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At least 127 records · Page 7Linked to original sources
PubMed1994

Metastatic epidural spinal cord compression: current concepts and treatment.

Metastatic epidural spinal cord compression (MESCC) is a medical emergency complicating the course of 5-10% of patients with cancer [1]. When diagnosis and treatment is early with the patient ambulatory prognosis for continued ambulation is good [2]. If the patient is nonambulatory or paraplegic, prognosis for meaningful recovery of motor and bladder function is markedly decreased. In the last decade, significant advances in the understanding, management and treatment of metastatic epidural spinal cord compression have occurred. Recent pathophysiological and pharmacological animals studies have afforded insights into disease mechanisms [3-9]. The audit of standard methods of investigation and magnetic resonance imaging have resulted in revision of guidelines for patient evaluation [10-17]. Finally, new surgical philosophies and technical advances have generated interest and controversy [18-25]. With improved clinical awareness, new imaging modalities will help us diagnose epidural spinal cord compression earlier and institute appropriate treatment.

Animals↗
PubMed1998

Spinal cord compression--do we miss it?

Four children with spinal cord compression due to malignant tumours are presented. The severity of the condition was not initially recognized by parents, or the nature of the likely cause by the initial physicians. Lower limb asymmetrical weakness, clear-cut sensory levels, and marked pain indicate need for urgent imaging and exclusion of a space occupying lesion. In 1997 diagnosis of Guillain-Barré syndrome should not be made without careful prior spinal imaging.

Child, Preschool↗
PubMed1999

Spinal cord compression secondary to hemangiosarcoma in a saddlebred stallion.

Hemangiosarcoma in the spinal canal was diagnosed in a 25-year-old stallion showing progressive and symmetrical 4-limb ataxia, proprioceptive deficits, and weakness. On necropsy, an extradural mass consisting of spindle-shaped cells and numerous free erythrocytes was found at the level of C7-T1. Immunohistochemical staining confirmed a neoplasm of endothelial origin.

Animals↗
PubMed1999

Changes in ornithine decarboxylase activity and putrescine concentrations after spinal cord compression injury in the rat.

Traumatic spinal cord injury results in direct physical damage to structures and the generation of local factors contributing to secondary pathogenesis. In the present study, we investigated changes in polyamine metabolism after spinal cord compression injury in the rat. This is a stress induced metabolic pathway, of which an activation may indicate both, secondary pathogenesis or induction of neuroprotective response. Ornithine decarboxylase (ODC) activity, the rate limiting step of polyamine synthesis, and levels of the diamine putrescine, the product of ornithine decarboxylase reaction, were analyzed in control (non-laminectomized) animals and at 2 and 4 h after laminectomy or compression injury at the L4 segmental level. ODC activity was significantly increased 4 h after laminectomy in L4 and in adjacent L3 and L5 segments and compression to L4 produced a further increase 4 h after injury as compared with the intact control group. Putrescine levels were likewise significantly elevated to the same extend in the laminectomized and injured cord as compared with the intact control group. These findings demonstrate increased ODC and putrescine levels in the laminectomized and traumatized spinal cord and suggest that laminectomy may be an important 'priming event' that contributes to secondary injury after spinal cord compression injury.

Animals↗
PubMed2003

Hodgkin's lymphoma presenting as extradural spinal cord compression.

OBJECTIVES: Hodgkin's lymphoma presenting with spinal cord compression is rare. Reports estimate that only 5% of patients with Hodgkin's lymphoma have spinal cord compression. The objectives of this study were:- (1) To review the histology of all cases of Hodgkin's lymphoma causing spinal cord compression. (2) To correlate the findings with the clinical details- lymphadenopathy, hepatosplenomegaly, and marrow involvement. METHOD: This was a retrospective study, the period of study being between 1987-2002. All cases were taken from the histopathology record files, pathology department, NIMS, Hyderabad. The clinical profile of each case was noted and the histology reviewed. When necessary, immunohistochemistry with the necessary markers was performed. RESULT: There were 12 cases, of which 11 were males, and one was a female. The patients ranged from 8-62 years of age, with a median age of 32 years. The cord involvement was at different levels- thoracic(8), lumbar(2) and cervical(2). CONCLUSIONS: The histologic diagnosis of Hodgkin's lymphoma presenting as cord compression requires awareness of the condition. The close differential diagnoses include non-specific inflammation, non-Hodgkin's lymphoma, tuberculosis and eosinophilic granuloma. Detailed clinical evaluation is essential for interpreting the histology.

Adolescent↗
PubMed1977

Spinal cord compression in thalassaemia.

Two cases of spinal cord compression resulting from extramedullary haemopoiesis in patients with thalassaemia of intermediate clinical severity are reported. The association between mild thalassaemia with long survival and the risk of spinal cord compression from extramedullary haemopoietic deposits is emphasised.

Adult↗
PubMed1980

Spinal cord compression in homozygous beta thalassaemia.

Spinal cord compression due to extramedullary haemopoietic tissue in a case of beta thalassaemia and G6 PD deficiency is described. Surgical decompression alone had no beneficial effect. However, the addition of radiotherapy proved very useful.

Adult↗
PubMed1994

Dumbbell schwannoma causing acute spinal cord compression: case report.

A case is presented of acute spinal cord compression by a thoracic dumbbell spinal schwannoma in a young woman with neurofibromatosis type 1 (NF-1). A successful outcome was achieved with total excision of the lesion and decompression of the spinal cord. Greater recognition of the reversibility of spinal cord compression in the developing world is necessary to reduce major permanent morbidity.

Adult↗
PubMed1991

Treatment of spinal cord compression by epidural malignancy in childhood.

Epidural spinal cord compression by a malignant tumor is a rare occurrence in children. Both the tumors involved and the extent of involvement of the vertebral column are different in children and adults. Often, the epidural tumor in a child is identified before significant spinal canal compromise has occurred, and these children frequently can be managed by radiation therapy and/or chemotherapy. There is a group of children, however, who have severe spinal canal encroachment by a tumor, as evidenced by a near complete or complete block on myelography. In this study, we report a group of patients with severe spinal cord compression, as documented by imaging studies. We compared the results of a decompressive laminectomy and subtotal tumor resection followed by adjuvant therapy with the results obtained with radiation therapy and/or chemotherapy alone. Thirty-three patients met the criteria for inclusion in the study. Twenty-six were treated with a laminectomy and adjuvant therapy, and 7 were treated without surgical intervention. With surgical therapy, 25 of 26 epidurals were either improved or stable, whereas 4 of 7 nonsurgical patients deteriorated. Especially notable was a decrease in pain in the operative patients immediately after their procedure. There was no surgical mortality or morbidity. The results of this study indicate that children with severe spinal cord compression as evidenced by a near complete or complete block on myelography or filling of 50% or more of the spinal canal on magnetic resonance imaging are best treated by a combination of surgical decompression and tumor removal followed by adjuvant therapy.

Adolescent↗
PubMed2003

Treatment and prognosis of patients with paraplegia or quadriplegia because of metastatic spinal cord compression in prostate cancer.

Metastatic spinal cord compression (MSCC) is a serious complication of metastatic prostate cancer (PCa). This study retrospectively evaluated patients who presented with paraplegia or quadriplegia because of MSCC of PCa. Of 847 patients with PCa who were treated between 1989 and 1998, 26 (3.1%) demonstrated paraplegia or quadriplegia because of MSCC. Characteristics, treatment efficacy, and prognosis of these patients were analyzed. In total, 15 cases became paraplegic despite androgen ablation therapy (Group I). Average time to paraplegia from initial hormonal treatment was 34 months. Out of nine cases who underwent radiation therapy (RT) to spinal lesions with/without chemotherapy, one patient became ambulatory. However, this patient subsequently had recurrent compression. Two cases had remission of paralysis. Two cases underwent laminectomy plus RT and in one case paralysis improved. MSCC was the first indication of PCa in 11 cases (Group II). Two cases underwent laminectomy plus hormone therapy and nine cases underwent hormone therapy alone. Four patients became ambulatory and two cases showed improved motor capacity. Average interval from paraplegia to death was 7.4 months in Group I and 27.1 months in Group II. However, there was no statistical difference in these two groups on disease-specific survival from the start of initial treatment. It is difficult to recover the ability to walk if paraplegia or quadriplegia occurs in PCa patients although decompression surgery plus hormone therapy seemed to impair the prognosis. Stage M1 patients with paraplegia had survival rates as good as stage M1 patients without paralysis. This should encourage an aggressive treatment approach. However, for patients with hormone-independent disease there seems to be no effective treatment and prognosis is poor.

Adenocarcinoma↗
PubMed1995

Somatosensory evoked potentials in the differential diagnosis between spinal cord compression and amyotrophic lateral sclerosis.

Spinal cord compression (SCC) often presents a similar clinical picture to amyotrophic lateral sclerosis (ALS). An early differential diagnosis is important because SCC is a potentially treatable clinical disorder. We carried out a longitudinal study of 43 patients with an initial diagnosis of ALS, in order to ascertain the percentage of patients with SCC, and to evaluate the usefulness of somatosensory evoked potentials (SEPs) in early diagnosis. Thirty-three patients had a final diagnosis of ALS and 8 of SCC. SEPs central conduction was abnormal in 3 ALS and 7 SCC patients, respectively (Fisher exact test, p < 0.05). We concluded that SEPs investigation is useful in the differential diagnosis between ALS and SCC patients with pure motor signs.

Adult↗
PubMed2004

Post-laminectomy long-term survival of a patient with spinal cord compression secondary to metastatic prostate cancer.

Spinal cord compression is a skeletal-related event in advanced malignancies and is associated with serious morbidity and poor prognosis. Despite the palliative nature of laminectomy treatment, it is important to prevent neurological deficits and relieve pain as a means to improve quality of life. Here we report on a prostate cancer patient with spinal cord compression who became ambulant from paraparesis after he underwent a decompression laminectomy; he survived for 9.5 years with good quality of life.

Decompression, Surgical↗
PubMed2000

Dorsal arachnoid web with spinal cord compression: variant of an arachnoid cyst? Report of two cases.

Spinal arachnoid cysts are diverticula of the subarachnoid space that may compress the spinal cord; these lesions are most commonly found in the thoracic spine. Two patients who presented with thoracic myelopathy were noted on magnetic resonance imaging to have focal indentation of the dorsal thoracic cord, with syringomyelia inferior to the site of compression. Both patients were found at operation to have discrete arachnoid "webs" tenaciously attached to the dura mater and pia mater. These webs were not true arachnoid cysts, yet they blocked the flow of cerebrospinal fluid (CSF) and caused focal compression of the spinal cord. The mass effect appeared to be the result of a pressure gradient created by the obstruction of CSF flow in the dorsal aspect of the subarachnoid space. Both patients responded well to resection of the arachnoid web. Arachnoid webs appear to be rare variants of arachnoid cysts and should be suspected in patients with focal compression of the thoracic spinal cord.

Arachnoid Cysts↗
PubMed1998

Magnetic resonance imaging of experimental subacute spinal cord compression.

STUDY DESIGN: Subacute compression of the spinal cord was applied to rats. The animals were chronologically observed using magnetic resonance imaging for more than 8 weeks after surgery and were killed for histopathologic examination. OBJECTIVES: To investigate the correlation of changes in signal intensity on magnetic resonance images with those observed in histopathologic study and with the degree of spinal cord compression and paralysis. SUMMARY OF BACKGROUND DATA: No consensus has been reached concerning the correlation of magnetic resonance images to clinical symptoms of compressive myelopathy. Few reports are available in which magnetic resonance imaging findings are compared with histopathologic features in chronic or subacute experiments. METHODS: In rats under general anesthesia, the T11 lamina was thinned and a slow increase in volume was applied. Hind limb paralysis appeared 1 week after the procedure and spontaneously subsided thereafter. The degree of spinal compression and signal intensity was observed chronologically using magnetic resonance imaging. The signal intensity on the final MR images was rated on a four-point scale and compared with histopathologic findings. RESULTS: As spinal compression increased, the incidence of high signal intensity on long spin-echo images became higher. Low signal intensities on short spin-echo images were visible in animals in which compression and paralysis were the most severe. In these animals, cavitation and a dilated central canal were visible. High signal intensities on long spin-echo images reflected various pathologic changes. CONCLUSIONS: Changes in signal intensity on MR images are visible after the induction of myelopathy by high-pressure compression. These signal intensities may be useful in predicting the outcome of compressive myelopathy.

Animals↗