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PubMed1988

Multiple myeloma presenting with spinal cord compression.

The clinical features, treatment, and course of 6 patients with multiple myeloma, who presented initially with spinal cord compression, are reviewed. These 6 represent 12% of all patients with myeloma seen at our institution since 1979. Eighty-three similar patients were identified from the medical literature. There are no patient characteristics predictive for this presentation. A higher than expected proportion of patents have clinically localized disease, but progression to myelomatosis is common. As these patients present without a known diagnosis of malignancy, a prompt, invasive diagnostic procedure and the immediate institution of definitive local therapy is mandatory. Despite such an aggressive approach, the prospect for significant return of neurologic function is poor. Survival does not appear to be different from that of other patients with myeloma. Unlike other malignancies, a presentation with cord compression is not inconsistent with long-term survival, although significant morbidity secondary to the resultant functional disability can be expected.

Adult↗
PubMed1998

Spontaneous longitudinally orientated axonal regeneration is associated with the Schwann cell framework within the lesion site following spinal cord compression injury of the rat.

Spontaneous cellular reorganisation at the lesion site has been investigated following massive spinal cord compression injury in adult rats. By 2 days post operation (p.o.), haemorrhagic necrosis, widespread axonal degeneration, and infiltration by polymorphnuclear granulocytes and OX42-positive macrophages were observed in the lesion site. By 7 days p.o., low affinity nerve growth factor receptor-positive Schwann cells, from activated spinal roots, were identified as they migrated far into the lesion. Between 7 and 14 days p.o., the overlapping processes of Schwann cells within the macrophage-filled lesion formed a glial framework which was associated with extensive longitudinally orientated ingrowth by many neurofilament-positive axons. Relatively few of these axons were calcitonin gene-related peptide (CGRP)-, substance P (SP)-, or serotonin (5HT)-positive; however, many were glycinergic or gamma aminobutyric acid (GABA)ergic. At 21 and 28 days p.o. (the longest survival times studied), a reduced but still substantial amount of orientated Schwann cells and axons could be detected at distances of up to 5 mm within the lesion. Glial fibrillary acidic protein (GFAP) immunoreactivity demonstrated the slow formation of astrocytic scarring which only became apparent at the lesion interface between 21 and 28 days p.o. The current data suggest the possibility of developing future therapeutic strategies designed to maintain or even enhance these spontaneous and orientated regenerative events.

Animals↗
PubMed1985

Malignant carcinoid causing spinal cord compression.

Neurological complications of malignant carcinoid are infrequent. Only 11 cases of central nervous system metastasis are documented, and neurological symptoms may be the initial or only manifestation of this tumor. We describe the case of a 60-year-old man with no known primary tumor who presented with spinal cord compression by a thoracic epidural tumor. After laminectomy, the diagnosis of carcinoid was made by light and electron microscopic demonstration of neurosecretory granules in tumor cells. Urine 5-hydroxyindole acetic acid and plasma serotonin levels were subsequently found to be elevated. Carcinoid tumors should be considered in the differential diagnosis of lesions metastatic to the spinal cord and brain.

Carcinoid Tumor↗
PubMed2007

Prognostic indicators in metastatic spinal cord compression: using functional independence measure and Tokuhashi scale to optimize rehabilitation planning.

STUDY DESIGN: Retrospective, descriptive study. OBJECTIVE: To determine if patients with metastatic spinal cord compression (MSCC) make significant functional gains through rehabilitation. To study survival and predictors of survival in MSCC. To explore predictive factors for high or low functional gains in MSCC. SETTING: Inpatient neuro-oncology rehabilitation ward, Henderson General Hospital, Hamilton, Canada. METHODS: Clinical records were examined for 63 inpatients with MSCC. Demographics, treatment of MSCC, length of rehabilitation, admission, and discharge Functional Independence Measure (FIM) scores, Tokuhashi score and survival data were collected. Statistical analyses included nonparametric comparisons, Kaplan-Meier analyses, Cox regression, and exploratory logistic regression. RESULTS: FIM score improved from 83 to 102 (P<0.0001). Estimated median survival from time of rehabilitation was 10.0 months. Kaplan-Meier analysis showed longer survival in patients with high Tokuhashi scores (9-15) compared to low scores (0-8) (P<0.005); and high FIM change (>13) compared to low FIM change (< or =13) (P<0.02). Cox regression revealed that high FIM gain and high Tokuhashi score were prognostic factors. Logistic regression showed Tokuhashi score (odds ratio (OR)=1.30, 95% confidence interval (CI)=1.04-1.62) and length of rehabilitation (OR=1.04, 95% confidence interval (CI)=1.01-1.07) were associated with high FIM gain. CONCLUSIONS: Rehabilitation improves functional outcomes in MSCC. Patients who had a high Tokuhashi score and achieved high functional gains after rehabilitation had longer survival. Tokuhashi score and length of rehabilitation were associated with high FIM gain. The Tokuhashi score can help identify patients with good prognosis and potential for improvement during rehabilitation.

Activities of Daily Living↗
PubMed2006

Functional outcome and survival after radiotherapy of metastatic spinal cord compression in patients with cancer of unknown primary.

PURPOSE: Patients with cancer of unknown primary (CUP) account for about 10% of patients with metastatic spinal cord compression (MSCC). This study aims to define the appropriate radiation regimen for these patients. METHODS AND MATERIALS: Data of 143 CUP patients irradiated for MSCC were retrospectively evaluated. Short-course radiotherapy (RT) (1x8 Gy, 5x4 Gy, n = 68) and long-course RT (10x3 Gy, 15x2.5 Gy, 20x2 Gy, n = 75) plus 8 further potential prognostic factors (age, gender, performance status, visceral metastases, other bone metastases, number of involved vertebrae, ambulatory status, time of developing motor deficits before RT) were compared for functional outcome and survival. RESULTS: Improvement of motor function occurred in 10% of patients, no further progression of motor deficits in 57%, and deterioration in 33%. On multivariate analysis, functional outcome was positively associated with slower development of motor deficits (p < 0.001), absence of visceral metastases (p = 0.008) and other bone metastases (p = 0.027), and ambulatory status (p = 0.054), not with the radiation regimen (p = 0.74). Recurrence of MSCC in the irradiated region occurred in 7 patients after median 6 months. Median survival was 4 months. On multivariate analysis, better survival was significantly associated with absence of visceral metastases (p < 0.001), absence of other bone metastases (p = 0.005), ambulatory status (p = 0.001), and slower development of motor deficits (p = 0.030). CONCLUSIONS: For MSCC treatment in patients with CUP, no significant difference was observed between short-course and long-course RT regarding functional outcome and survival. Short-course RT appears preferable, at least for patients with a poor predicted survival, as it is more patient convenient and more cost-effective.

Adult↗
PubMed1991

Spinal cord compression secondary to extramedullary hematopoiesis: a noninvasive management based on MRI.

We report the first case of spinal cord compression secondary to extramedullary hematopoiesis in which the diagnosis was made by magnetic resonance imaging (MRI). Based on the great advantage of this imaging test that visualizes the entire spine, the noninvasive approach to such patients, using low-dose radiation therapy and guided by MRI is discussed. This management appears to be both efficacious and safe.

Adult↗
PubMed1988

Spinal cord compression: delay in the diagnosis and referral of a common neurosurgical emergency.

In 76 consecutive patients with spinal cord compression the process of diagnosis and referral was investigated. This investigation was carried out at the time of admission to the neurosurgical unit when it was possible to obtain fresh information about each patient's pre-admission management. All the patients had been referred from District General Hospitals and 71 had previously consulted their general practitioners. Sixty-two per cent took over a week from the time they first saw their own doctor to reach the referring hospital, after reaching hospital 47% of patients waited a week or more before they were referred to a neurosurgeon. During the process of referral, the proportion of patients able to walk unaided and control their sphincters fell from 68% to 10% while the proportion with complete cord lesions rose from 1.5% to 28%. In 48% of cases there had been delays in diagnosis and referral which appeared avoidable. The reasons for these delays and their effect on the eventual outcome are assessed.

Aged↗
PubMed1986

Spinal cord compression in multiple myeloma: who gets it?

Of 97 Chinese patients with multiple myeloma seen over a 12-year period, 23.7% were found to have cauda equina or spinal cord compression (SCC). Predictive features for SCC include paraprotein type, hemoglobin level, and the extent of bone lesion at initial hematological diagnosis. A discriminant function derived from this analysis can be used to predict the likelihood of SCC with 79% accuracy. It is postulated that when the cortex is more involved than the medulla in a vertebra, it will predispose to SCC while hemopoiesis is relatively preserved. Our patients presented late with advanced neurological deficit so that treatment was unsatisfactory. It is emphasised that early recognition of back pain and neurological symptoms is essential, as any delay would jeopardize the chance of neurological recovery.

Adult↗
PubMed1975

[Spinal cord compression in multiple cartilagineous exostoses (case report)].

A 53-year-old patient with multiple cartilagineous exostoses developed narrowing of the thoracic spinal canal with compression of the cord and spastic paraplegia. The importance of radiologic examination of the whole spine as well as of the extremities is emphasized. When there is an exostosis in the spine neurologic examination disclosing cord compression should be carried out at regular intervals. If there are signs of cord compression, early decompressive laminectomy is the treatment of choice.

Arthritis↗
PubMed2002

The increase of reactive oxygen species and their inhibition in an isolated guinea pig spinal cord compression model.

STUDY DESIGN: In vitro studies using isolated guinea pig spinal cord. OBJECTIVES: To develop an alternative model using isolated guinea pig spinal cord, which can be used to screen antioxidants for in vivo SCI treatment. SETTING: Department of Basic Medical Sciences, Purdue University, West Lafayette, Indiana, USA. METHODS: The compression injury was induced by a constant-displacement of 5-s compression of spinal cord using a modified forceps possessing a spacer. Reactive oxygen species (ROS) were evaluated using three distinct methods: fluorescence microscopy, lipid peroxidation assay, and flow cytometry. RESULTS: The injury-mediated ROS increases are comparable with other in vivo studies and consistent with our previous observation using a similar injury model and measured with electrophysiological and anatomical technique. Further, ascorbic acid, hypothermia, or the combination of both significantly suppressed superoxide and lipid peroxidation. The combination treatment was the most effective when compared with ascorbic acid or hypothermia alone. CONCLUSION: This in vitro model has the advantage of replicating some of the in vivo conditions while gaining the ability to control the experimental conditions. This in vitro model is suitable to study the mechanisms of ROS generation and degradation and can also be used to critically evaluate the effective suppressor of ROS in the contents of spinal cord traumatic injury.

Action Potentials↗
PubMed2003

Hypertransfusion: a successful method of treatment in thalassemia intermedia patients with spinal cord compression secondary to extramedullary hematopoiesis.

SUMMARY OF BACKGROUND DATA: Extramedullary hematopoiesis is a common compensatory phenomenon to chronic hemolytic anemias including thalassemia. Several sites can be involved including the liver, the spleen, the lymph nodes, and other less common locations. Spinal cord compression may result in the rare cases wherein the hematopoietic develops intraspinally. Treatment of such conditions still is controversial. OBJECTIVE: This article reviews the literature and reports two cases of thalassemia intermedia involving patients who presented with neurologic symptoms after acute spinal cord compression secondary to extramedullary hematopoiesis. METHODS: The diagnosis was established by magnetic resonance imaging. Hypertransfusion therapy was used as our first-line treatment method. RESULTS: Complete neurologic recovery was achieved. Improvement in the neurologic status started as soon as the first week of treatment. CONCLUSIONS: Clinical awareness is important for early diagnosis and prevention of irreversible neurologic complications in such cases. Magnetic resonance imaging is the radiologic method of choice for diagnosing extramedullary hematopoietic masses and for delineating the extent of spinal cord involvement. Hypertransfusion seems to be a promising treatment method that should be recommended as a first-line approach or as an adjuvant therapy to other methods.

Adult↗