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PubMed2004

Nicotine attenuates oxidative stress, activation of redox-regulated transcription factors and induction of proinflammatory genes in compressive spinal cord trauma.

Pathophysiology of neurodegeneration following spinal cord injury (SCI) involves alterations of cellular redox status, activation of transcription factors and induction of proinflammatory genes. In addition, recent evidence indicates that nicotine can induce potent neuroprotective effects. To study the influence of nicotine on the redox signaling pathways in relationship to SCI, moderate contusions of spinal cords at the level of T-10 were induced in rats treated or untreated with nicotine. Cellular oxidative stress, DNA binding activity of redox-responsive transcription factors (AP-1, NF-kappaB and CREB) as well as mRNA levels of inflammatory genes (MCP-1 and TNF-alpha) were determined in the thoracic and lumbar regions of the spinal cords. Nicotine was administrated 2 h after the SCI in a single i.p. injection at the dose of 0.35, 3.5 or 7 mg/kg, and rats were sacrificed 3 h following such an injection. Spinal cord trauma was associated with a significant increase in oxidative stress, and activation of NF-kappaB, AP-1 and CREB, as well as overexpression of MCP-1 and TNF-alpha in both the thoracic and lumbar regions. Nicotine administration following the SCI markedly attenuated, especially in the lumbar region, these oxidative and proinflammatory responses. These protective effects of nicotine were fully reversed by inhibition of neuronal nicotinic receptors by mecamylamine. The present results indicate that nicotine administration can attenuate the oxidative injury to spinal cords and suggest that neuronal nicotinic receptors can be attractive targets for neuroprotective therapy.

Animals↗
PubMed1986

Scheuermann's dorsal kyphosis and spinal cord compression: case report.

Although Scheuermann's disease (juvenile dorsal kyphosis) is a common problem of late childhood and adolescence, its potential for neurological complications is not widely appreciated. In rare instances, spinal cord compression appears to be produced by the kyphotic protrusion alone, and we present an example of this unusual problem. Although the results of surgical treatment in this situation cannot be substantiated, anterior spondylotomy and decompression followed by posterior fixation appear to offer the best mechanical relief. Spinal cord compression can also be produced by extradural cysts, with which Scheuermann's disease is frequently associated. Scheuermann's disease also is reported to occur in combination with thoracic disc protrusion, but the coincidence here may be random. Pertinent literature is reviewed.

Adolescent↗
PubMed2000

[Children with stumbling gait due to acute spinal cord compression].

Three previously healthy children, two girls aged 2 and almost 5 years and a boy aged 20 months, developed a progressively stumbling gait within days. In two this occurred after a period of weeks during which they complained of, or seemed to have back pain. In all three cases acute spinal cord compression by a malignant tumour was diagnosed. Histological examination revealed Ewing sarcoma, granulocytic sarcoma and T-cell lymphoma. Surgical decompression led to complete neurological recovery. Although rare, acute spinal cord compression during childhood is a medical emergency because of the risk of neurological morbidity. Back pain, weakness and a stumbling gait usually are the first symptoms. Sensory symptoms and sphincter dysfunction may develop later. Early recognition is essential, as prognosis depends on neurological findings and duration of symptoms when treatment is started.

Acute Disease↗
PubMed1984

A rare cause of spinal cord compression in childhood from intraspinal mesenchymal chondrosarcoma. A report of two cases and review of the literature.

Two children presented with acute spinal cord compression by primary and metastatic intraspinal mesenchymal chondrosarcoma, a rare pediatric malignancy. Patients with the primary intraspinal tumor usually present early and often respond well to combined surgery, irradiation and chemotherapy. Patients with intraspinal metastases present late in the course of their disease and their prognoses are poor.

Adolescent↗
PubMed1995

Primary osseous amyloidoma causing spinal cord compression.

The myelographic, CT, and MR findings of a rare localized primary bone amyloidoma causing upper thoracic spinal cord compression are presented. Imaging showed a large, calcified mass centered in the posteromedial portion of the left second rib that invaded the second thoracic vertebra and the spinal canal.

Amyloidosis↗
PubMed1998

[Vertebral body exocytosis and spinal cord compression].

Osteochondroma is a cartilaginous tumor, the most common benign tumor of bone. It may involve solitary or multiple exostoses (or osteochondromatosis) usually in hereditary multiple exostosis. The authors report a case of 13-year-old girl with a family history of hereditary multiples exostoses who presented with bilateral sciatica and cauda equina compression. The MRI showed a tumor of the L1 vertebral body. After surgery, pathologic specimens revealed the lesion to be an osteochondroma. Involvement of the vertebral column has been estimated from 1.3 to 4%. Spinal cord compression is rare. CT provides the analysis of the components of the tumor and clearly demonstrates it's intracanalar extension. MRI is superior in visualizing spinal cord compression. The prognosis is favorable after a surgical decompression.

Adolescent↗
PubMed2006

Infolding of the ligamentum flavum: a cause of spinal cord compression after reduction of cervical facet injuries.

Controversy exists regarding management of cervical facet injuries. Previous literature has focused on associated disc herniations reported to cause neurologic injury upon reduction. Although rupture of the ligamentum flavum has been noted with these injuries, its clinical significance has not been examined. In this case report, we present two patients in whom neurologic deterioration occurred due to infolding of the torn ligamentum flavum with spinal cord compression after reduction of cervical facet subluxations. Both had large flaps of ligamentum flavum arising from the caudal lamina which infolded upon reduction and became trapped between the spinal cord and cephalad lamina. Both patients regained normal motor function after removal of the pathologically infolded ligamentum. Neither patient had a disc herniation, hypotensive/anemic/hypoxic event, or epidural hematoma that could have otherwise been causative of the neurologic deficit. Pathologic infolding of ligamentum flavum, in addition to extruded disc herniations, should be recognized as another potential cause for spinal cord compression with reduction of cervical facet injuries. In particular, if there is a long flap of flavum arising from the caudal lamina poised to become entrapped in the spinal canal with reduction and the patient has a congenitally narrow canal, the surgeon should consider removal of the ligamentum flavum prior to reduction.

Adult↗
PubMed1989

Spinal cord compression due to metastatic disease: diagnosis with MR imaging versus myelography.

To determine the efficacy of magnetic resonance (MR) imaging and myelography for the diagnosis of spinal cord compression due to metastatic disease, the authors prospectively examined 70 patients who had known or suspected spinal involvement by malignancy. Most MR examinations consisted of T1-weighted sagittal imaging of the entire spine, with additional sequences as needed for clarification. Extradural masses were found in 46 patients, 25 of whom had cord compression. For extradural masses causing cord compression, the sensitivity and specificity of MR imaging was .92 and .90, respectively, compared with .95 and .88 for myelography. For extradural masses without cord compression the sensitivity and specificity of MR imaging was .73 and .90, versus .49 and .88 for myelography. MR imaging was much more sensitive for metastases to bone (.90 vs .49), as expected. MR imaging is an acceptable alternative to myelography for diagnosing spinal cord compression and is preferable as a first study because it is noninvasive and better tolerated.

Adult↗
PubMed1994

Combined radiotherapeutic and surgical management of a spinal cord compression by extramedullary hematopoiesis in a patient with hemoglobin E beta-thalassemia.

A 22-year-old male with a history of hemoglobin E beta zero-thalassemia presented with thoracic spinal cord compression due to extramedullary hematopoietic tissue in the epidural space. Following decompressive laminectomy, this epidural mass was irradiated to 20.4 Gy in 12 fractions. The patient made a complete recovery from his neurological symptoms following treatment. Follow-up radiographs showed significant reductions in size of the extradural tumor. Results from this case supported by review of the literature suggest that radiation therapy, with or without decompressive surgery, is an effective therapy in treatment of patients with spinal cord compression due to epidural extramedullary hematopoietic tissue.

Adult↗
PubMed2006

A pilot randomised comparison of dexamethasone 96 mg vs 16 mg per day for malignant spinal-cord compression treated by radiotherapy: TROG 01.05 Superdex study.

AIM: To test the viability of a full-scale randomised comparison of two steroid doses given with radiotherapy for malignant spinal-cord compression (MSCC), to test Internet randomisation and to compare different functional outcome measures. MATERIALS AND METHODS: A log of screened patients at eight recruiting centres was maintained. Patients were randomised via the Superdex website to either 96 mg or 16 mg daily of dexamethasone. Radiotherapy treatment was 30 Gy in 10 fractions. Outcomes assessed used ambulation, Barthel Index ambulation, Functional Independence Measure (FIM) ambulation and Functional Improvement Score (FIS) at 1 month. RESULTS: One hundred and thirty-one patients were screened. Ninety-three (71%) were ineligible, 65% of these were because duration of prior steroid use was greater than 12 h, failure to meet strict definition of magnetic resonance imaging, defined MSCC, multi-level disease or previous spinal-cord compression treatment. Twenty of the 38 eligible patients were randomised, including seven outside standard office hours. There was a high rate of serious adverse events (n = 9), but only one was considered likely to be related to study medication. At baseline, 75% were ambulant, 70% had FIM ambulation scores greater than 5 and 50% had Barthel Index ambulation scores greater than 2. At day 28, including all randomised patients (by scoring four dead patients as non-ambulant), ambulation scores by the various definitions were 60%, 45% and 40%, respectively. For the 16 patients evaluable at day 28, the mean FIS was -1.4. Median survival was 69 days and 1-year survival 13%. CONCLUSION: Web randomisation was successful; however, the high ineligibility rate precludes a full-scale dexamethasone dose trial in Australia. Choice of measure of ambulation has potentially significant effects on outcomes and implications for the design of any future MSCC trials. Referral delays are of concern.

Adult↗
PubMed2004

Src family kinase inhibitor PP1 reduces secondary damage after spinal cord compression in rats.

The synthetic pyrazolopyrimidine, 4-amino-5-(4-methylphenyl)-7-(t-butyl)pyrazolo[3,4-d]pyrimidine (PP1) is a novel, potent, and selective inhibitor of Src family tyrosine kinases. Vascular permeability appears to be mediated by vascular endothelial growth factor (VEGF), which requires the activation of downstream Src family kinases to exert its function. This study investigates the effects of PP1 on vascular permeability and inflammatory response in a rat spinal cord compression model. Ten minutes after compression, PP1 (PP1 group) or the vehicle only (control group) was administered. On days 1, 3, and 7 after compression, the spinal cords were removed and examined histopathologically to determine the expression of VEGF and the extent of edema and inflammation. The dryweight method was used to measure the water content of the spinal cords. The mRNA levels of tumor necrosis factor a (TNFalpha) and interleukin 1beta (IL-1beta), which is related to inflammatory responses, were measured with a real-time polymerase chain reaction (RT-PCR) system 6 h after compression. Although VEGF expression was similar in both groups, the extent of contusional lesion in the PP1 group was reduced by approximately 35% on day 3. Moreover, the water content on days 1, 3, and 7 was significantly reduced and macrophage infiltration on days 3 and 7 was dramatically reduced in the PP1 group. TNF and IL-1beta mRNA expression in the PP1 group were also significantly reduced. These results indicate that PP1 reduces secondary damage after spinal cord injury.

Animals↗
PubMed1988

Discovertebral destruction in ankylosing spondylitis complicated by spinal cord compression.

A 56 year old man with ankylosing spondylitis and discovertebral destruction presented with signs of spinal cord compression that was the result of the soft tissue reaction occurring at the level of the discovertebral destruction. This case emphasises the importance of early recognition, use of appropriate imaging techniques (computed tomographic myelography or magnetic resonance), and operative intervention in the management of this rare complication of ankylosing spondylitis.

Humans↗
PubMedDate not supplied

Spinal cord compression from intrathecal catheter-tip inflammatory mass: case report and a review of etiology.

OBJECTIVES: The majority of intrathecal pumps are implanted by anesthesiologists. Despite a recent increase in case reports involving intrathecal catheter-tip inflammatory masses, this complication is rarely reported in the anesthesiology literature. The present case report describes a patient with spinal cord compression as a result of an inflammatory mass and reviews the current literature as to the etiology of inflammatory mass formation. CASE REPORT: A 47-year-old man with intractable neck and arm pain received an intrathecal pump implantation in 2001, at a stable dose of morphine 8 mg and clonidine 40 microg/d. After an injury in late 2001, his dose requirement for intrathecal morphine steadily increased. In May 2002, hydromorphone was substituted for morphine. The concentrations of hydromorphone and clonidine were 12.5 mg/mL and 150 microg/mL, respectively, infusing at 0.3 mL/d. In October 2003, he developed progressive T9 paraparesis. A computed tomography scan with myelogram showed complete blockage of contrast flow at T8-9. Surgical exploration found an intradural-extramedullary mass compressing the spinal cord anteriorly and to the left. Four weeks after surgical removal of the mass, the patient's neurologic function had improved minimally. All the microbiological analyses were negative. Review of the current literature suggests that the development of an inflammatory mass is related to the delivery of the high dose opioids in the intrathecal space. CONCLUSION: Delivery of high-dose intrathecal opioids can result in the formation of an inflammatory mass, leading to poor pain control and neurologic complications. Anesthesiologists should be vigilant as to these complications when managing patients receiving intrathecal pump therapy.

Anesthesia, Spinal↗
PubMed1985

[61 years' survival of Koch's bacillus in a closed focus. Disclosure in a case of spinal cord compression caused by sequelae of Pott's disease].

A 68 year-old woman presented with a spinal cord compression from an angular kyphosis due to Pott's disease at age 7. Clinical, radiological and pathological studies of the vertebral lesions did not demonstrate an evolutive lesion. However, culture yielded some viable Koch's bacilli. This bacteriologic confirmation 61 years later exemplifies the importance of host immunity reactions, that may prevent the development of KB, and the remarkable capacity of survival of the bacillus.

Aged↗
PubMed1991

Epidural lipomatosis as a cause of spinal cord compression in polymyalgia rheumatica.

Polymyalgia rheumatica (PMR) is a common rheumatologic disorder in older individuals that usually requires chronic, low dose corticosteroid therapy for adequate control of symptoms. Epidural lipomatosis is a rare complication of chronic corticosteroid use in which neurologic deficits occur due to extradural fat compression of the spinal cord. The author describes the first reported case of epidural lipomatosis occurring as a complication of corticosteroid therapy in a patient with PMR.

Adrenal Cortex Hormones↗
PubMed1998

Spinal cord compression due to extramedullary hematopoiesis in beta-thalassemia intermedia.

BACKGROUND: Extramedullary hematopoiesis (EMH) occurs in many disorders, including thalassemias and other hemoglobinopathies, and commonly presents in the spleen and liver. We present a case of spinal cord compression in a patient with beta-thalassemia intermedia, and review the literature and available treatment options. PATIENT AND METHODS: A 35-year-old black female with beta-thalassemia intermedia presented with a 3-week history of back pain and lower extremity weakness. Neurologic examination was consistent with spinal cord compression, and gadolinium enhanced magnetic resonance imaging (MRI) confirmed this diagnosis. She was given intravenous steroids and radiotherapy was begun in 200 cGy fractions to a total dose of 2000 cGy. RESULTS: At the completion of radiotherapy the patient was ambulatory with mild residual weakness. MRI scans 16 months later showed smaller, but persistent masses, and she remains asymptomatic 5 years from her diagnosis. CONCLUSION: Recognition of spinal cord EMH requires prompt physical examination and MRI for accurate diagnosis. EMH can be managed with radiation, surgery, transfusions, or a combination of these therapies. Radiation in conservative doses of (750-3500 cGy) is non-invasive, avoids the surgical risks of potentially severe hemorrhage and incomplete resection, and has a high complete remission rate in the majority of patients. Relapse rates are moderate (37.5%), but retreatment provides excellent chance for second remission.

Adult↗