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PubMed1980

Spinal cord compression: with special reference to metastatic epidural tumors.

Compression of the spinal cord or cauda equina is an increasingly important problem in cancer patients. The most common primary tumors are carcinoma of the breast in women and carcinoma of the lung in men. Metastases invade the epidural space by extension from involved vertebrae, by growth through intevertebral foramina, and by hematogenous dissemination. Pain is the usual initial symptom, followed by progressive sensory, motor, and sphincteric dysfunction. Appropriate x-ray films of the spine are positive in most patients, and complete myelographic examination to delineate the exact location and extent of the compression is essential. Patients generally require emergency management; results of treatment depend primarily on the neurologic status at the time of diagnosis. Corticosteroids should be administered in an effort to reduce compressive edema. Decompressive laminectomy followed by radiation therapy is indicated for patients with compression of unknown cause, relapse during or after radiation therapy, or certain radioresistant tumors. Primary radiation therapy is indicated for patients with lymphoma and some patients with carcinoma.

Dexamethasone↗
PubMed1982

Spinal cord compression by amyloid tissue.

Spinal cord compression by a mass of amyloid tissue arising from the thoracic vertebrae is described in a 72-year-old female. Investigations failed to provide a primary cause for this amyloid tissue.

Aged↗
PubMed1980

Edema and circulatory disturbance in the spinal cord compressed by epidural neoplasms in rabbits.

An experimental model of spinal cord compression by epidural neoplasms was produced in rabbits by injecting a VX2 tumor-cell suspension anterior to the T-13 vertebral body. With this experimental model, edema and circulatory disturbance of the spinal cord compressed by epidural tumors were studied. The characteristic histopathological findings in the compressed spinal cord were edema and axonal swelling in the white matter. Water content and uptake of intravenously injected 99mTc pertechnetate in the compressed spinal cord were significantly greater than in the spinal cord distant from the tumor, and increased in proportion to the degree of neurological loss. Microangiography and fluorescein angiography demonstrated stenosis or obstruction of the epidural venous plexus and impairment of venous drainage in the compressed spinal cord at the early stage of neurological symptoms. It is suggested that venous stasis and subsequent vasogenic edema in the spinal cord play an important role in the symptomatology of metastatic epidural spinal cord compression.

Animals↗
PubMed1996

The effects of taxol, methylprednisolone, and 4-aminopyridine in compressive spinal cord injury: a qualitative experimental study.

BACKGROUND: Taxol is a diterpene alkaloid that stimulates tubulin production in cells. It may be effective in preserving the cytoskeleton of spinal cord axons after injury. METHODS: Thirty-nine rats were submitted to spinal cord compression. The animals were divided into three groups that received taxol (18.75 mg/m2), methylprednisolone (30 mg/kg), or 4-aminopyridine (1 mg/kg). Taxol was administered as one dose immediately after injury and two additional doses on days 14 and 21. Methylprednisolone was given as a single injection immediately postinjury. Four-aminopyridine was administered on days 25, 26, and 27. A group of nine injured animals served as a control without any treatment. Evoked potentials were recorded before, during, and 4 weeks postinjury. Behavioral tests were measured to evaluate recovery of motor function. RESULTS: The taxol and methylprednisolone-treated animals demonstrated a significant improvement in comparison with the control group. No functional improvement was found at 1 mg/kg treatment of 4-aminopyridine in rats. CONCLUSIONS: We conclude that taxol and methylprednisolone given shortly after the compression injury improve functional outcome after an incomplete spinal cord injury.

4-Aminopyridine↗
PubMed2001

Segmental neurofibromatosis-induced spinal cord compression. Case report.

Spinal segmental neurofibromatosis (NF) is a rare entity. To date, patients in reported cases of segmental NF (or NF5) have harbored neurofibromas involving the peripheral nerves only. The author reports a rare case of segmental NF that caused spinal cord compression in a 40-year-old woman who presented with a 6-month history of intercostal neuralgia. Examination revealed mild lower-extremity weakness and dysesthesia in the right-sided T-9 dermatome. Magnetic resonance imaging revealed three neurofibromas involving the T-9 region, which were excised, and the patient's neuralgic pain was resolved postoperatively. Traditionally, it has been believed that segmental NF involved only the peripheral nerves. The present case illustrates that although rare, spinal cord compression can also occur in patients with segmental NF.

Adult↗
PubMed1983

Vertebral metastases and spinal cord compression.

Clinical interest in spinal compression and resultant paraplegia due to metastases has mounted in recent years. This has stimulated attention to the neuropathology of the condition. Fourteen cases of spinal cord compression due to vertebral metastases are compared with over 100 traumatic cases. In the traumatic lesions there is central haemorrhagic necrosis leading to cavitation and gliosis with nerve root regeneration in the late stages. In the metastatic cases, lesions are often peripheral, pie-shaped and are related to vascular factors. The neuropathology of cord necrosis due to metastatic spinal disease is therefore different to trauma. These observations have clinical importance in planning treatment.

Adult↗
PubMed1991

Spinal cord compression due to pagetic spinal stenosis with involvement of extradural soft tissues: a case report.

Although Paget's disease of the spine may cause neurological dysfunction by bone hypertrophy or collapse, it is very rare for the disease process to extend into the soft tissues of the spinal canal. We report a case of Paget's disease causing ossification of the ligamentum flavum and extradural fat, thus causing spinal cord compression. Decompressive laminectomy was carried out, resulting in neurological improvement. In such cases surgical decompression should be followed by therapy with calcitonin.

Humans↗
PubMed2001

Surgery for spinal cord compression in multiple sclerosis.

Compression of cervical spinal cord secondary to cervical spondylosis or disc herniation can result in acute or chronic myelopathy. This may go unnoticed in patients with multiple sclerosis who frequently present with similar symptoms. A high index of suspicion, recognition of differences in clinical features, and appropriate use of neuroimaging studies assist in the differentiation of these two disorders. Decompression surgery in carefully selected MS patients who have coexistent spinal cord compression is well tolerated and may result in an excellent outcome.

Adult↗
PubMed1987

The role of vertebral body collapse in the management of malignant spinal cord compression.

The management of malignant spinal cord compression has been reviewed recently and attention drawn to the adverse effects of laminectomy. Data from that review suggested that the presence of vertebral body collapse could have an important negative effect on the outcome of laminectomy. However, there was only scant evidence available in the literature to support that conclusion. Eighty consecutive patients with thoracic spinal cord compression due to a single metastasis treated by laminectomy are reported here. It is seen that the presence of vertebral collapse signified: a much reduced chance of regaining the ability to walk; a much greater possibility of further neurological deterioration; and a major increase in the incidence of post-operative spinal instability. The role of laminectomy in the management of such patients needs to be further questioned and alternative therapeutic measures such as radiotherapy, posterior spinal instrumentation or anterior surgery should be strongly considered in the presence of vertebral body collapse.

Adolescent↗
PubMed1986

Thoracic intervertebral disc protrusion with spinal cord compression.

Four patients presenting with spinal cord compression and spinal nerve root irritation are described. The clinical and radiological features are described and the contribution of CT scanning to accurate diagnosis of this condition is highlighted. Review of the literature indicates that the natural history of this disorder is one of steadily progressive neurological dysfunction. Surgical decompression of the lesion, although hazardous, is the only therapeutic option. Brief comment is made on the neurosurgical approaches currently in vogue.

Aged↗
PubMed1990

New spinal cord injury model produced by spinal cord compression in the rat.

Graded spinal cord injuries were produced in rats by compressing the spinal cord at the level of the T11 vertebra for 5, 15, 30, 60, or 180 min with stainless steel screws of 2-mm diameter and 2.8-mm length, or for 60 min with screws of the same diameter and various lengths (2.5, 2.8, 3.1, or 3.4 mm). The main neurologic symptoms caused by spinal cord compression were motor deficits, sensory deficits, and urinary incontinence. Neurologic scores, based on both motor and sensory deficits, correlated significantly with both the screw length and the duration of compression at every observation point from 4 hr to 21 days after removal of the screw. The incidence of urinary incontinence (from 24 hr to 21 days) and the percentage of rats surviving (from 14 days to 21 days) also correlated closely with the two factors (screw length and duration of compression). These results suggest that the present procedure could be a useful and simple model for studying traumatic spinal cord injury in rats.

Animals↗
PubMed2002

Spinal cord compression of dual etiology, multiple myeloma and spinal tuberculosis.

Spinal cord compression as an initial manifestation of multiple myeloma is a well-known phenomenon. We report for the first time a patient with spinal cord compression of dual etiology, multiple myeloma and spinal tuberculosis, treated successfully by local radiotherapy, chemotherapy and an antituberculous regimen.

Combined Modality Therapy↗
PubMedDate not supplied

Clinical, morphometric and ultrastructural aspects in a new model of spinal cord compression.

A new model of spinal cord compression is presented. Forty-two New Zealand albino rabbits weighing between 1.2 and 1.5 kg were submitted to spinal cord compression to about half of its normal diameter by vascular Sugita's clip to different compression time (sham, 5-10-20 minutes e 1-6-12 hours) and sacrified after 72 hours. The consequent neurological dysfunction size of lesion was graded by Tarlov's scale for voluntar motility. Ultrastructural and morphometrical studies were carried out to evaluate changes in shape, perimeters, axonal and myelin areas of the lateral and the posterior tract of spinal cord. A 10 minute decrease of 50% of the transverse diameter of the spinal cord causes a defined damage. The swelling of myelin is a useful index of the importance of the damage.

Animals↗
PubMed1990

Malignant spinal cord compression: when a backache signals danger.

Spinal cord compression is a true medical emergency. This article outlines clues in the history and physical examination that may lead to the diagnosis of spinal cord compression. The evaluation and emergent management of the compression are discussed. The advantages and disadvantages of magnetic resonance imaging in the evaluation are detailed. Treatment options, including surgery, are presented.

Back Pain↗
PubMedDate not supplied

Extradural spinal cord compression from metastatic tumor.

Extradural spinal cord compression (ESCC) as a consequence of metastasis from various primary cancers represents the most common type of malignant lesion affecting the spinal cord. It has been estimated that 5% of all patients with systemic cancer who are autopsied have pathologic evidence of tumor invading the extradural space. The incidence of ESCC is expected to increase due to improved survival of the cancer patient. The current approach to the diagnosis of ESCC depends upon the recognition of early symptoms and signs of spinal cord compression. Despite the increasing clinical awareness of these complications, irreversible loss of ambulation continues to occur in over half of these patients. Early diagnosis is critical since onset of spinal cord injury may be sudden, often progressing to irreversible paralysis in a period of hours. Consequently, physicians dealing with cancer patients must maintain a high index of suspicion. This paper analyzes prognostic factors based on our prospective study and emphasize the use of diagnostic tests in early recognition of ESCC before onset of neurologic deficits.

Adolescent↗
PubMed1981

Thyroid carcinoma with spinal cord compression.

Characteristics of cases of spinal cord compression from metastatic thyroid carcinoma show that this rare complication is not necessarily a preterminal event. It seems to have some propensity to occur during withdrawal of thyroid suppressive therapy in preparation for radioactive iodine treatment.

Adenocarcinoma↗