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PubMed2000

[Spinal compression syndrome and circulatory disorders].

Disorders due to spinal cord compression or ischemic spinal cord lesions represent the most relevant nontraumatic spinal cord injuries causing acute para- and tetraplegia. In acute spinal cord compression early diagnosis is most reasonable to indicate early operative intervention with decompression to prevent progressive neurological deficits. In patients suffering from malignant disorders the indication for operation is directed to maintain quality of life in an appropriate level (pain treatment, mobility by wheelchair). In chronic spinal cord compression operations are aimed to prevent the development or progression of neurological deficits, as the outcome of rehabilitation is very much dependent to the neurogenic damage. In ischemic spinal cord lesion therapy is restricted to prevent further cadiovascular complications which additionally induce spinal cord dysfunction.

Diagnosis, Differential↗
PubMed1984

[Compression of the cervical spinal cord in achondroplasia].

Two cases of tetraparesis due to cervico-occipital spinal cord compression in infants with achondroplasia are reported. Neurological disorders in achondroplasia are produced by structural anomalies of the cranium and spinal canal. They can be divided into two categories: hydrocephalus and radicular and spinal cord compression syndromes. Cervico-occipital compression is more frequent in childhood and may occur very early, in the first months of life. Early diagnosis of this complication and anatomic evaluation can now be obtained by computed tomography, which shows the exact dimensions of the foramen magnum, and myelography. Achondroplasia requires very close neurologic monitoring and, when findings are abnormal, radiologic investigations of the cervico-occipital zone. This allows for early surgical management which is the only means of obtaining significant therapeutic results.

Achondroplasia↗
PubMedDate not supplied

Two-level disc herniation in the cervical and thoracic spine presenting with spastic paresis in the lower extremities without clinical symptoms or signs in the upper extremities.

BACKGROUND CONTEXT: There is no report in the literature of two-level disc herniation in the cervical and thoracic spine presenting with spastic paresis/paralysis exclusively in the bilateral lower extremities. PURPOSE: To identify the clinical characteristics of specific myelopathy resulting from C6-C7 disc herniation through a case with spastic paresis in the lower extremities without upper extremities symptoms due to separate disc herniation in the cervical and thoracic spine, which was surgically removed in two stages. STUDY DESIGN/SETTING: A case report. METHODS: A 48-year-old man developed a gait disturbance as well as weakness and numbness in the lower extremities. Thoracic magnetic resonance imaging (MRI) showed a T11-T12 disc herniation, which was removed under the surgical microscope through a minimally invasive posterior approach. He improved, but 2 months after surgery developed recurrent numbness and spasticity. On this occasion, no evidence of recurrence of the thoracic disc herniation could be identified, but cervical MRI demonstrated a compressed spinal cord at the C6-C7 level. The patient had no neurological findings in the upper extremities. The herniated disc at C6-C7 was removed under the surgical microscope with laminoplasty. RESULTS: The symptoms gradually improved after surgery. At the present time, 2 years and 9 months after the initial operation, the patient had a stable gait and was able to work. CONCLUSIONS: Our experience suggests that in the diagnosis of patients with spastic paresis and sensory disturbances in the lower extremities, spinal cord compression should be explored by imaging studies not only in the thoracic spine but also in the cervical spine, especially at the C6-C7 level, even if the symptoms and abnormal neurological findings are absent in the upper extremities.

Arm↗
PubMed2001

Tuberculous spondylitis: analysis of 69 cases from Saudi Arabia.

DESIGN: Retrospective chart and radiographic review of all cases admitted to the authors' hospital and diagnosed to have tuberculous spondylitis. OBJECTIVE: To identify the frequency, presenting features, utility of diagnostic tests, and treatment outcome of spinal tuberculosis in a tertiary care center. METHODS: All cases of spinal tuberculosis treated in the authors' hospital over 14 years were reviewed. Only those with histologic or microbiologic confirmation or those who responded to antituberculous spondylitis therapy were included. Outcome was assessed according to predefined criteria. RESULTS: Between 1985 and 1998, 69 cases of tuberculous spondylitis were found, i.e., 5% of all tuberculous spondylitis cases diagnosed. The mean age was 52.8 years (range, 15-80 years), and 37 (53.6%) were male. Only five patients had a history of tuberculosis. The most frequent symptoms were backache (84%) and fever (32%), and the most frequent sign was spinal tenderness (45%). Nineteen (28%) patients had paraparesis and 12 (17%) had kyphosis. Except for elevated sedimentation rate (94.5%), the laboratory workup was not helpful. Both computed tomography and magnetic resonance imaging were found to be helpful in diagnosis, often with complementary information. Thirty-eight patients (55%) had thoracic spine involvement and 55 patients (80%) had paraspinal abscesses. Tissue aspirates had a yield of 70%, 35%, and 57% for granulomas, acid-fast bacilli smear, and culture, respectively. Medical therapy alone was given in 37 cases (54%), whereas 32 patients (46%) required additional surgical intervention, mainly those with spinal cord compression, spinal deformity, or risk of spinal instability. There was definite improvement in 63 cases (91%). The best outcome was in those patients presenting early before the occurrence of spinal deformity or neurologic symptoms. CONCLUSION: Tuberculous spondylitis is prevalent in the authors' hospital. Both computed tomography and magnetic resonance imaging are extremely helpful for diagnosis, and tissue aspirate is a good confirmatory method. A good outcome is expected if the diagnosis is made in early stages before the appearance of spinal deformity and neurologic symptoms. Surgical intervention can be avoided in these cases regardless of the presence or absence of paraspinal abscesses.

Adolescent↗
PubMed2000

[A case of effective urgent irradiation therapy for metastatic spine tumor].

A 74-year-old man noticed weakness in bilateral lower limbs 2 months prior to admission. The weakness had rapidly progressed and he could not stand by himself on admission. All thoracic vertebral bodies showed mosaic pattern on T 2 weighted-image. At Th 10 and Th 11, two enhanced masses compressed spinal cord posteriorly. Basal-serum tumor markers, such as LDH, ALP, total-acid phosphatase and prostatic acid phosphatase were elevated, metastatic spine tumor from prostatic carcinoma was suspected. Biopsy specimen from its prostate revealed low differentiated adenocarcinoma. Because sphincter dysfunction progressed rapidly after admission, we started 3 Gy/day irradiation within 24 hr from its appearance targeting both Th 10 to L 1 vertebral bodies and the prostate in total 30 Gy. The clinical symptoms started to resolve immediately, and the disappearance completely within 7 months. This case illustrated that urgent irradiation was effective for broad metastatic spinal tumor with rapidly progressive neurological deficits.

Adenocarcinoma↗
PubMed1999

Solitary exostosis of the thoracic spine. Early diagnosis and treatment.

STUDY DESIGN: A case report. OBJECTIVE: To highlight the importance of early diagnosis and treatment of vertebral exostosis. SUMMARY OF BACKGROUND DATA: Few cases of spinal cord compression caused by solitary thoracic exostoses have been reported. METHOD: A solitary exostosis in the midline of the neural arch of the fifth thoracic vertebra, causing compression of the spinal cord documented on both magnetic resonance and computed tomographic examinations, is reported in a 51-year-old woman who had normal findings in a neurologic examination. RESULTS: The exostosis was successfully excised. CONCLUSION: Accurate preoperative diagnosis of vertebral exostoses is possible using magnetic resonance and computed tomography. Early excision avoids the development of a permanent neurologic deficit.

Exostoses↗
PubMed2004

Low back pain in a pregnant woman.

Low back pain is very common and often considered a part of normal pregnancy. Because the pain is always attributed to pregnancy, referral to a specialist is often delayed. We describe a young woman who developed low back pain and signs of progressive spinal cord compression at 33 weeks' gestation of her second pregnancy. Magnetic resonance imaging of the thoracic spine showed a collapsed T11 vertebral body and a large paraspinal and intraspinal tumor compressing on the spinal cord from the right. Emergent surgical decompression and removal of the tumor mass was done. Pathological examination revealed metastatic adenocarcinoma and subsequently, a palpable nodule was found in the left breast, which, on biopsy, proved to be an invasive lobular carcinoma.

Adult↗
PubMed1986

Incidence, presentation, and outcome of spinal cord disease in children with systemic cancer.

During a 40-month period, in 24 of 643 (4%) newly diagnosed patients with systemic cancer younger than 18 years of age (range: 3 months to 17 years) spinal cord disease developed. Patients with spinal cord disease included 21 children with metastatic spinal cord compression, two with treatment-related transverse myelopathies, and one with an anterior spinal artery stroke. Spinal cord disease occurred in 13 of 102 children (12%) with sarcomas, six of 82 (7%) with neuroblastomas, and four of 94 (4%) with lymphomas. Spinal cord compression occurred as the presenting sign of malignancy in six children (four with sarcomas and two with lymphomas). In the remaining 15 patients, cord compression occurred a median of 13 months after initial diagnosis, and in four patients it occurred at the time of first relapse. Symptoms of metastatic cord compression included back pain in 17 patients (80%), weakness in 14 (67%), sphincter dysfunction in 12 (57%), and sensory abnormalities in three (14%). Findings on plain radiographs of the spine were abnormal in only seven of 20 patients with cord compression, and myelography was needed to differentiate compression from other causes of spinal cord disease. Treatment included high-dose corticosteroids followed by operation (seven patients) or radiotherapy (14 patients). After treatment, nine of 15 nonambulatory patients became ambulatory, and five of 10 incontinent patients regained sphincter control. None of the patients with nonmetastatic spinal cord disease had a satisfactory outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[A case of congenital fissure of C2 and C3 arches with compression of cervical spinal cord].

A 41-years old male patient is reported who had spastic paresis of all extremities, and evidence of peripheral motor neuron damage. He had been treated with steroids for 10 years after erroneous diagnosis of multiple sclerosis. The final diagnosis was a congenital fissure of C2 and C3 arches with spinal cord compression in cervical part. After operation some improvement of the neurological status was obtained.

Adult↗
PubMed1980

[Clinical application of the evoked spinal cord potentials. Part 1. Neurophysiological assessment of the evoked spinal cord potentials in experimental cord trauma - with reference to cord compression and ischemia (author's transl)].

Numerous investigators endeavored to make clear pathophysiological changes in a traumatic spinal cord lesion. The development of neuroscience contributed to have an influence on methods of these researches. This study was undertaken to assess electrophysiological changes resulting from variable periods of experimental spinal cord compression or ischemia by using the evoked spinal cord potentials. Experiments were performed on dogs. Following laminectomies at Th7-9 and L3-4 levels under anesthesia, cord injuries were produced at the lower thoracic level by inflation of an extradurally placed balloon which produced slow graded compression of cord dorsum. Evoked spinal cord potentials to sciatic nerve stimulation were recorded from bipolar electrodes in the midline dorsal subdural space at the operative sites. The normal wave forms of two responses consisted of initially positive triphasic potentials (P1, N1, P2). The conduction velocity of the ascending afferent from the leg was found on the average to be 54.8 +/- 9.7 m/sec between lumbar and dorsal cord. On the basis of the conduction velocities and the responses to stimulus intensities, the afferent volley recorded in the present experiments might reflect synaptic cord afferent pathways originated without Group I fibers in the cord dorsum which were situated ipsilateral to the stimulated nerve. After inflation of the balloon with 0.1 cc of water, spinal canal narrowing rate increased to 14.3 +/- 2.9%. The evoked spinal cord potentials in the lead rostral to the site of compression began to decrease in amplitude. When more water was added into the balloon up to 0.4 - 0.6 cc, spinal canal narrowing rate was enhanced to 42.5 - 77.7% in which potentials were abolished. P2 wave was the first to be abolished and subsequently N1, P1 disappeared in order. On the other hand, the potentials reappeared after decompression in the reverse of their disappearance in order. Responses in dogs with complete recovery from paraplegia returned to the precompression wave pattern both in the amplitude and in latency. On the contrary, in dogs with spastic paraparesis, the recovery of wave form was shown as P1, N1 or P1, N1 with depressed P2. Despite this variability, the evoked response from animals with reversible cord injury were discernible in the early period of spinal shock phase. The degree of recovery varied and had no linear relationship to the recovery grade of clinical symptoms. The experimental cord ischemia was made by inflation of a balloon catheter which was inserted from femoral artery into the upper thoracic aorta. The evoked spinal cord potentials were recorded at the midthoracic and lumbar level. Changes of wave form resulting from the ischemic period of 30 minutes were first the amplitude loss of N1 and subsequently that of P2, P1. On the other hand, the responses gradually returned to their pre-ischemic characteristic about 30 minutes after circulatory reestablishment...

Animals↗
PubMed2003

Symptomatic spinal arachnoid cysts: report of two cases with review of the literature.

STUDY DESIGN: Two unusual cases of intradural extramedullary noncommunicating arachnoid cysts are presented, with a review of literature. OBJECTIVE: To assess surgical excision results in the reversal of symptoms and neurologic deficits. SUMMARY OF BACKGROUND DATA: Most patients harboring arachnoid cysts are asymptomatic. Noncommunicating intradural extramedullary arachnoid cysts are more rare than communicating intradural extramedullary cysts. Noncommunicating intradural extramedullary arachnoid cysts are a very rare cause of spinal cord compression. Rarely, these cysts can present with bizarre symptoms, such as angina. MATERIALS AND METHODS: The first case, a 75-year-old woman, presented with progressive paraparesis. The second case, a 40-year-old man, presented with signs and symptoms of angina, with mild spasticity in the lower limbs. In both cases, magnetic resonance imaging revealed compression of the spinal cord as the etiology of presentation. The first patient is the second oldest patient in the literature with an idiopathic spinal arachnoid cyst. The second case has an unusual presentation that has not previously been reported in the literature. RESULTS: Both cases underwent surgical excision of the arachnoid cyst, with resolution of symptoms and reversal of neurologic deficit. CONCLUSIONS: Our experience indicates that complete recovery from an arachnoid cyst is possible after surgical excision, even when symptoms are present for a long duration, even in the elderly.

Adult↗
PubMed1996

Differences in sensitivity between magnetic motor-evoked potentials and somatosensory-evoked potentials in experimental spinal cord lesions.

STUDY DESIGN: Graded posterior spinal cord compression and partial sectioning of the spinal cord were performed, and magnetically induced descending spinal cord potentials were recorded. OBJECTIVES: To compare the sensitivity of transcranial magnetic motor-evoked potentials in the spinal cord and other spinal cord evoked potentials to spinal cord lesions. SUMMARY OF BACKGROUND DATA: Somatosensory-evoked potentials have been the standard technique for monitoring spinal cord function during spinal surgery. These potentials, however, do not necessarily reflect descending motor tract function. Transcranial electric or magnetic stimulation for motor-evoked potentials is a more direct measure of motor tract function. However, more research on magnetic motor-evoked potentials is needed. METHODS: Fifteen adult cats were used. Graded posterior spinal cord compression was performed at L2 in 10 cats, and partial sectioning of the spinal cord was performed at L2 in five cats. The location sequence of lesioning was dorsal column section, dorsal 1/2 section, dorsal 2/3 section, and total spinal cord section. Magnetic motor-evoked potentials were recorded by epidural catheter electrodes placed above at, and below the lesion. Electric motor evoked potentials and spinal and cortical somatosensory-evoked potentials were recorded serially for a comparison of their sensitivity to spinal cord dysfunction. RESULTS: In posterior spinal cord compression, N1 amplitude of magnetic motor-evoked potentials at and below the lesion decreased after 1 minute of compression with a 70 g weight, and N1 and N2 amplitude disappeared after 1 minute of compression with a 100 to 120-g weight. Electric motor-evoked potentials changed at amplitudes comparable with those shown by magnetic motor-evoked potentials. Spinal somatosensory-evoked potentials showed the most sensitive changes to spinal cord posterior compression and disappeared after 1 minute of compression with 80 g Cortical somatosensory-evoked potentials in five cats were not sensitive enough for spinal cord posterior compression injury and did not disappear even after 1 minute of compression with 120 g. In magnetic motor-evoked potentials, after dorsal hemisectioning of the spinal cord only N3 disappeared; N1 and N2 disappeared after ventral spinal cord sectioning in spinal somatosensory-evoked potentials, amplitudes decreased after dorsal column sectioning, and all negative peaks disappeared after dorsal hemisectioning of the spinal cord. CONCLUSIONS: Posterior compression injuries are diagnosed more easily with spinal somatosensory-evoked potentials. Motor-evoked potentials were slightly less sensitive, but they were significantly more useful in diagnosing posterior compression injuries than were cortical somatosensory-evoked potentials.

Animals↗
PubMed2001

Spinal tuberculosis (Pott's disease): its clinical presentation, surgical management, and outcome. A survey study on 694 patients.

Tuberculosis (TB) of the spine (Pott's disease) is both the most common and most dangerous form of TB infection. Delay in establishing diagnosis and management cause spinal cord compression and spinal deformity. This study investigated the data on all cases of Pott's disease reported in Turkey from 1985 to 1996. A total of 694 cases were included. Out of the patients evaluated, 19% were reported in the first half of the period (1985-1990) and 81% in the second half (1991-1996). Tuberculosis affecting the spine was commonly localized in the thoracic region and involved the vertebral body. The presenting symptoms were leg weakness (69%), gibbus (46%), pain (21%), and palpable mass (10%). Decompressive surgery plus anti-TB chemotherapy remains the best mode of therapy for Pott's disease. Follow-up information was available in 414 of the 694 patients and there were ten deaths (2%), one occurring intraoperatively and the other nine postoperatively. This meta-analysis demonstrates that in Turkey Pott's disease remains a serious problem, causing paraplegia. It should be considered when patients present with neurological findings suggesting spinal cord compression and spinal deformity. In the present study, it was concluded that the neurological involvement due to Pott's disease is relatively benign if urgent decompression is performed at the onset of the disease.

Adult↗
PubMed2005

Metastatic meningioma WHO grade II of the cervical spine: case report and review of the literature.

The authors report a rare case of metastatic atypical meningioma WHO grade II involving the dorso-lateral region of the cervical spine and causing spinal cord compression in a 76-year-old man. The patient was treated surgically in June 1998 for an atypical parasagittal meningioma in the right frontal lobe. Local recurrence with extension to the left hemisphere required surgical treatment in January 2000, and in December 2000 recurrence caused paraplegia of the lower extremities and paresis of the left arm. A 3 (rd) operation was carried out in January 2001, followed by radiotherapy with a total dose of 45 Gy. The patient presented again in March 2003 because of pain in the neck and a progredient new paresis and paresthesia of the right arm. Computed tomogram of the cervical spine showed a large tumor with compression of the spinal cord. MRI was not possible due to a pacemaker which had been implanted in the meantime. Surgical subtotal removal of the tumor via hemilaminectomy of the 3 (rd) and 4 (th) cervical vertebrae was performed. After decompression of the cervical spine the paresis of the right arm improved, the paraplegia of the legs and the left arm, existing since December 2000, remained unchanged. Histological findings of the cranial lesions and the metastatic lesion had a similar appearance and were compatible with atypical meningioma (WHO grade II).

Aged↗
PubMed2002

Cervical kyphosis: predictive factors for progression of kyphosis and myelopathy.

STUDY DESIGN: A retrospective study of 13 patients with cervical kyphosis. The authors propose new methods of measuring spinal cord compression and predicting the progression of kyphosis. OBJECTIVES: To ascertain predictive factors for progression of cervical kyphosis and myelopathy. SUMMARY OF BACKGROUND DATA: Cervical kyphosis may be congenital, result from decompression surgery, or occur as a posttraumatic deformity. Although there is the potential for progressive deformity and the development of myelopathy in all these situations, there are few previous reports of predictive factors for progression of cervical kyphosis and myelopathy in patients with cervical kyphosis. METHODS: The authors studied radiographs and magnetic resonance imaging scans of 13 patients with cervical kyphosis, including 9 who had been operated on and had postsurgical secondary kyphosis, and 4 with idiopathic kyphosis without any of the above causes. Compression of the spinal cord at the apex of the cervical kyphosis was evaluated by magnetic resonance imaging of the ratio between the anteroposterior diameter of the medulla-pons junction and the spinal cord at the apex. RESULTS: The mean ratio between the anteroposterior diameter of the medulla-pons junction and the spinal cord at the apex in five patients in whom myelopathy did not develop was 0.37, and was 0.21 in the patients in whom myelopathy developed. Progression of cervical kyphosis was associated with osteophyte formation at the anterior aspect of the vertebral body. CONCLUSION: A ratio below 0.3 between the anteroposterior diameter of the medulla-pons junction and the spinal cord at the apex was a risk factor for cervical myelopathy. One of the most predictable risk factors of progression of the cervical kyphosis was osteophyte formation at the anterior aspect of the vertebral body.

Adolescent↗
PubMed2005

Differential expression of cell fate determinants in neurons and glial cells of adult mouse spinal cord after compression injury.

Cellular responses after spinal cord injury include activation of astrocytes, degeneration of neurons and oligodendrocytes, and reactions of the ependymal layer and meningeal cells. Because it has been suggested that tissue repair partially recapitulates morphogenesis, we have investigated the expression of several developmentally prominent molecules after spinal cord injury of adult mice where neurogenesis does not occur after injury. Cell fate determinants Numb, Notch-1, Shh and BMPs are abundantly expressed during development but mostly decline in the adult. In the present study, we investigated whether these genes are triggered by spinal cord injury as a sign of attempted recapitulation of development. Expression of Numb, Notch, Shh, BMP2/4 and Msx1/2 was analysed in the adult mouse spinal cord after compression injury by in situ hybridization up to 1 month after injury. The mRNA expression levels of Notch-1, Numb, Shh, BMP4 and Msx2 increased in the grey matter and/or white matter and in the ependyma rostral and caudal to the lesion site after injury. However, BMP2 and Msx1 were not up-regulated. Combining immunohistochemistry of cell type-specific markers with in situ hybridization we found that all the up-regulated genes were expressed in neurons. Moreover, Numb, BMP4 and Msx2 were also expressed by GFAP-positive astrocytes, while Shh was expressed by MBP-positive oligodendrocytes. In conclusion, the cell fate determinants Notch-1, Numb, Shh, BMP4 and Msx2 are expressed in neurons and/or glial cells after injury in a time-dependent manner, suggesting that these genes reflect to some extent an endogenous self-repair potential by recapitulating some features of development.

Animals↗
PubMedDate not supplied

[Posterio-median approach in ventral tumor compression of the spinal cord].

The paper describes two types of resection of primary and metastatic spinal tumors via a posterolateral approach: by curettage and en-block resection. The outcomes of treatment in 15 patients operated on by curettage and 2 patients undergone en-block resection are analyzed. Postoperative pain relief was noted in 100% of the patients. Six (55%) patients who had not been able to move became outpatient after surgery. There was a neurological improvement in 5 (29%) patients, i.e. they were at a higher stage by the Frankel scale. The above results show that removal of spinal tumors via posteriomedian access with lateral extension by curettage or en-block resection might be effective in surgically treating this pathology. Choice of a type of surgery (carcinological or palliative) primarily depends on the histological nature of a tumor, on the degree of neurological deterioration, on the extent and site of a tumorous process, and on the expected survival of a patient.

Adolescent↗