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PubMed2005

Acute spinal cord compression in hereditary multiple exostoses.

Osteocartilaginous exostoses are benign bone tumors frequently found in the metaphysis of long bones but rarely in the spine. Four patients with acute spinal cord decompensation due to vertebral exostoses spinal cord compression have been previously described in the literature. We report an additional case of rapidly evolving spinal cord compression due to a cervical osteochondroma in a patient with hereditary multiple exostoses (HME), also known as Bessel Hagen disease. Careful analysis of the 5 cases suggested to us that patients with HME should have a systematic spinal imaging screening, in order to prevent rapid neurological decompensation. A minimal risk surgical procedure can be performed at a time of election.

Adult↗
PubMed1999

Abnormally large evoked potentials arising from dorsal column fibers in the region of chronically compressed spinal cord.

OBJECTIVE: To understand the origin and mechanism of the large evoked potentials known to occur in chronically compressed spinal cord. METHODS: Electrophysiological analysis was made of evoked potentials produced in the cervical cord compressed for more than 1 year by rotating a screw in the vertebral body, in 4 adult cats. RESULTS: In all cats, manifesting no motor disturbance, large positive or negative evoked potentials were recorded from the cord dorsum at the compressed region following lumbar cord stimulation. These potentials followed high-frequency stimulation and were judged as conducting volleys of directly activated fibers. Intraspinally, single fiber spikes, normally barely recordable with the glass microelectrodes, were recorded extracellularly from localized areas within the dorsal column restricted to the compressed region. Such single fibers showed slowed conduction at the compressed region without a conduction block. Histologically, demyelinated fibers were observed in localized areas in the dorsal column of the compressed region. CONCLUSION: We concluded that the large abnormal surface potentials originated from the dorsal column and were attributed to an increase in action current in affected fibers, which presumably occurred associated with demyelination.

Animals↗
PubMed1989

Magnetic resonance imaging in suspected metastatic spinal cord compression.

This study describes high field magnetic resonance imaging (MRI), in 55 patients with suspected metastatic spinal cord compression. MRI, principally using T1-weighted sagittal surface coil images, showed evidence of cord compression in 29 patients, and intramedullary masses in three patients. MRI clearly showed the site, nature and extent of the cord compression and gave useful additional information about the presence of bone marrow metastases and paravertebral soft-tissue masses. Comparison with conventional myelography was possible in 21 patients and MRI was superior or equivalent to myelography in 18 patients and inferior in three patients. MRI is the method of choice for the investigation of patients with suspected metastatic spinal cord compression.

Adolescent↗
PubMed1980

The effect of exogenous thyroid hormones on functional recovery of the rat after acute spinal cord compression injury.

The effect of triiodothyronine (T3) or thyroxine (T4) on functional recovery after acute spinal cord compression injury in the rat was assessed. Rats treated with T3 for 14 consecutive days after injury showed significantly improved recovery at 12 and 16 weeks, and rats treated with T4 for 4 days after injury showed significantly improved recovery at 12 weeks as compared with control animals. The possible modes of action of these two hormones on the injured spinal cord are briefly discussed.

Acute Disease↗
PubMed1993

Malignant spinal cord compression: a prospective evaluation.

PURPOSE: To determine the influence of treatment on ambulancy, pain control and functional outcome of patients with Malignant Spinal Cord Compression. METHODS AND MATERIALS: One hundred and thirty-seven patients with Malignant Spinal Cord Compression presenting or referred to the Department of Radiation Oncology, Westmead Hospital between August 1, 1989 and August 1, 1990 were studied prospectively. Patients were treated with palliative radiation therapy alone, surgery followed by radiotherapy or surgery alone. Two patients were not treated. Post-treatment outcome was assessed in terms of ambulatory status, improvement in pain and functional independence using the Functional Independence Measure. RESULTS: Thirteen of 16 patients (81%) who were ambulant pre-treatment remained ambulant after treatment. Two of 16 patients (16.5%) who were non-ambulant pre-treatment became ambulant following treatment. Pain improved following treatment in 22 of 30 patients (73%). This benefit was seen equally for ambulant and non-ambulant patients. A high level of functional independence was maintained in patients who remained ambulant. CONCLUSION: We conclude that prompt treatment of patients with Malignant Spinal Cord Compression while still able to walk is effective in maintaining ambulancy and functional independence, and that treatment improves pain in most patients.

Female↗
PubMed1992

The role of radiation therapy in the management of spinal cord compression due to extramedullary haematopoiesis in thalassaemia.

Extramedullary haematopoiesis associated with thalassaemia leading to spinal cord compression is an extremely rare event in the course of the disease. The efficacy of radiation therapy is advocated in the management of such a complication. Two patients with thalassaemia, who had presented with spinal cord compression, were successfully treated by a modest dose of local radiotherapy. In one of the patients, however, radiotherapy was resorted to after an initial decompressive laminectomy and partial removal of the intraspinal haematopoietic mass proved unsuccessful. The other patient was managed solely by radiation therapy.

Adult↗
PubMed1996

Spontaneous, extra-dural haematoma causing spinal cord compression.

We describe a patient with acute compression of the spinal cord by a spontaneous extra-dural haematoma. This rare condition is often misdiagnosed. We believe that an urgent MRI scan is indicated in patients presenting with progressive neurological deficit following spinal trauma. This allows the diagnosis of extra-dural haematoma to be made rapidly and for prompt decompression of the cord.

Aged↗
PubMed1988

Methodological analysis of an experimental spinal cord compression model in the rat.

A technique for producing graded spinal cord compression injuries in rats is described. A metal plate 2.2 x 5.0 mm in size is applied to the exposed spinal dura and loaded with weights. Neurological function is tested postoperatively on an inclined plane. Reading of the maximal angle of rat performance on this plane was found reproducible on comparison between different observers. Laminectomy per se had a minimal effect on the performance. Compression of 35 g for 5 min caused a pronounced but incomplete injury, with almost total recovery within 14 days and with no difference between animals on artificial respiration and those breathing spontaneously. Animals whose spine was fixed during the compression had a better outcome than those without such fixation.

Animals↗
PubMed2004

A prospective evaluation of two radiotherapy schedules with 10 versus 20 fractions for the treatment of metastatic spinal cord compression: final results of a multicenter study.

BACKGROUND: The optimal treatment of patients with metastatic spinal cord compression (MSCC) is still being debated. The current observational multicenter study, performed prospectively by the authors, evaluated two radiotherapy (RT) schedules and prognostic factors with respect to functional outcome METHODS: In the current study, 214 patients with MSCC were irradiated between April 2000 and September 2003 with 30 gray (Gy) per 10 fractions per 2 weeks (n = 110) or with 40 Gy per 20 fractions per 4 weeks (n = 104). Motor function and ambulatory status were evaluated before RT and until 6 months after RT. The following potential prognostic factors were investigated: RT schedule, performance status, age, number of irradiated vertebrae, type of primary tumor, pretreatment ambulatory status, and length of time developing motor deficits before RT. RESULTS: Both groups were balanced for patient characteristics and potential prognostic factors. Motor function improved in 43% of patients after 30 Gy and in 41% of patients after 40 Gy (P = 0.799). Posttreatment ambulatory rates were 60% and 64% (P = 0.708), respectively. A multivariate analysis demonstrated that a slower progression of motor deficits before RT (P < 0.001), a favorable histology of the primary tumor (P < 0.001), and being ambulatory before RT (P = 0.035) were associated with a better functional outcome. RT schedule (P = 0.269) and other variables had no significant impact. Acute toxicity was mild, and late toxicity was not observed during the period of follow-up. Follow-up was 12 (6-28) months in patients surviving >/= 6 months. CONCLUSIONS: Thirty gray per 10 fractions was preferable to 40 Gy per 20 fractions, because it was associated with similar outcome, less treatment time, and lower costs. The type of tumor, pretreatment ambulatory status, and length of time developing motor deficits before RT were relevant prognostic factors and should be considered in future studies.

Adult↗
PubMed1996

Eosinophilic granuloma of C4 causing spinal cord compression.

A rare case of vertebral eosinophilic granuloma (C4) causing spinal cord compression is reported. The clinical, histological and radiological features of this pathological entity are discussed. After surgery a complete neurological recovery was observed. The value, in selected cases, of surgical treatment with total removal of the tumour and reconstruction of the spine to ensure spinal stability and to prevent irreversible neurological deficit is emphasized.

Cervical Vertebrae↗
PubMed1988

Palliative radiotherapy for metastatic malignant melanoma: brain metastases, bone metastases, and spinal cord compression.

The records of all patients receiving palliative radiotherapy for malignant melanoma metastatic to brain, to bone, or with spinal cord compression were reviewed. The median survival of 77 patients with brain metastases from the initiation of radiotherapy was 14 weeks. A statistically improved survival was observed only in the 10 patients who underwent subtotal to total resection of a solitary brain metastasis prior to radiotherapy (median = 36 weeks). No improved survival was observed in the 12 patients with a solitary brain metastasis treated by radiotherapy alone (median = 16 weeks). Multivariate analysis revealed that fraction size, total dose, patient age, sex, and duration of the interval between initial diagnosis and appearance of brain metastases did not significantly influence survival, but the use of chemotherapy was associated with a decreased survival. Twenty six patients with symptomatic and radiographic evidence of 39 bone metastases showed a palliative response rate of 85%. 18 of 20 bony lesions treated with high-dose-per-fraction (greater than or equal to 400 cGy) and 15 of 19 bony lesions treated with conventional fractionation (less than or equal to 300 cGy) were palliated. Total dose, patient age, sex, interval between initial diagnosis of malignant melanoma and the appearance of bone metastases, prior or concurrent chemotherapy, or lesion location did not significantly influence palliation. Seventeen patients were identified with symptomatic and myelographic evidence of spinal cord compression. Complete palliation was observed in 47% (8/17) and partial palliation was observed in 24% (4/17). The overall palliation response rate for neurologic symptoms due to spinal cord compression of 71% appeared to be independent of fraction size and total dose.

Bone Neoplasms↗
PubMed1985

Spinal cord compression in breast cancer.

Myelography was performed on 78 patients with breast cancer who had signs or symptoms compatible with spinal cord compression. Of 42 patients (54%) with extradural defects, 21 (50%) had a complete block. All patients with positive myelograms (M+) had a positive bone scan and 41 of 42 (97%) had positive skeletal x-rays. Except for paraplegia, paraparesis, or a sensory level abnormality, signs and symptoms were usually not precise enough to accurately predict patients with cord lesions; however, back pain, paresthesias, and bladder or bowel dysfunction were significantly more common in M+ patients. Cerebrospinal fluid (CSF) protein was elevated in almost all M+ patients but also in approximately half of the M- group. Cytology and glucose analysis of CSF were not of value in predicting cord involvement. Response to treatment was better for patients with fewer sites of metastatic disease and a shorter time from diagnosis to treatment. There was no notable difference in survival between M+ and M- patients. Myelography remains the most precise tool for diagnosing spinal cord lesions. Unfortunately, the prognosis of patients with metastatic breast cancer is poor regardless of whether spinal cord compression is present.

Adult↗
PubMed1988

Vertebral hemangioma associated with spinal cord compression.

We have described a case in which a vertebral hemangioma caused spinal cord compression in a 14-year-old girl. The diagnosis was originally missed for several reasons, one of which was the failure to obtain a plain film of the spine before ordering both CT and MR studies. This case illustrates the importance of basic diagnostic procedures.

Adolescent↗
PubMed2001

Spinal cord compression, infection, and unknown primary cancers.

The management of a patient with spinal cord compression can be complicated and challenging; however, this challenge becomes even more pronounced if the patient presents without a known cancer diagnosis in the context of progressive neurologic symptoms. Unless potential causes such as infection/tuberculosis are included in the differential diagnosis of an apparent unknown primary, then the correct diagnosis may be incorrectly determined.

Female↗
PubMed1977

Indications for nonoperative treatment of spinal cord compression due to breast cancer.

A retrospective series of 12,478 patients with breast cancer included 2467 patients with spinal metastases. Local treatment was not necessary in 688 patients. Neurological dificit did not develop in 1735 patients who underwent radiotherapy. Forty-four patients developed myelopathy due to spinal cord compression as demonstrated by neurological examination and myelography. Twenty-six of these patients were initially treated by laminectomy and 18 were initially treated with radiotherapy. The two groups did not significantly differ in their outcome with respect to motor power, pain relief, or ability to walk. Six patients who underwent radiotherapy deteriorated during 2 months of treatment. Four of these patients were not operative candidates because of poor general condition (three patients) or long duration of paraplegia (one patient). Of two patients who underwent emergency laminectomy, one became paraplegic; however, the other patient was significantly improved. For this reason it is essential that patients undergoing radiotherapy for spinal cord compression be followed closely by a neurosurgeon. The authors believe that in appropriate cases radiotherapy alone can yield results as good as laminectomy combined with radiotherapy.

Adult↗
PubMed1987

A glucagon-secreting pancreatic alpha islet cell tumor presenting as spinal cord compression.

We describe a patient with a pancreatic islet carcinoma presenting with spinal cord compression owing to vertebral metastases. Subsequent studies demonstrated a typical islet cell carcinoma by light microscopy. By electron microscopy, the neurosecretory granules were morphologically suggestive of glucagon production. Radioimmunoassay studies revealed markedly elevated levels of serum glucagon. Notably, the patient did not exhibit the characteristic glucagonoma syndrome. This case exemplifies clearly that elevated levels of immunoreactive neuropeptide hormones are not necessarily associated with overt hormonal syndromes. Possible mechanisms for explaining this apparent discrepancy include the production of immunoreactive molecules with weak or absent systemic biological activity. Nevertheless, the determination of immunoreactive hormone levels in neuroendocrine neoplasms is an extremely effective adjunct method for their diagnosis and monitoring.

Adenoma, Islet Cell↗