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PubMed1995

[Value of local radiotherapy in treatment of osseous metastases, pathological fractures and spinal cord compression].

Local radiotherapy plays an important and responsible role in the management of bone metastases. The valence will be described according to the different treatment objectives in the sense of pain relief, remineralization and cord decompression. Radiotherapy schedules, aimed at the relief pain, need to take into consideration life expectancy. Patients with a reduced life expectancy could have a good high chance of achieving pain relief with a single dose of 8 Gy. Patients with a solitary metastasis, patients with a longer life expectancy and patients with a pathological fracture should be treated with 'curative' irradiation doses, aimed at killing the maximum number of tumor cells. In addition to pain relief, remineralization is also an important treatment goal. Conventional radiotherapy with doses of 40-50 Gy resulted in pain relief in 70-100% and in remineralization in 60-80% of the patients. Remineralization could not be accelerated by short-course fractionation courses, but resulted in faster pain relief. Short-course fractionation schedules are not indicated as a 'standard' treatment in the vertebral column. Surgery is the treatment of choice for immediate cord decompression and stabilization of a pathological vertebral fracture. Radiotherapy alone could decrease neurological impairment and is suitable for patients with gradual onset and progression of symptoms, no spinal instability and lesions of the cauda equina.

Bone Neoplasms↗
PubMed1989

Endemic fluorosis with spinal cord compression. A case report and review.

We report a case of spinal cord compression in a Mexican immigrant due to vertebral osteosclerosis from chronic fluoride intoxication. Endemic fluorosis is acquired through drinking water. Groundwater sources with high fluoride content occur worldwide. The epidemiology, metabolism, and clinical features of fluorosis are reviewed. Greater physician awareness of this entity is important to identify correctly patients with this unusual and potentially devastating clinical disorder.

Aged↗
PubMed2000

Selected neurologic complications in the patient with cancer. Brain metastases and spinal cord compression.

Nurses play a key role in care of patients with brain metastases and spinal cord compression. Care of this patient population is unique because the skills and knowledge of medical-surgical, neurologic, oncologic, and critical care nurses are required. With the wide variability among patients, a highly individualized care plan is necessary to meet the tremendous challenges of caring for patients with metastatic central nervous system disease.

Brain Neoplasms↗
PubMed1999

[Thoracic spinal cord compression by a gouty tophus. Case report. Review of the literature].

An unusual case of thoracic spinal cord compression caused by extradural tophaceous deposits is reported in a 59-year-old female with a long-standing history of gout involving the metatarsophalangeal joints. T1 and T2 magnetic resonance images of the spine illustrated an extradural hyperintense signal extending from T2 to T9. A decompressive laminectomy disclosed a white caseum-like material in the extradural space, together with a small organized hematoma. Histologic examination showed areas of amorphous substance containing urate crystals surrounded by inflammatory cells, which was diagnosed as a gouty tophus. The patient made an uneventful recovery after surgery. Fifteen similar cases of the literature are reviewed. Although spinal involvement by gout seems relatively common, a compression of the spinal cord or of the cauda equina in gout patients seems exceptional. The diagnosis should be considered in patients showing a relevant history of gout, but spinal cord compromise may also represent the initial manifestation of the disease.

Arthritis, Gouty↗
PubMed2005

Early detection and treatment of spinal cord compression.

Several key areas must be considered in the diagnosis and management of spinal cord compression. Because the outcome can be devastating, a diagnosis must be made early and treatment initiated promptly. Although any malignancy can metastasize to the spine, clinicians should be aware that this occurs more commonly in certain diseases, i.e., lung cancer, breast cancer, prostate cancer, and myeloma. The current algorithm for early diagnosis of spinal cord compression involves neurologic assessment and magnetic resonance imaging of the entire spine. Treatment generally consists of intravenous dexamethasone followed by oral dosing. Depending on the extent of the metastases, symptoms may also be managed with nonnarcotic pain medicines, anti-inflammatory medications, and/or bisphosphonates, with local radiation administered as needed. Surgery has often led to destabilization of the spine.

Administration, Oral↗
PubMed1989

Spinal cord compression due to intradural extramedullary aspergilloma and cyst: a case report.

A case of thoracic spinal cord compression caused by intradural extramedullary cyst associated with aspergilloma is presented. The specific diagnosis was extremely difficult and required specialized tissue studies. Clinical suspicion of fungal infection, surgical intervention for spinal cord decompression, and tissue biopsy and relentless diagnostic laboratory studies are particular features of this case.

Adult↗
PubMed2001

[Vertebral actinomycosis with spinal cord compression. A case report].

INTRODUCTION: Vertebral involvement of actinomycosis is extremely rare and associated spinal cord compression is unusual. EXEGESIS: We report a case of a 31-year-old man with vertebral actinomycosis presenting with spinal cord compression. Magnetic resonance imaging demonstrated a paravertebral abscess and lytic areas on the vertebral body of C5 requiring emergency surgery and antibiotic treatment. The patient was still asymptomatic after 12 months of follow-up. CONCLUSION: Clinical aspects of this unusual localization are reviewed. Treatment may be particularly difficult.

Abscess↗
PubMed2006

Spinal cord compression in a patient with multiple hereditary exostoses caused by breast adenocarcinoma metastatic to osteochondromas of the spine: case report.

STUDY DESIGN: Case report. OBJECTIVE: To report on thoracic spinal cord compression caused by a mass in a 66-year-old female with new onset of myelopathic symptoms and a history of multiple hereditary exostoses. SUMMARY OF BACKGROUND DATA: To our knowledge, there have been no previous reports of spinal cord compression in a patient with multiple hereditary exostoses caused by breast adenocarcinoma metastatic to osteochondromas of the spine. METHODS.: Chart, pathologic, and radiographic documentation of the preoperative and postoperative clinical course of the patient was used. RESULTS: The patient had resolution of her neurologic symptoms following wide surgical excision, decompression, and stabilization from T2 to T10. The patient's mass was found to be breast adenocarcinoma metastatic to osteochondromas of the spine. CONCLUSIONS: When faced with a patient with a history of multiple hereditary exostoses with new onset of myelopathic symptoms and a mass compressing the spinal cord, the clinician's differential should be broad and always initially include a metastatic lesion, osteochondroma, or chondrosarcoma.

Adenocarcinoma↗
PubMed1980

The treatment of hypotension due to acute experimental spinal cord compression injury.

The therapeutic value of elevating the systemic blood pressure was studied in an acute spinal cord compression injury model in rats. In this model an acute spinal cord compression at T1 by a 180 gram clip for one minute consistently produced profound hypotension, and untreated animals served as controls. Treated animals had their mean systemic blood pressure raised for one hour after injury. Functional recovery was assessed weekly for eight weeks post-operatively by the inclined plane method. It was found that with noradrenaline mean systemic blood pressure could be maintained at normotensive (100 to 120 mmHg) or hypertensive levels (125 to 150 mmHg) for one hour after injury, but that this had no effect on the functional recovery of the animals.

Animals↗
PubMed1998

Metastatic spinal cord compression as initial presentation of follicular thyroid carcinoma.

Follicular thyroid carcinoma, initially presenting as spinal cord compression due to metastatic lesions, is a less reported event. We present two cases of well-differentiated thyroid carcinoma that led to spinal cord compression. A thorough search of the literature revealed only five similar cases. We summarize the clinical characteristics of these cases, the therapeutic measures used, their outcome, and the prognosis.

Adenocarcinoma, Follicular↗
PubMed1991

Epidural spinal cord compression from metastatic cancer: clinical features and management.

We retrospectively analyzed thirty-three patients (21 males, 12 females) with malignancy induced spinal cord compression (SCC). The mean age of the patients was 42.8 years and almost half (51%) of them presented with SCC. Mean duration of symptoms was 4.5 months and the mean interval between the original diagnosis of cancer and the development of SCC was 14.6 months. Back pain was the most frequent (97%) symptom with an equal number of patients having subjective or objective evidence of lower limb weakness. Majority (73%) of the patients were non-ambulatory at the time of diagnosis. Spinal level involvement was mostly thoracic (62%) followed by lumber (38%). Breast cancer was the commonest underlying malignancy (21%). Lung (12%), prostrate (12%), multiple myeloma (9%), and carcinoma with unknown primary (12%) were also frequently encountered. There was an overall response rate of 22% to the therapeutic interventions: mostly observed in the ambulatory patients. Only 7% of the non-ambulatory patients regained ability to walk. None of the responders had bladder or bowel dysfunction. Twenty-two percent of the responders are still ambulatory with a mean follow-up of six months.

Adolescent↗