[EXOSTOSES CAUSED BY COMPRESSION OF THE SPINAL CORD].
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Exostoses↗
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Acute neurologic deficit associated with a posterior cervical drain: a case report.
STUDY DESIGN: Descriptive. OBJECTIVES: To document a rare complication involving the use of a wound drain after cervical laminectomy. SUMMARY OF THE BACKGROUND DATA: No previous reports describe spinal cord compression by a surgical drain resulting in a neurologic deficit. Most texts recommend the use of a drain following this procedure. METHODS: An 80-year-old female underwent cervical laminectomy for myelopathy with initial improvement in symptoms. Approximately 6 hours following surgery, she developed acute onset of quadriparesis when repositioning in bed. Magnetic resonance imaging revealed cord compression by the surgical drain, which was immediately removed. RESULTS: The patient experienced partial improvement of the neurologic deficit. At 18-month follow-up, left handed weakness, left leg spasticity, and neurogenic bladder persist. CONCLUSION: The development of neurologic deficits due to compression by a surgical drain can occur. This complication might be avoided by approximating the neck musculature before placement of the drain and closure of the fascia.
Acute Disease↗
Src family kinase inhibitor PP1 improves motor function by reducing edema after spinal cord contusion in rats.
Following spinal cord injury vascular permeability increases around the area of injury, which possibly leads to secondary tissue damage. Vascular endothelial growth factor (VEGF) and Src which exists downstream of VEGF may contribute to edema formation. We here report that the Src family kinase inhibitor PPI could reduce edema and the inflammatory response after spinal cord injury. In this study we have examined the effect of PPI on motor function after mild spinal cord compression injury. We utilized a mild spinal cord compression model in rats. PPI or vehicle only was administered intraperitoneally after cord compression. The motor function of the hind limbs after injury was categorized into 7 grades. At 1, 3, 7 and 14 days after injury, the spinal cord was removed and the extent of edema formation and inflammation were examined using immunohistochemistry with an anti-IgG and anti-ED-1 antibody. The immunohistochemical analysis revealed that the area of edema formation and inflammation was remarkably reduced in animals with PPI. The muscle function was flaccid in both groups immediately after injury. However, at 3 and 8 days after injury, a significant improvement was observed in the PPI group. These results suggest that PPI is a strong candidate for drug treatment of spinal cord injury.
Animals↗
An animal model of epidural compression of the spinal cord.
A new model of subacute compression of the spinal cord is described. Using an expanding epidural mass, a gradual, progressive, and highly reproducible neurological deficit was induced in rats over a 7-day period, resulting in paraplegia. Studies of spinal cord edema, disruption of the blood-spinal cord barrier, and somatosensory evoked responses, as well as histopathological and microangiographical studies, revealed a marked similarity to changes produced in other spinal compression models and in humans. The model may serve to answer some fundamental questions regarding the pathophysiology and efficacy of various treatment modalities of spinal cord compression.
Animals↗
Spine surgery in morbidly obese patients.
OBJECT: The diagnosis, treatment, and postoperative care of morbidly obese patients undergoing spinal surgery require modifications for body habitus. With a growing percentage of the United States population becoming morbidly obese, the surgeon may need elective or emergency treatment plans that address the special needs of these patients. The authors retrospectively reviewed the diagnosis, treatment, and postoperative care of the severely obese patient undergoing spinal surgery. METHODS: To assess the associated results and complications of management that required modification for body habitus, 12 patients were included in the study (nine females); the mean age was 50 years and mean weight was 320 lb. Cases of cervical (two cases), thoracic (four cases), and lumbar surgeries (six cases) were included. The follow-up period ranged from 6 months to 2 years. Patients presented with myelopathy (five cases), radicular pain and weakness (four cases), radiculopathy (two cases), and cauda equina syndrome (one patient). Chronic progressive neurological deterioration secondary to spinal cord compression was demonstrated in nine patients and acute pain and/or weakness secondary to nerve root compression was observed in three patients. CONCLUSIONS: The authors found that although morbidly obese patients may present late in the course of their symptoms and require modifications in the use of standard neuroimaging, operative facilities, and treatment plans, open mindedness and persistence can yield satisfactory results in most cases.
Female↗
[Dorsal cord compression by aspergilloma. Apropos of a case].
Spinal cord compressions are mainly due to Pott disease. We present a rare case. A 31 years old woman presenting a spinal cord compression due to an aspergilloma. Our patient presented also a pulmonary aspergillosis. The spinal compression was due to a contiguous extension of aspergillus to the epidural site. The treatment associated surgery and medical treatment (Ketoconazole), with efficient results.
Abscess↗
Syringomyelia secondary to compression of the cervical spinal cord by an extramedullary lymphoma.
A case of syringomyelia secondary to an extramedullary cervical spinal cord compression by a non-Hodgkin's lymphoma is described. After radiotherapy, the syrinx was no longer seen. The pathogenesis of this type of syrinx is discussed, and the potential benefit of radiotherapy in these cases is suggested.
Adult↗
[Posterior osteosynthesis in the treatment of spinal cord tumors].
Prognosis of cancerous tumors of the spine depends above all on their neurological consequences. The authors have wondered whether osteosynthesis of the spine -- in addition to decompressive surgery -- can improve patient's survival and fonctional results. 23 patients, 20 with a metastatic tumor and 3 with a plasmocytoma were treated in this way. All of them had neurological deficits, 4 had isolated radicular symptoms, 1 a cauda equina syndrome and 18 a spinal cord compression (7 of which were complete). 20 of these patients suffered intractable pain of the spine. All the patients underwent decompressive surgical removal of tumor through laminectomy, associated with a bilateral posterior metallic osteosynthesis. The type of osteosynthesis consisted of two metallic plates placed along each articular column and screwed into the articular processes and the vertebral body through the pedicles of the adjacent normal vertebrae. Cobaltotherapy was added in 14 cases, hormonotherapy in one case and radioactive 131 1 in one another patient. Selective spinal angiography, performed in one case of thoracolumbar tumor was found useful in the location and avoidance of Adamkiedwicz's artery. With regard to the complication, there were two operative wound infections requiring reoperation. Our series -- in comparaison with others -- prove the effectiveness of the combined procedure. Patients without complete spinal deficit had a 20 months survival average. Patients with complete deficit had the same survival as in comparative group. But all the 20 patients suffering pain in the spine were substantially relieved. Such a combined procedure is indicated in cases of tumors involving the vertebrae, whether or not the epidural space is invaded especially when there are riskes of unstable fracture and only partial neurological deficits. The technique may be extended even to complete paraplegia because of its worth while antalgic effects. Thus this method -- by consolidating the spine -- relieving pain and consequently allowing kinesitherapy to be resumed earlier is able to improve the functionnal status and increase survival of the patients.
Adult↗
Epidural lipomatosis simulating an epidural abscess: case report and literature review.
A case of epidural lipomatosis in a 49-year-old man presenting with paraparesis, midthoracic pain, and Staphylococcus aureus pneumonia is reported. The patient had been on low dose corticosteroid therapy for 7 years for rheumatoid arthritis. The clinical and myelographic findings suggested a diagnosis of epidural abscess, but the only abnormality discovered at operation was abundant fatty tissue in the dorsal epidural space significantly compressing the spinal cord, and this was partially removed. Postoperative neurological improvement suggested that the lipomatosis was responsible for the spinal cord compression and dysfunction. If this diagnosis had been suspected, it might have been confirmed by magnetic resonance imaging or postmyelography computed tomographic scanning. With such a diagnosis, an alternative treatment could have been to decrease the steroid dose, observe for clinical improvement, and perhaps avoid operation.
Abscess↗
Magnetic resonance imaging of acute central cord syndrome: correlation with prognosis.
OBJECTIVE: To report the magnetic resonance imaging (MR) findings of acute cervical central cord syndrome and to determine their correlation with the prognosis. METHODS: MRI findings of 35 patients with acute central cord syndrome were studied and compared with the recovery rate of ASIA score at presentation and in follow-up. RESULTS: MRI data demonstrated spinal cord compression for 32 patients, spinal cord swelling for 16 patients, and abnormal signal intensity within the spinal cord for 19 patients, including 14 with edema and 3 with hematoma. No significant difference of the recovery rate was noted between the patients treated nonoperatively and operatively (P > 0.05). There was a significant inverse correlation between the recovery rate and the degree of spinal cord compression as shown in MRI scans (P < 0.01). The presence of hematoma in MRI scans was associated with poor prognosis, as demonstrated by a significant difference of the recovery rate (P < 0.01) among the patients with normal intensity, edema and hematoma within the spinal cord. CONCLUSIONS: MRI scans provide an efficient assistance for decision-making and accurate prognostic information regarding neurological function, and therefore should routinely be performed within the early phase of acute central cord syndrome.
Adult↗
[Spinal epidural abscess].
The aspecific spinal epidural abscess is an uncommon cause of the spinal cord compression. Forty eight patients presented with epidural abscess were operated on during the last 37-year-period in the National Institute of Neurosurgery Budapest. Experiences with the diagnostic methods and the results of the treatment of these patients are analysed. Based on the case history data, preoperative symptoms and operative findings 31 male and 17 female patients (their age ranged from 15-64 years) have been selected in acute, subacute and chronic groups. Localized backpain, acceleration of the blood sedimentation, leukocytosis and fever were significant findings which were followed by sings of radicular or medullary compression. This clinical picture developed rapidly in the acute group. Aspecific abscess most commonly appeared in thoracal or lumbal localisation and was rarely found in the ventral area. Staphylococcus aureus was the causative organism in nearly 100 percent of the cases. Surgery carried out before the onset of the neurological deficits according to proper CSF examination and myelography, proved to be favourable. Early diagnosis and emergency operation led to a significant improvement of the outcome.
Abscess↗
Secondary tetraplegia due to giant-cell tumors of the cervical spine.
BACKGROUND AND PURPOSE: Giant-cell tumor of the bone is a neoplasm which rarely affects the spine, and occurs even more infrequently above the sacrum. The symptomatology depends on the tumor site, and may be attributable to a compression mechanism. Spinal cord injury is seldom a complication and tetraplegia is even more infrequent. In this paper, we present an unusual case involving a giant cell tumor. We also review its possible diagnoses and treatments. CLINICAL CASE: We present the case of giant-cell tumors in the cervical spine affecting C6 and C7, in a young woman who suffered tetraplegia due to spinal cord compression. After surgery and radiotherapy, the tumor reappeared, requiring a second operation. CONCLUSION: Early clinical diagnosis of giant-cell tumors of the spine is difficult because their development tends to go unnoticed. Imaging techniques, especially MRI, help identify them; but their diagnosis still requires histopathologic tests. Resection of the neoplasm is recommended, when possible. Curettage may allow recurrence and radiotherapy may lead to sarcomatous degeneration of the tumor.
Adult↗
Selective spinal cord arteriography in cord compression by tumour.
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Angiography↗
Effects of methylprednisolone on extracellular lactic acidosis and amino acids after severe compression injury of rat spinal cord.
We evaluated in rats with severe spinal cord compression at T8-9 the influence of methylprednisolone (MP) on lactic acidosis and extracellular amino acids, which may cause secondary, perifocal injuries of the cord. MP (30 mg/kg) was given intravenously 30 min before compression and hourly thereafter (15 mg/kg). Other rats with compression, given saline, served as controls. Samples from the extracellular fluid of one dorsal hom were collected by microdialysis and analyzed by HPLC. Microdialysis was performed for 1.5 h to establish basal levels. Samples were collected for 3 h after compression. MP-treated rats showed a reduction of dialysate lactic acid and arginine levels during the first 1-2 h after trauma. The mean dialysate levels of glutamate in MP-treated rats were lower than those of the controls, but the difference was not statistically significant. MP treatment did not influence dialysate levels of aspartate, glutamine, histidine, glycine, threonine, taurine, alanine, GABA, and tyrosine. Our study shows that MP has several effects, including reduced lactic acid formation, reduced levels of arginine (the substrate for nitric oxide production), and a trend toward decreased extracellular accumulation of the excitotoxic amino acid glutamate. We conclude that MP has the capacity to change the composition of the extracellular edema fluid after trauma to the spinal cord. These changes may counteract free radical formation and may be important mechanisms by which MP exerts its beneficial actions.
Acidosis, Lactic↗
Effects of moderate hypothermia on extracellular lactic acid and amino acids after severe compression injury of rat spinal cord.
We evaluated in rats, the effect of moderate hypothermia (30-31 degrees C) on extracellular levels of amino acids, with special emphasis on the excitatory amino acids (EAAs) glutamate and aspartate, lactate and pyruvate, after severe spinal cord compression. A laminectomy of Th7 and Th8 was made. A probe was inserted in a dorsal horn and microdialysis was performed for 1.5 h before and 4 h after applying severe compression for 5 min. Dialysate samples were collected at intervals of 10 min and analyzed by high-performance liquid chromatography. In normothermic (37.5 degrees C) animals there was a several-fold rise of glutamate that peaked in the first 10 min fraction after trauma. Hypothermic animals showed a similar increase after trauma, which was statistically significant until 20 min after injury. The level of glutamate was significantly higher in hypothermic animals from 20 to 70 min after injury, compared with normothermic animals. Aspartate also showed a marked increase following injury. The peak concentration was similar for both groups, whereas recovery was delayed in hypothermic animals. There was no significant difference between the normothermic and hypothermic animals for arginine, taurine, alanine, glutamine, histadine, glycine, threonine, tyrosine, and asparagine. No significant effect of hypothermia on lactate or lactate/pyruvate was noted. However, the mean level of lactate tended to be lower and recovery was quicker in hypothermic animals. The results of the present study suggest that moderate hypothermia does not attenuate extracellular accumulation of EAAs or markedly improve energy metabolism in our model. Instead, our findings raise the possibility that moderate hypothermia prolongs the duration of glutamate receptor overactivation. Since hypothermia effectively attenuates glutamate release in CNS and spinal cord ischemia models our results suggest different mechanisms of extracellular accumulation of EAAs in ischemia and trauma.
Acidosis, Lactic↗
Changes of extracellular levels of amino acids after graded compression trauma to the spinal cord: an experimental study in the rat using microdialysis.
We evaluated in rats, the time course of changes in extracellular levels of amino acids, lactate and pyruvate, which ensued spinal cord compression of mild, moderate, and severe degrees. The neurochemical findings measured by HPLC were compared with known outcome measures of this model. A laminectomy of vertebrae Th7 and Th8 was made and a microdialysis probe was inserted in one dorsal horn. Fluid samples were collected at intervals of 10 min. Dialysate lactate and lactate/pyruvate ratios increased in proportion to the severity of injury, suggesting a progressive derangement of energy metabolism. Mild trauma, with no neurologic deficits, did not induce any remarkable change of amino acids, but taurine values were temporarily slightly elevated. Moderate trauma, leading to transient paraparesis, resulted in a transient rise of glutamate and taurine. Severe trauma resulting in paraplegia of the hind limbs induced profound changes of extracellular amino acids. Glutamate and aspartate rose 5-6 times above basal level. There were marked elevations of taurine, glycine, arginine, alanine, asparagine, histidine, serine, threonine, and tyrosine after this degree of trauma. Glutamate, aspartate, and taurine returned to the basal level within 50 min, whereas most of the other amino acids remained elevated throughout the experiment. Thus, we found profound disturbances of extracellular amino acids and energy metabolites. The elevations of glutamate and aspartate correlated with previously recorded data on neurological outcome. The composition of the early extracellular edema showed marked temporal changes related to the severity of impact. Future studies regarding treatment of traumatic edema should focus on its chemical composition as well as its volume since such edema is not uniform in composition.
Amino Acids↗
Enterogenous cyst of cervical spine: clinical and radiological aspects (including CT and MRI).
Enterogenous cysts are relatively rare causes of spinal cord compression. A case of enterogenous cyst causing compression of spinal cord at C2-3 is presented. Radiological findings, including MRI, are discussed.
Adult↗
Roles of nitric oxide in compression injury of rat spinal cord.
Nitric oxide (NO) was measured directly after spinal cord injury (SCI) in rats by an ESR spin-trapping technique using Fe2+ and diethyldithiocarbamate (DETC). The levels of NO and lipid peroxides expressed as thiobarbituric acid reactive substances (TBARS) were increased by SCI in the injured region and the adjacent central region. Pretreatment with 30 mg/kg of NG-nitro-L-arginine methylester (L-NAME), an inhibitor of NO synthase, accelerated increases of the TBARS level and myeloperoxidase (MPO) activity in the injured tissue and caused deterioration of hind limb motor function after SCI, suggesting that NO formation by constitutive NO synthase (c-NOS) has a protective effect against cellular damage resulting from ischemia-reperfusion after SCI. Though c-NOS mRNA expression was not altered after SCI, inducible NO synthase (i-NOS) mRNA expression increased to a maximum of 24 h after SCI with progress of motor dysfunction. Intravenous injection of L-NAME (0.1 mg/kg) 6, 24, 48, and 72 h after SCI reduced the motor disturbance. These results indicate that NO induced by i-NOS may be neurotoxic in the subacute phase after SCI.
Animals↗