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At least 343 records · Page 19Linked to original sources
PubMed1989

Surgical management of spinal epidural disease: an update.

Management of spinal cord compression from metastatic malignant disease remains unsatisfactory. Results of surgical decompression are at best less than those of radiation therapy alone. However, new surgical approaches now focus on removing the anterior-situated tumor tissue which produces neural compression in about 85% of the cases. The results of these procedures that allow removal of the ventrally compressing tumor show significant improvement in the management of patients with spinal epidural disease. We review the surgical strategy of these new approaches and the attendant results.

Aged↗
PubMed1986

Incidence, presentation, and outcome of spinal cord disease in children with systemic cancer.

During a 40-month period, in 24 of 643 (4%) newly diagnosed patients with systemic cancer younger than 18 years of age (range: 3 months to 17 years) spinal cord disease developed. Patients with spinal cord disease included 21 children with metastatic spinal cord compression, two with treatment-related transverse myelopathies, and one with an anterior spinal artery stroke. Spinal cord disease occurred in 13 of 102 children (12%) with sarcomas, six of 82 (7%) with neuroblastomas, and four of 94 (4%) with lymphomas. Spinal cord compression occurred as the presenting sign of malignancy in six children (four with sarcomas and two with lymphomas). In the remaining 15 patients, cord compression occurred a median of 13 months after initial diagnosis, and in four patients it occurred at the time of first relapse. Symptoms of metastatic cord compression included back pain in 17 patients (80%), weakness in 14 (67%), sphincter dysfunction in 12 (57%), and sensory abnormalities in three (14%). Findings on plain radiographs of the spine were abnormal in only seven of 20 patients with cord compression, and myelography was needed to differentiate compression from other causes of spinal cord disease. Treatment included high-dose corticosteroids followed by operation (seven patients) or radiotherapy (14 patients). After treatment, nine of 15 nonambulatory patients became ambulatory, and five of 10 incontinent patients regained sphincter control. None of the patients with nonmetastatic spinal cord disease had a satisfactory outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Somatosensory evoked potentials in spinal cord diseases.

Somatosensory evoked potentials (SEPs) were studied in 115 patients with spinal cord diseases (multiple sclerosis, amyotrophic lateral sclerosis, cervical myelopathy, subacute combined degeneration, myelitis, spinal cord injury, tumours). The SEPs were recorded at three levels: parietal, spinal (cervical or lumbar), and at the Erb point. The central conduction time was also estimated (N9-N13 and lumbar potential (LP): LP-P37). The most sensitive test (95% abnormalities) was represented by the cortical recording of the SEPs when the tibial nerve was stimulated. The interval LP-P37 was increased, the SEPs being delayed or unrecordable and desynchronized (in cases of polyneuropathies only the latency was increased whereas the waveform was normal). In 50 patients with definite form of multiple sclerosis (MS) abnormalities of the cervical potential N13 were obtained in 96% of cases. The cortical SEPs to the median nerve stimulation were abnormal in 64% of cases only (32 patients). Of 10 patients with amyotrophic lateral sclerosis (ALS), cortical SEPs to the lower limb stimulation were abnormal in 6 patients (20%) and only 2 patients had also abnormal N13 and N20. Of 15 patients with cervical myelopathy, SEPs to the tibial nerve stimulation were abnormal and N9-N13 delayed in all but 2 patients. All the 5 patients with subacute combined degeneration had abnormal SEPs to the tibial nerve stimulation. In all the 15 patients with inflammatory spinal cord diseases, the SEPs were abnormal and the central conduction time was delayed. In 5 cases with spinal cord injury the SEPs were absent above the lesion. In 15 patients with tumoral compression SEPs to the stimulation of the nerve dependent on the sensitive root compressed as well as the lower limb SEPs were abnormal.

Adult↗
PubMed1992

[Magnetic resonance imaging in spinal cord diseases: 127 cases].

Acute or chronic spinal cord syndromes with or without evidence of cord compression are a common diagnostic problem in neurology. Magnetic resonance imaging (MRI) was performed on 127 patients to assess the sensitivity of this examination in detecting local spinal cord lesions. The most common location noticed in this study were the cervico-thoracic (40.9%) and cervical regions (33.8%). A total spine examination accounted for 14.9% of the examinations performed, and the lumbar spine was evaluated in 10.2%. An increased signal corresponding to plaques of multiple sclerosis was the most frequent diagnosis (25 cases), followed by cervical narrowing of the spinal canal and cervical disk diseases (23 cases), neoplasms (15 cases), spinal cord infarctions (12 cases), spinal infections (6 cases) and spinal cord injuries (3 cases). A myelopathy of undetermined etiology was diagnosed in 19 cases. MRI is very sensitive in multiple sclerosis, but it is not possible to diagnose the disease from abnormal scan only, other supportive laboratory results, such as oligoclonal bands, are necessary. MRI is very useful in evaluating intraspinal cord parenchymal lesions, such as neoplasms or congenital abnormalities.

Adult↗
PubMed1990

Nuclear medicine studies in the differential diagnosis of diseases with spinal involvement.

Plain X-rays computed tomographic and magnetic resonance images all yield information on the pathophysiology of diseases with spinal involvement. Descriptions of the following nuclear medicine methods are presented: Bone scanning with 99 m-technetium labeled phosphonate complexes used for the evaluation of skeletal metastases, primary bone tumors, traumatic, degenerative, and postoperative changes as well as in inflammatory conditions. Specific radionuclides used for the localization of inflammatory conditions are radioactive labeled leucocytes. Iodine total body scans used to detect spinal metastases of follicular and papillary thyroid carcinoma. 201-thalliumchloride is used as a tumor-marker with high affinity and sensitivity in malignant thyroid tumors. 131- or 123-iodine-meta-iodobenzylguanidine scans used in the detection of metastases of pheochromocytoma and neuroblastoma. Immunoscintigraphy with radioactive labeled anti-CEA antibodies used for the specific labelling of metastases of gastrointestinal tract tumors, melanoma, breast, and ovarian carcinoma. The value of the various nuclear medicine methods in the diagnostic schedule is illustrated in case reports.

Humans↗
PubMed1984

Computed tomography of the lumbar spine: techniques, normal anatomy, pitfalls, and clinical applications.

Normal cross-sectional anatomy and anatomical variants. Detailed line drawings of important features and images from a correlative CT/anatomical study of human cadaver spines will be included. The cross-sectional appearance of deviations from normal anatomy will also be demonstrated. Scanning techniques and methods of image recording. Patient processing efficiency and expeditious data recording and analysis will be stressed. The utility of multiplanar computer reformations will be discussed. Commonly encountered pathological conditions. Examples of intervertebral disc disease, spinal canal and lateral recess stenosis, facet arthropathy, trauma, infections, and neoplasms will be presented. A protocol for the use of intravenous and intrathecal contrast agents will be proposed.

Humans↗
PubMed1995

A longitudinal study of the effect of spinal degenerative disease on bone density in the elderly.

OBJECTIVE: To describe the relationship between spinal degenerative disease and bone density in the elderly both cross sectionally and longitudinally. METHODS: Random population based sample of 113 men and 187 women over 60 yrs of age participating in the Dubbo Osteoporosis Epidemiology Study (a longitudinal population based study of fracture risk factors) who had bone density measured on 2 occasions (average interval 2.5 yrs) and spinal radiographs on one occasion (performed according to a standardized approach). RESULTS: Spinal degenerative disease, of varying severity, was common in this population (osteophytes 69%, disc narrowing 67%, posterior element disease 99%). Scores for osteophytosis, disc narrowing, and posterior element disease (together with age and body mass index) independently explained 43% of the variation in spinal bone density in men (p < 0.00001) and 26% in women (p < 0.00001). The rate of change at the spine increased with increasing severity of osteophytosis in both men (p = 0.03) and women (p = 0.05), but not the other measures, and the total amount of variation explained by these measures was modest. In comparison, severity of spinal degenerative disease had only a modest but significant relationship with femoral neck bone density in both sexes, but not its rate of change. Subjects with any degree of osteophytosis had higher bone density compared to those without osteophytes at both the lumbar spine (men 21% higher, 95% CI 12-31; women 16% higher, 95% CI 9-23) and, to a lesser extent, femoral neck (men 12% higher, 95% CI 4-20; women 6% higher, 95% CI 1-13). Vascular calcification had no relationship with bone density at either spine or hip. CONCLUSION: Spinal bone density measurement and its sequential followup may be erroneous in the elderly due to concomitant degenerative disease. Bone density at the femoral neck was much less affected by spinal degenerative disease, which suggests that this site may be more efficacious for both monitoring response to treatment and determining fracture risk in the elderly.

Absorptiometry, Photon↗
PubMed1992

The diagnostic impact of magnetic resonance imaging on the evaluation of suspected spinal cord disease.

The data from 262 patients studied consecutively for suspected spinal cord disease were analysed to determine the utility of magnetic resonance imaging (MRI) in this clinical setting. Damage to the spinal cord was detected in a total of 188 (72%) patients and was caused by myelocompression in two thirds and by intramedullary lesions in one third of the patients. Misleading sensory levels 5 to 12 segments below the actual lesion site were seen in 26% of patients with both extra- and intramedullary types of abnormality. A negative spinal MRI implied predominantly demyelinating or inflammatory origin of the clinical symptomatology, as was indicated by additional MRI studies of the brain and CSF findings. It is concluded that MRI is the procedure of choice for assessing patients with medullary symptoms. Irrespective of localizing neurologic findings the evaluation of the entire spine and even of the brain may be necessary to obtain maximum diagnostic information.

Adolescent↗
PubMedDate not supplied

Somatosensory evoked potentials after posterior tibial nerve stimulation in focal spinal cord diseases.

We investigated the somatosensory evoked potentials (SEPs) produced by posterior tibial nerve (PTN) stimulation in 8 infants and children with focal spinal cord disorders. The spinal responses of the PTN-SEPs were considered to assist in the localization of spinal lesions because their abnormalities were consistent with the neurologic and/or radiologic findings in all 6 examinations that revealed abnormal spinal SEPs. The cortical responses correlated significantly with proprioception in the lower limbs because proprioception was only disturbed when the cortical SEPs were absent (3 examinations). When both the spinal and cortical responses were abnormal, the spinal lesion probably involved the dorsal column so extensively that it completely interrupted the afferent impulses. In contrast, when SEP studies demonstrated abnormal spinal and normal cortical SEPs (3 examinations), the dorsal column involvement was probably less severe; therefore, both the spinal and cortical responses provided useful information regarding afferent conduction in the dorsal column. PTN-SEPs appear to have the potential to be of value in the diagnosis of focal spinal disease, especially in infants and young children who cannot cooperate with detailed neurologic examinations.

Child↗
PubMed1995

Influence of degenerative joint disease on spinal bone mineral measurements in postmenopausal women.

We assessed the impact of various forms of spinal degenerative joint disease (DJD) on bone mineral density (BMD) measured by quantitative computed tomography (QCT) and dual X-ray absorptiometry (DXA) in a group of postmenopausal women. Lateral (T4-L4) and AP (L1-L4) spinal radiographs were reviewed for fracture and DJD in 209 women (mean age 62.6 +/- 6.7). The severity of DJD findings was graded as 0, 1, or 2 on the lumbar films, except for vertebral osteophytes which were graded from 0 to 3. Vertebral fractures were defined semiquantitatively as approximately 20% reduction in anterior, middle, or posterior vertebral height. BMD was measured in all subjects by QCT and DXA, including posteroanterior DXA (PA-DXA), lateral DXA (L-DXA) and midlateral DXA (mL-DXA). When BMD was measured by QCT and mL-DXA in the 168 women without fractures, no significant differences were found between women with and those without DJD. However, BMD by PA-DXA was significantly higher in women with DJD changes, particularly when osteophytes were present at the vertebral bodies or facet joints. BMD by L-DXA was less affected by DJD. For this measurement a significant increase in BMD was only noted in subjects with vertebral osteophytes. Multivariate analysis of variance (MANOVA) showed that BMD by QCT and mL-DXA was not affected by DJD. In contrast, for all women, BMD by PA- and L-DXA was affected more by DJD than by fracture status. Chi-square testing demonstrated no significant relationships between vertebral fractures and any of the DJD changes. We conclude that QCT and mL-DXA are superior to PA-DXA and L-DXA in detecting bone loss in patients with DJD. Thus, for these patients, BMD assessment by QCT or mL-DXA may be advisable.

Absorptiometry, Photon↗
PubMed2003

[History and development of spinology].

Spinal disease is the injury caused by congenital malformation, degeneration, inflammation and trauma. These injuries lead to structural lesion of spinal itself, intervertebral discs, spinal cord, nerve root and the attachment, and can cause spinal and associated diseases. Spinal diseases include some frequently encountered diseases, as well as some stubborn and serious diseases. These diseases may cause pain of head and neck, shoulder and arm, waist and leg when they are mild, and partial or thorough paralysis when they are serious. In this article, the history, development, foundations and research progress of non-surgical operation of spinal diseases and the developing tendency of modern spinology are introduced.

Animals↗
PubMed1999

[Surgical treatment of low back pain].

Sciatica in low back pain is usually caused by lumbar disc herniation, degenerative spinal disease or lumbar spinal stenosis. Important pathogenetic factors are mechanical compression of and inflammatory changes in nerve roots caused by nucleus pulposus tissue. Decompression of nerve roots and removal of nucleus pulposus tissue are the main surgical goals. Emphasis should be placed on clinical identification of the symptomatic nerve roots. Computerized tomography (CT) and magnetic resonance (MR) imaging are the most important diagnostic tools today. Plain X-ray may be required for correct identification of the lowest mobile segment. Functional myelography combined with CT may be required to diagnose lumbar spinal stenosis. A proper selection of patients for surgery seems to be more important for a successful outcome than whether macro- or microsurgery is used, or wether the operation comprises one or several nerve roots. The combination of clear nerve root affection, mechanically provoced pain, and corresponding pathological findings at imaging are the best predictors of successful outcome. Psychosocial stability is an additional positive predictive factor. Impaired fibrinolysis occurring in smokers and in sedentary and obese patients, may be a negative predictive factor.

Decompression, Surgical↗