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PubMed1998

[Multiple epidural metastases and development of secondary metastatic spinal cord compression].

The purpose was to examine the frequency of initial multiple epidural metastases, and the occurrence of secondary spinal cord compression (SCC). One hundred and seven patients with SCC from a histologically verified solid tumour were followed prospectively with regular neurological examinations until death. Multiple metastases were demonstrated in 37 (35%). Eight (7.5%) patients developed a second occurrence of SCC all in a new location within the spinal canal. The second occurrence of SCC was found with the same frequency in patients with single metastases (7.1%) compared to patients with multiple metastases (8.1%). The median survival time after the diagnosis of spinal cord compression was 3.4 months, while in the group of patients who developed a second occurrence of SCC the median survival time was 9.2 months. We concluded that only symptomatic epidural metastases should be irradiated, and that all patients treated for SCC should be followed regularly and observed for development of a second SCC.

Aged↗

PubMed2000

Effects of core body temperature on changes in spinal somatosensory-evoked potential in acute spinal cord compression injury: an experimental study in the rat.

STUDY DESIGN: Acute spinal cord injury was induced by a clip compression model in rats to approximate spinal cord injury encountered in spinal surgery. Spinal somatosensory-evoked potential neuromonitoring was used to study the electrophysiologic change. OBJECTIVES: To compare and correlate changes in evoked potential after acute compression at different core temperatures with postoperative neurologic function and histologic change, to evaluate current intraoperative neuromonitoring warning criteria for neural damage, and to confirm the protective effect of hypothermia in acute spinal cord compression injury by electrophysiologic, histologic, and clinical observation. SUMMARY OF BACKGROUND DATA: With the increase in aggressive correction of spinal deformities, and the invasiveness of surgical instruments, the incidence of neurologic complication appears to have increased despite the availability of sensitive intraoperative neuromonitoring techniques designed to alert surgeons to impending neural damage. Many reasons have been given for the frequent failures of neuromonitoring, but the influence of temperature-a very important and frequently encountered factor-on evoked potential has not been well documented. Specifically, decrease in amplitude and elongation of latency seem not to have been sufficiently taken into account when intraoperative neuromonitoring levels were interpreted and when acceptable intraoperative warning criteria were determined. METHODS: Experimental acute spinal cord injury was induced in rats by clip compression for two different intervals and at three different core temperatures. Spinal somatosensory-evoked potential, elicited by stimulating the median nerve and recorded from the cervical interspinous C2-C3, was monitored immediately before and after compression, and at 15-minute intervals for 1 hour. RESULTS: Spinal somatosensory-evoked potential change is almost parallel to temperature-based amplitude reduction and latency elongation. Significant neurologic damage induced by acute compression of the cervical spinal cord produced a degree of effect on the amplitude of spinal somatosensory-evoked potential in normothermic conditions that differed from the effect in moderately hypothermic conditions. Using the same electromonitoring criteria,moderately hypothermic groups showed a significantly higher false-negative rate statistically (35%) than normothermic groups (10%). CONCLUSIONS: Systemic cooling may protect against the detrimental effects of aggressive spinal surgical procedures. There is still not enough published information available to establish statistically and ethically acceptable intraoperative neuromonitoring warning and intervention criteria conclusively. Therefore, an urgent need exists for further investigation. Although a reduction of more than 50% in evoked potential still seems acceptable as an indicator of impending neural function loss, maintenance of more than 50% of baseline evoked potential is no guarantee of normal postoperative neural function, especially at lower than normal temperatures.

Acute Disease↗

PubMed1979

Malignant fibrous histocytoma producing spinal cord compression.

Three cases of malignant fibrous histiocytoma presented as primary paraspinal tumours causing extradural spinal cord compression. Study of these cases suggests that pain relief is considerable after laminectomy but pain may recur with further tumour growth. Total removal is unrealistic and diagnosis, difficult. The prognosis in terms of continuing neurological deficit after surgery followed by local radiotherapy appears poor.

Female↗

PubMed1996

C1-C2 fusion in children with atlantoaxial instability and spinal cord compression: technical note.

Children with atlantoaxial instability and subluxation that will not reduce with extension of the cervical spine often present with clinical and/or radiographic evidence of spinal cord compression at the C1-C2 level. If the patient requires a laminectomy at the C1 level, occipital fusion is necessitated with associated reduction in mobility and high incidence of nonunion, as compared with a C1-C2 fusion. Also, passing wires under the intact lamina at C1 can further compromise an already compressed cervical cord. To address the problems associated with either of the above options, we used a C1-C2 fusion with removal of the mid 2 cm of the lamina of C1. Another option is the application of a transarticular screw fixation of C1-C2, which does not require the posterior element of C1. The current study was performed before the introduction of this type of fixation. Over a 10-year period, we have used the described technique to treat 13 patients. After decompression and fusion at the C1 and C2 levels as described, all patients had resolution of their preoperative neurological symptoms and all have achieved a stable fusion. Partial removal of the lamina at C1 and then C1-C2 fusion are safe and effective procedures to treat children with atlantoaxial instability and spinal cord compression.

Adolescent↗

PubMed2001

Spinal cord blood flow changes following systemic hypothermia and spinal cord compression injury: an experimental study in the rat using Laser-Doppler flowmetry.

STUDY DESIGN: It is well known that changes of the body temperature as well as trauma influence the blood flow in the brain and spinal cord. However, there is still a lack of knowledge concerning the levels of blood flow changes, especially during hypothermia. OBJECTIVES: This investigation was carried out to examine the effects of systemic hypothermia and trauma on spinal cord blood flow (SCBF). METHODS: Twenty-four rats were randomized either to thoracic laminectomy only (Th VII-IX) or to 35 g spinal cord compression trauma. The animals were further randomized to either constant normothermia (38 degrees C) or to a systemic cooling procedure, ie reduction of the esophageal temperature from 38 to 30 degrees C. SCBF was recorded 5 mm caudal to the injury zone using Laser-Doppler flowmetry which allows a non-invasive continuous recording of local changes in the blood flow. The autoregulation ability was tested at the end of the experiments by inducing a 30-50 mmHg blood-pressure fall, using blood-withdrawal from the carotid artery. RESULTS: The mean SCBF decreased 2.8% and 3.5% per centigrade reduction of esophageal temperature in the animals sustained to hypothermia with and without trauma, respectively. This could be compared to a decrease of 0.2%/min when only trauma was applied. No significant differences were seen between the groups concerning auto regulatory ability. CONCLUSIONS: Our results indicate that the core temperature has a high impact on the SCBF independent of previous trauma recorded by Laser-Doppler flowmetry. This influence exceeds the response mediated by moderate compression trauma alone.

Animals↗

PubMed1997

MRI and CT of metastatic hepatocellular carcinoma causing spinal cord compression.

We report the imaging features in five patients with metastatic hepatocellular carcinoma causing spinal cord compression, three of which were biopsy proven and two were in patients with known diagnosis of hepatocellular carcinoma. The radiographic, magnetic resonance imaging (MRI) and computed tomography (CT) features are highlighted. Although the occurrence of metastatic disease in hepatocellular carcinoma is exceedingly rare, it may be increasingly encountered as survival of patients is improved with advancing methods of therapy, both surgical and palliative. It often accompanies local recurrence, and invariably signals a grave prognosis with extremely short life expectancy. Unusually, two of the five patients in this series presented initially with skeletal metastases which led to the diagnosis of hepatocellular carcinoma.

Adult↗

PubMed1961