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PubMed2002

Strontium-89 (Metastron) and the bisphosphonate olpadronate reduce the incidence of spinal cord compression in patients with hormone-refractory prostate cancer metastatic to the skeleton.

Spinal cord compression (SCC) is a devastating complication of metastatic cancer. We investigated the potential beneficial effect of two palliative therapies--strontium-89 (Metastron) and the nitrogen-containing bisphosphonate olpadronate--on the incidence of SCC in hormone-refractory prostate cancer (HRPC) metastatic to the skeleton. We retrospectively studied 415 patients with histologically proven prostate cancer who underwent bone scintigraphy at the time of diagnosis and were followed up at the Leiden University Medical Center between 1990 and 1999. Medical or surgical castration was undertaken in 172 patients with evidence for skeletal metastases. Within 2 years, 147 of these patients (85%) developed HRPC associated with severe progressive bone pain. Palliative treatment was given to 131 patients in the form of local radiotherapy ( n=10), 89Sr ( n=46) or intravenous olpadronate ( n=66), with ( n=57) or without ( n=9) maintenance oral olpadronate. Nine patients received both 89Sr and olpadronate at various intervals. Sixteen patients who did not receive any of these treatments were used as historical controls. There was no significant difference in baseline characteristics between treatment modalities. The incidence of SCC was 17% in the whole group, and highest in controls receiving no palliation (50%). None of the patients treated with local radiotherapy, only 4% of patients receiving 89Sr and 21% of patients given olpadronate developed this complication. Our findings suggest a significant reduction in SCC in patients with symptomatic HRPC metastatic to the skeleton who receive palliative therapies. Local radiotherapy completely prevents the incidence of SCC, 89Sr leads to an important decrease in this complication and olpadronate induces a significant, albeit smaller decrease in the incidence of SCC. The use of these agents opens new avenues in the difficult management of patients with advanced prostate cancer who are most at risk of developing SCC.

Aged↗
PubMed2006

Spinal cord compression secondary to bone metastases from hepatocellular carcinoma.

Bone metastases are rare in primary hepatocellular carcinoma (HCC). Spinal cord compression (SCC) due to bone metastases occur commonly in patients with lung and breast carcinomas, and metastatic HCC is an unusual cause of SCC. Spinal cord compression is an oncologic emergency and treatment delays can lead to irreversible consequences. Thus, the awareness that SCC could be a potential complication of bone metastases due to HCC is of significance in initiation of early treatment that can improve the quality of life and survival of the patients, if diagnosed earlier. This paper describes four cases of primary HCC with varied manifestations of SCC due to bone metastases. The first patient presented primarily with the symptoms of bone pains corresponding to the bone metastases sites rather than symptoms of associated hepatic pathology and eventually developed SCC. The second patient, diagnosed as having HCC, developed extradural SCC leading to paraplegia during the course of illness, for which he underwent emergency laminectomy with posterior fixation. The third patient developed SCC soon after the primary diagnosis and had to undergo emergency laminectomy. Post laminectomy he had good neurological recovery. The Fourth patient presented primarily with radicular pains rather than frank paraplegia as the first manifestation of SCC.

Aged↗
PubMed1994

Spinal cord compression immediately following, but unrelated to, epidural analgesia.

A patient developed spinal cord compression following epidural analgesia. The diagnosis was made difficult by the presence of epidural analgesia, although the compression was not in fact related to the analgesic technique employed. This case highlights the need for close observation of patients in whom epidural analgesia is, or has recently been, employed and the need to consider alternative reasons for neurological deficit.

Adult↗
PubMed1997

Spinal cord compression by secondary epi- and intradural metastases in childhood.

Over a 9-year period, 35 out of 614 children with malignant tumours who were treated at the Centre Léon Bérard developed spinal metastases. Of these, 18 with known malignancies before the development of spinal cord compression are reviewed. The most common tumours causing spinal metastases were Ewing's sarcoma, neuroblastoma and renal tumours. Cord compression occurred 5-88 months after the diagnosis of systemic cancer. The median interval from first symptoms to the diagnosis of compression was 17 days. There were 16 patients with neurological deficit, including 5 with paraplegia. Specific imaging procedures were performed in 16 patients. Treatment included operation in 8 patients, followed by chemotherapy (6 patients) and/or radiotherapy (4 patients); 9 of the 10 non-operated patients received radiotherapy. Only 6 patients had a significant neurological improvement. All patients but 1 died within a median time of 2 months. Early diagnosis might prevent permanent disability in these children with a short survival expectancy.

Adolescent↗
PubMed1992

Spinal cord compression in widely metastatic Wilms' tumor. Paraplegia in two children with anaplastic Wilms' tumor.

Spinal cord compression in Wilms' tumor is a rare event, generally caused by invasion of the canal by paraspinal lesions or metastatically involved vertebral bodies. This case report reviews the clinical presentation, radiologic evaluation, and emergent therapy in two cases of spinal cord compromise involving patients with widely metastatic Wilms' tumor. One of these is the only known report of intradural metastasis in a child with this malignancy. Both cases illustrate the importance of anticipating and rapidly responding to neurologic complications that may arise in patients with aggressively metastatic Wilms' tumor.

Child, Preschool↗
PubMed2001

Kinematic analyses of air-stepping of neonatal rats after mid-thoracic spinal cord compression.

Although human infants suffer traumatic spinal cord injury, appropriate animal models have not been developed. The consequences of neonatal injury are not necessarily the same as in adults, so treatments designed for adults may not generalize to infants. Therefore, understanding the effects of traumatic injury to the developing cord is important. In this experiment, mid-thoracic spinal cords of 4-day-old rats were compressed with forceps by 0% (sham), 90% or 95% of the uncompressed width. On postoperative day (POD) 1 or 11, rats were suspended in harnesses and administered L-DOPA to activate locomotor circuits. Slight modifications of interlimb coordination remained on POD 11 following the lesser compression, whereas the amount of hindlimb air-stepping, step rates, step lengths and coordination were reduced and declined post-operatively following the greater compression. Lesions were proportional to severity of compression. Progressive motor dysfunction during air-stepping revealed deficits in descending control of lumbar circuits, whereas previous reports of recovery of overground walking probably reflect activation of reflex mechanisms caudal to the transection.

Animals↗
PubMed1982

Spinal cord compression by extradural fat after prolonged corticosteroid therapy.

This young man was operated on twice for thoracic spinal cord compression. He had been on corticosteroid therapy for the last 2 years subsequent to a renal transplant. The only anomaly discovered during the operation was a large quantity of extradural fat that did not present the characteristics of lipoma. The remarkable postoperative clinical improvement suggested that the fat deposit was responsible for the spinal cord compression.

Adipose Tissue↗
PubMed1995

The Barthel Index in assessing the response to palliative radiotherapy in malignant spinal cord compression: a prospective audit.

A prospective study of functional assessment of response to palliative radiotherapy (RT) in malignant spinal cord compression (SCC) is reported. The relevant components of the Barthel Activities of Daily Living Index (ADLI: walking, transfer, and bladder and bowel control) were used to assess functional capacity, and compared with a standard neurological assessment. Fifty-one consecutive patients (38 men, 13 women; mean age 63.9 years) were assessed, all of whom were treated by primary or postoperative radiotherapy. Five of the 51 patients had had decompressive laminectomy prior to RT. Median survival was 34 days (range 2-570). Walking improved in only five of 12 patients who had an improvement in motor power. The ability to transfer from bed to chair improved in 11 patients. Ambulation at presentation was the single most important determinant of outcome. Of the eight patients ambulatory at presentation, all were alive at 1 month and seven remained ambulatory. Of the 43 non-ambulatory patients, only four were able to walk following treatment (all prostatic carcinomas). Only four patients regained urinary continence, and none regained bowel control after this was lost. Functional assessment using ADLI and standard neurological examination provide a more useful guide to outcome in malignant SCC than neurological examination alone.

Adolescent↗
PubMed1992

Radiation therapy of spinal cord compression caused by breast cancer: report of a prospective trial.

Fifty-six breast cancer patients with metastatic spinal cord compression were consecutively treated with radiation therapy alone. All patients received steroids plus chemotherapy and/or hormonal therapy. Emergency radiation therapy was administered using a split-course regimen: 5 Gy for 3 days, stopped for 4 days and, only in responders, a further 3 Gy for 5 days (time dose fractionation 68). Median follow-up was 22 months (range, 4 to 52 months). Response and survival were assessed on the basis of, pretreatment and posttreatment walking capacity, presence of vertebral body collapse or osteolysis, presence of other metastatic sites apart from bone and chemotherapy and/or hormonal therapy. In 89% of patients with back pain the pain disappeared or lessened. Four of 6 cases (67%) with urinary dysfunction responded to radiation therapy. Of 35 cases with motor dysfunction at the time of diagnosis, 21 (60%) regained the ability to walk and another five (14%) who were able to walk with support at diagnosis did not deteriorate. All 21 cases without motor deficits before treatment maintained good motor performance after radiation therapy. Response to therapy was better in pretreatment walking than in nonwalking patients (97% vs 69%; p less than 0.02). Probability of duration of response at 1 year was 59% and 10% for posttreatment walking and nonwalking patients, respectively (p less than 0.0001). One year survival probability was 66% for posttreatment walking and 10% for posttreatment nonwalking patients, respectively (p less than 0.0001). Pretreatment and posttreatment ambulatory status were the most important prognostic factors.

Adult↗
PubMed1986

[Spinal cord compression complicating gynecological malignancy--report of four cases].

Five episodes of spinal cord compression (SCC) in four patients with gynecological malignancy are described. Two patients had a recurrent cervical cancer, one had a recurrent uterine sarcoma, and one had a primary ovarian cancer. All presented with back pain, and the site of compression was at the thoracic spine. Three patient were treated with radiotherapy, and one underwent decompression laminectomy followed by radiotherapy. One patient improved, but the other three did not. SCC is an oncologic emergency, which should be borne in mind by all physicians who take care of cancer patients.

Adenocarcinoma↗
PubMedDate not supplied

Spinal cord compression by extramedullary hematopoietic tissue in a thalassemic patient: prompt effect of radiotherapy.

As described in the literature, spinal cord compression by extramedullary hematopoietic tissue rarely occurs in thalassemic patients. Laminectomy and/or radiotherapy are the main approaches. We report on a patient with thalassemia intermedia who developed paralysis of both lower extremities due to the compression of the spinal cord by extramedullary hematopoietic tissue.

Adult↗
PubMed2004

A no-laminectomy spinal cord compression injury model in mice.

The purpose of this study was to develop a minimally invasive recovery model of spinal cord injury in the C57Bl/6J mouse. Without laminectomy, the epidural space was exposed by disruption of the T10-T11 interspinous ligament. Perpendicular to the rostral-caudal axis of the spine, a 1.5-mm silicone tube (O.D. 0.047 in.) was placed in the T11 epidural space. Prior to placement, a suture was passed through the tube allowing withdrawal of the tube after discontinuation of anesthesia. After 1, 30, 60, or 120 min (n = 5-8) of spinal cord compression (SCC), the tube was withdrawn. Neurological function was measured at 1, 3, 7, and 14 days after injury followed by histologic analysis. BBB locomotor score, rotarod latency, and screen grasping were worsened in a SCC duration-dependent manner (p < 0.0001). With increasing SCC duration, the number of histologically normal neurons in the ventral horns decreased (p < 0.0001) while the cross-sectional area of spinal cord with pancellular necrosis increased (p < 0.0001). Increased duration of SCC caused progressive rostral-caudal spread of histologic damage. The results indicate that this is a simple, reliable model with neurologic and histologic injury highly dependent on SCC duration. This model may be useful for study of spinal cord injury in genetically modified mice in the absence of anesthetic confounds while leaving the vertebral column intact.

Animals↗
PubMed1990

Epidural spinal cord compression as the presenting manifestation of tumor of unknown origin.

Epidural spinal cord compression is a common complication of malignancy. In the majority of cases, the primary site is known at diagnosis or is evident following limited investigation. During the period January 1975 to December 1987 we encountered seven cases of tumor of unknown origin presenting as cord compression. Myelography detected the site of cord involvement in six cases, and computed tomography of the spine was utilized in one case. All seven patients underwent laminectomy. Histologic diagnosis was adenocarcinoma in four cases, squamous in one case, and large cell undifferentiated carcinoma in two cases. Evaluation for a primary site was unrewarding. Prognosis was poor, with a median survival of 10 weeks. Only one patient had a satisfactory response to treatment.

Adenocarcinoma↗
PubMed1997

The efficacy of treatment for malignant epidural spinal cord compression.

The aims of this study were to document the efficacy of treatment and to identify factors that were predictive of the outcome in malignant epidural spinal; cord compression. The medical records of patients treated at the Prince Henry and Prince of Wales Hospitals in the period 1980-1989 with a diagnosis of malignant epidural spinal cord compression were reviewed. A total of 94 patients were eligible for the study and were treated by radiotherapy alone (37), surgery alone (19) and surgery followed by radiotherapy (38). Efficacy was determined by measuring complete resolution of symptoms and signs at 1 month after presentation, and also by using an overall functional improvement score (FIS). Complete resolution of individual pre-treatment symptoms that were measured 1 month after treatment occurred as follows: pain (30/88), sensory disturbance (12/61), weakness (8/17), bladder dysfunction (10/42), and bowel dysfunction (10/36). Complete resolution of motor deficit occurred in 7/82 and of sensory deficit in 9/73. The ability to walk was regained in 19/51 previously non-ambulatory patients, and bladder function improved sufficiently to remove an indwelling catheter in 9/32 previously catheterized patients. As judged by FIS, 67 patients improved, 15 patients remained stable and 12 patients deteriorated. Of the treatments given, a combination of surgery followed by radiotherapy was associated with the greatest functional improvement (P = 0.001). The coexistence of 'liver failure' was the only patient-related factor identified which was associated with outcome (P = 0.041). The treatment of malignant spinal cord compression appears to be worthwhile; however, the outcome of treatment is not easy to predict from pretreatment factors. A 'functional improvement score' may be useful in assessing treatment efficacy.

Activities of Daily Living↗
PubMed1994

Calcification of ligamentum flavum causing spinal cord compression in a stroke patient.

Hypertrophy or calcification of the ligamentum flavum may be a cause of spinal cord compression. Most cases have been reported to occur in either the cervical or thoracolumbar region. We report an unusual case of a 59-year-old man admitted to the rehabilitation service with a recent diagnosis of right cerebrovascular accident with left hemiparesis. The patient had a history of gait disturbance, motor weakness, and bowel/bladder changes. Admission FIM scores were approximately 62 with complete dependence in mobility (ie, transfers) and locomotion. Fluctuating changes in his neurological status were observed; further testing led to an uncommon diagnoses of thoracic radiculomyelopathy caused by calcification of the ligamentum flavum. This diagnosis, although rare, should be considered in the diagnosis of patients suspected to have spinal cord compression.

Calcinosis↗
PubMed1987

Conductivity of dorsal column fibers during experimental spinal cord compression and after decompression at various stimulus frequencies.

The effects of spinal cord compression on conduction of dorsal column fibers at various stimulus frequencies were analyzed in pentobarbital anesthetized cats. The responses to L6 dorsal root stimulation at 1 to 500 Hz were recorded from the L2 cord dorsum. The L4 cord segment was compressed gradually until the compound action potential (CAP) at 1 Hz was flat. There was no significant change of CAP at any frequency during the first part of compression, but there was progressive conduction failure, which was more severe with increased stimulus frequency, at a later stage. After decompression, the CAPs at all frequencies recovered progressively for 1 hour but slowly thereafter. However, marked differences were observed in recovery rate at different stimulus frequencies. The recovery rate at 500 Hz was much slower than that at 1 Hz, whereas the recovery rate at 100 Hz exceeded those at 1 Hz. Serial analysis of a train of high frequency impulses revealed the following different response patterns with stimulus frequencies after decompression. At 333-500 Hz the amplitude of CAPs decreased progressively, whereas at 33-125 Hz it increased up to 110-134% of the first CAP and then reached an almost steady level. At 200-250 Hz the amplitude increased transiently and then decreased progressively. The latency increased with decreased amplitude, and decreased with increased amplitude. Conduction failure at a high stimulus frequency (500 Hz) was observed at the compression site. In contrast, augmentation of CAPs at moderately high stimulus frequency (100 Hz) was observed rostral to the compressing site. The conduction failure at high stimulus frequency indicates incomplete impairment of spike generation in axons injured by mechanical compression and that these axons can transmit impulses at a low stimulus frequency. High frequency stimulation may be useful for monitoring of the function of the CNS axons. The mechanism underlying the augmentation of CAPs at moderately high stimulus frequency is briefly discussed.

Animals↗
PubMed1982

Spinal cord compression in mycosis fungoides.

Symptomatic involvement of the central nervous system (CNS) with mycosis fungoides is rare, and usually characterized by involvement of meninges. We describe a patient with long-standing mycosis fungoides who developed acute spinal cord compression. Since tumor-related spinal cord compression requires early intervention for a successful outcome, it should be recognized as an additional form of CNS mycosis fungoides.

Humans↗