bone collapse. There were two with intrathecal deposits. The patterns were correlated with response to radiotherapy. Positive response was observed in 64% of those with soft tissue epidural disease and 27% of those with bone collapse. These data support the animal model, suggesting soft tissue epidural disease rather than collapse as the predominant cause of cord compression. This implies that prophylactic bisphosphonates alone would be unlikely to reduce the incidence of spinal cord compression. It also introduces concern about the long term safety of low dose single fraction radiotherapy for bone metastases in patients with a medium term life expectancy (e.g. > 2 years). These patients may benefit from more than a single fraction of radiotherapy to produce longer growth delay for sub-clinical epidural disease.

Adolescent↗
PubMed1984

Nocardial osteomyelitis of the spine with epidural spinal cord compression--a case report.

A 53-year-old man presented with complaints of back pain and weakness in his lower extremities. Physical examination demonstrated a thoracic myelopathy with a sensory level at T-4. The diagnostic work-up revealed vertebral osteomyelitis of the thoracic spine with epidural compression at T-2-T-4 causing a nearly complete block on myelography. A decompressive laminectomy and debridement were performed, followed by anterior spinal fusion. Nocardia asteroides was cultured from the epidural space. The patient was concurrently treated with sulfonamides. No underlying malignancy or immunosuppression could be demonstrated, but a primary pulmonary nocardial infection was suspected. A satisfactory recovery was accomplished. Only four other cases of nocardial osteomyelitis of the spine have been reported in the literature. These are discussed, and possible mechanisms are proposed for the pathophysiology of this rare manifestation. Current recommendations on the specimen processing, diagnosis, and therapy of nocardial infections are briefly reviewed.

Debridement↗
PubMedDate not supplied

A model of chronic spinal cord compression in the cat.

An experimental method of producing chronic compression of the cat spinal cord is described. A ligature placed around the lumbar spinal cord of 3-month-old kittens restricts the growth of the spinal cord to produce compression with a slow onset and an insidious progression. The methods of following the clinical progress of affected animals and of sampling the spinal cord after perfusion fixation are presented. The sampling method used allowed analysis of the three dimensional distribution of the pathological changes caused by the compression. These changes were not symmetrically distributed: the spinal cord caudal to the ligature became swollen and extensive partial demyelination occurred under the ligature and caudal to it, in the swollen region of the cord, whereas cranial to the ligature there was only minimal damage. It is concluded that the method produces a useful model of chronic compression of the spinal cord, which will be of value in studying partial demyelination.

Animals↗
PubMed2003

Granulocytic sarcoma: an unusual complication of aleukemic myeloid leukemia causing spinal cord compression. A case report and literature review.

Granulocytic sarcoma (chloroma) is a rare solid tumor resulting from the proliferation of myelogenous leukemia cells. Chloromas usually present as soft tissue or bony masses of the head and neck in patients with acute myelogenous leukemia (AML) of the French-American-British M2 subtype. Occasionally chloromas may occur in patients with myelodysplasia and other myeloproliferative disorders and rarely precede the development of systemic disease. It is distinctly rare for such tumors to cause epidural compression as a first manifestation of disease. Herein, we report the case of a man with a thoracic extradural chloroma whose presentation of progressive lumbar pain ultimately led to the diagnosis of M2 AML. Surgical intervention prior to the onset of paraplegia and the prompt initiation of chemotherapy resulted in an excellent neurological and hematological outcome. We also review the literature of previously reported cases of spinal cord-associated chloroma and focus on the clinical presentation and treatment of this disorder.

Adult↗
PubMed2000

Infection as a cause of spinal cord compression: a review of 36 spinal epidural abscess cases.

A retrospective survey of 36 cases treated in the Department of Neurosurgery, Hacettepe University Hospitals since 1970 was performed. Clinical presentation, aetiology and outcome of this rare disease compared to recently published series. All cases were admitted with signs of neural compression. Clinical and laboratory data suggesting an infectious origin were present only in 4 cases. Radiological investigation including magnetic resonance imaging in 10 patients, were not confirmative for an epidural abscess except for two cases. All cases underwent urgent surgical decompression and tuberculous abscess either in granulation or pus form was found in the majority. Overall mortality rate was 5.8%. Outcome was closely related to the neurological condition on admission rather than the underlying infectious origin. When compared with recently reported series, our cases demonstrated a significant divergence in terms of clinical presentation, pathogenesis and outcome. The most probable reason for this discrepancy is that risk factors for compromised immunity or systemic infection were much less than the other series and mycobacterium tuberculosis is the responsible agent in the majority which has a much more favourable outcome than non-spesific infections.

Adolescent↗
PubMed1976

Spinal cord compression in malignant lymphoma. Treatment and results.

The natural history, treatment, and results of 73 spinal cord compressions caused by malignant lymphomas are analyzed. It is found that the spinal cord compression caused by malignant lymphomas is generally a late manifestation of the illness, although primary or early involvements are occasionally seen. In our study, reticulum cell sarcoma is the most frequently variety followed by Hodgkin's disease and lymphosarcoma. The dorsal spinal cord is the most frequently involved segment and pain, weakness, and paresthesia are cardinal symptoms. Radiation treatment delivered in the early phase of the compression is commonly successful in reversing the neurologic symptoms and a dose above 2500 rads appears to be optimal for local control of disease. The low incidence of cerivcal cord compression in Hodgkin's disease patients may be related to frequent manifestation and irradiation of the neck nodes in these patients. Early detection of disease in the deep seated areas along the spinal cord and irradiation of these areas may prevent progression of tumor to the epidural space.

Adolescent↗
PubMed1992

Spinal cord compression by epidural tumors in childhood.

Epidural malignancy is the most common cause of nontraumatic spinal cord compression in children. Many different tumors may cause compression, either at presentation or sometime during treatment. Treatment options include surgery, irradiation, and chemotherapy. The decision as to the correct option depends on the tumor type and the degree of compression present.

Child↗
PubMed2003

[A new case report of spinal cord compression secondary to beta-thalassemia].

Extramedullary hematopoiesis is an unusual cause of spinal cord compression. We report the case of a 39-year-old man who presented symptoms of progressive dorsal spinal cord compression. Hemogramm showed erythrocytosis with microcytosis. Hemoglobin electrophoresis revealed heterozygous beta-thalassemia. Diagnosis of extramedullary hematopoiesis was based on magnetic resonance imaging findings. Radiological and therapeutic options in this rare condition are briefly discussed.

Adult↗
PubMed1986

Characteristics of spinal cord compression in adenocarcinoma of prostate.

Of 611 patients with biopsy-proved adenocarcinoma of the prostate, spinal cord compression developed in 41 (6.7%) at a median interval of twenty-four months after primary diagnosis. Spinal cord involvement most often occurred in the thoracic area, with 95 per cent of patients showing radiographic evidence of osseous vertebral metastasis at the level of cord compression. All lesions but one were located extradurally, and patients with Stage D2 disease, by virtue of bony metastases, were therefore at greatest risk for development of neurologically compressive disease. There was also a significant increase in the incidence of spinal cord involvement among the more poorly differentiated tumors, although tumor histology did not appear to influence the median interval between vertebral metastasis and cord compromise. Survival following spinal cord involvement was relatively poor and unrelated to tumor differentiation. Forty-six per cent of patients survived less than six months and 20 per cent less than two months. The two most noteworthy survivors are alive at thirty and ninety-seven months, the latter after combined treatment for an intradural lesion.

Adenocarcinoma↗
PubMed2001

Radiation-induced osteochondroma of the T4 vertebra causing spinal cord compression.

A case of a radiation-induced osteochondroma arising from the vertebral body of T4 in an 18-year-old man is reported. The patient presented with a history of progressive left lower extremity weakness. At 7 years of age, he had undergone resection of a cerebellar medulloblastoma and received adjunctive craniospinal irradiation and systemic chemotherapy. Both CT and MR imaging revealed an extradural mass contiguous with the posteroinferior endplate of the T4 vertebral body. This case indicates that radiation-induced osteochondroma should be considered in the differential diagnosis of patients with symptoms of myelopathy or nerve root compression and a history of radiation therapy involving the spine in childhood.

Adult↗
PubMed2006

Association of spinal cord compression seen on magnetic resonance imaging with clinical outcome in 67 dogs with thoracolumbar intervertebral disc extrusion.

OBJECTIVES: To determine whether there is an association between the degree of transverse spinal cord compression detected by magnetic resonance imaging following thoracolumbar Hansen type 1 intervertebral disc disease in dogs and their presenting and postsurgical neurological status. METHODS: Medical records of 67 dogs with surgically confirmed Hansen type 1 intervertebral disc disease (2000 to 2004) were reviewed to obtain the rate of onset of disease, duration of clinical signs and presurgical and postsurgical neurological grade. Percentage of spinal cord compression was determined on transverse T2-weighted magnetic resonance images. Linear regression was used to examine the association between spinal cord compression and each of the above variables. Chi-squared tests were used to examine associations among postsurgical outcome and presurgical variables. RESULTS: Eighty-five per cent (57 of 67) of dogs were chondrodystrophoid. Mean spinal cord compression was 53 per cent (sd=219.7, range 14.3 to 84.9 per cent). There was no association between the degree of spinal cord compression and the neurological grade at presentation, rate of onset of disease, duration of clinical signs or postsurgical outcome, with no difference between chondrodystrophoid and non-chondrodystrophoid dogs. CLINICAL SIGNIFICANCE: The degree of spinal cord compression documented with magnetic resonance imaging in dogs with thoracolumbar Hansen type 1 intervertebral disc disease was not associated with the severity of neurological signs and was not a prognostic indicator in this study.

Animals↗
PubMed1994

Co-incidence of Guillain-Barré syndrome and spinal cord compression in non-Hodgkin lymphoma.

Extradural, radicular and spinal cord compressions are severe neurological complications of lymphomas. Less frequently, involvement of the peripheral nervous system, polymyositis, myasthenia gravis and Guillain-Barré syndrome (GBS) occur. We report a patient with GBS along with a lymphoma of the spinal extradural space where at the beginning the features of GBS outweighed the symptomatology of the extradural spinal mass.

Child, Preschool↗
PubMed1996

Spinal cord compression resulting from Burkitt's lymphoma in children.

We report seven cases of spinal cord compression resulting from Burkitt lymphoma in boys aged 15 years and below. This became manifest clinically as acute or rapidly progressive spinal cord compression. All the patients showed total paraplegia with a sensory loss at thoracic level and sphincter disturbances. Four patients were operated on, the operation permitting exeresis of an epidural tumor. In three cases surgery was followed by chemotherapy. One patient was treated exclusively with chemotherapy. Owing to the effectiveness of chemotherapy, surgery should be considered only in cases of rapid deterioration or for diagnostic purposes.

Adolescent↗
PubMed2006

Evaluation of functional outcome and local control after radiotherapy for metastatic spinal cord compression in patients with prostate cancer.

PURPOSE: Patients with prostate cancer with metastatic spinal cord compression have better survival prognosis than other patients with MSCC and may live long enough to develop a local recurrence of MSCC. This study investigates prognostic factors and radiation schedules for functional outcome and local control of MSCC after radiotherapy in patients with prostate cancer. MATERIALS AND METHODS: A total of 281 patients irradiated between January 1992 and December 2003 were included. Potential prognostic factors were investigated including age, performance status, number of involved vertebra, pretreatment ambulatory status, time of developing motor deficits before RT and radiation schedule--short course RT (1x8/5x4 Gy) vs long course RT (10x3/15x2.5/20x2 Gy). RESULTS: Overall response to RT was 86% (33% improvement of motor function, 53% no further progression). Of the nonambulatory patients 33% regained the ability to walk. On multivariate analysis functional outcome was significantly affected by the time of developing motor deficits before RT (more than 14 days better than 8 to 14 days and 1 to 7 days, p <0.001) and number of involved vertebrae (1 to 2 better than 3 or more, p = 0.013), but not by the radiation schedule (p = 0.859). The 2-year local control of MSCC was 84% depending on the radiation schedule (better after long course RT, p = 0.001). CONCLUSIONS: Functional outcome after RT was significantly influenced by the time of developing motor deficits before RT and number of involved vertebra. Local control was significantly better after application of long course RT. Patients with a poor expected survival could be treated with short course RT, because a short treatment time means less discomfort for the patient. For patients with good survival prognosis, long course RT should be applied to achieve better local control.

Aged↗
PubMed2007

Outcome after radiotherapy alone for metastatic spinal cord compression in patients with oligometastases.

PURPOSE: To investigate outcome and prognosis of metastatic spinal cord compression (MSCC) patients with oligometastatic disease treated with radiotherapy alone. PATIENTS AND METHODS: Oligometastatic disease was defined as involvement of three or fewer vertebrae and lack of other bone or visceral metastases. Five hundred twenty-one patients with oligometastatic disease and MSCC were evaluated for functional outcome, ambulatory status, local control of MSCC, and survival. Furthermore, seven potential prognostic factors were investigated. RESULTS: Motor function improved in 40% (n = 207), remained stable in 54% (n = 279), and deteriorated in 7% (n = 35) of patients. Fifty-eight (54%) of 107 nonambulatory patients became ambulatory, and 388 (94%) of 414 ambulatory patients remained ambulatory. Improved functional outcome was significantly associated with tumor type and slower development of motor deficits (> 14 days). Local control at 1, 2, and 3 years was 92%, 88%, and 78%, respectively. Improved local control was significantly associated with long-course radiotherapy. Survival at 1, 2, and 3 years was 71%, 58%, and 50%, respectively. Better survival was significantly associated with tumor type, ambulatory status, slower development of motor deficits, and long-course radiotherapy. Patients who developed motor deficits slowly (onset > 14 days before initiating treatment) were further analyzed. In this subgroup, the best results were observed for myeloma/lymphoma and breast cancer patients. No patient had progression of motor deficits. One hundred percent (myeloma/lymphoma) and 99% (breast cancer) of patients were ambulatory after radiotherapy. One-year local control was 100% and 98%, 1-year survival was 94% and 89%. CONCLUSION: Given the limitations of a retrospective review, improved outcome of patients with oligometastatic MSCC was associated with myeloma/lymphoma and breast cancer, slower development of motor deficits, and a more prolonged course of radiation.

Aged↗
PubMed1993

Metastatic spinal cord compression--options for surgical treatment.

Fourty-three cases with metastatic spinal cord compression were reviewed post-operatively to clarify the usefulness of the procedures concerning restoration of neurological function, and pain relief. Only patients with pathological spinal instability and neurological sequelae were included. Posterior decompression and stabilization was performed in all but six patients. All but four patients (91%) reported decrease of pain symptoms. Amelioration of neurological function was achieved in 58%. Re-establishment of walking ability was obtained in 57%. Post-surgery life expectancy averaged 11 months. In patients with widespread metastatic disease and/or multi-level instability of the spine restriction to palliative dorsal procedures is sensible. Post-operative ancillary treatment is necessary.

Adult↗