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PubMed1976

Tumours within the spinal column.

Sixty-six cases of mass lesions compressing the spinal cord are presented. The masses were neoplastic in 86.36% of the cases. Epidural masses (80.30%) remain by far the largest group, consisting chiefly of Burkitt's lymphoma and various metastatic carcinomas. Only 6.06% of the lesions were intramedullary and the glioma/paraglioma remains virtually absent.

Adolescent↗
PubMed2001

A new rabbit model for the study on cervical compressive myelopathy.

Development process and pathology of myelopathy due to chronic spinal cord compression have not been fully elucidated. This study was conducted in order to establish an experimental model which can efficiently produce myelopathy and be useful in the studies on myelopathy due to chronic spinal cord compression. Under electrophysiological monitoring of the spinal cord, anterior compression was produced on C5 using a plastic screw. Two weeks later, a plastic plate was inserted under the C5 arch. For the subsequent 10 months on average, walking pattern and MR images were periodically monitored. Before the sacrifice, electrophysiological test was performed and then histopathological examination was done. Palsy appeared at 5 months on average after the addition of posterior compression. Mean compression ratio of the spinal cord calculated on MR images was 34%. All animals with compression showed a high intramedullary signal intensity, and the mean contrast-to-noise ratio (CNR) in the compressed area was 49%. Electrophysiological test showed a significant decrease in the amplitude of spinal cord evoked potentials (SCEPs) at the given compression level. Histology showed flattening of the anterior horn, disappearance and necrosis of anterior horn cells in the gray matter; and demyelination and axonal degeneration in the white matter. The antero-posterior compression produces the condition of spinal canal stenosis. Repeated antero-posterior compression to the spinal cord is important in establishing myelopathy. The present animal model was evaluated to be useful in the studies on myelopathy.

Animals↗
PubMed1995

[Intraspinal metastasis of stage I anaplastic Wilms tumor].

PURPOSE: Intraspinal metastasis of Wilms' tumors is a rare event with only 6 cases documented in the literature. PATIENT AND METHODS: We report a case of an intraspinal metastasis by a young child with anaplastic Wilms' tumor (stage I). A 9-year-old girl developed 8 months following nephrectomy and pre-operative chemotherapy strong back pain. Within 2 weeks signs of beginning of spinal cord compression were obtained. The magnetic resonance imaging showed a spinal cord compression with an intraspinal tumor mass Th 8 to 10. RESULTS: The child underwent immediate spinal cord decompression followed by chemotherapy and an additional radiotherapy of the metastatic region up to 30 Gy with most of neurologic recovery within 6 weeks. CONCLUSIONS: The case illustrates the importance of rapidly responding neurologic complications in patients with Wilms' tumor, even in stage I.

Child↗
PubMed1985

[Somatosensory evoked potentials in intraspinal tumors].

SEPs have been recorded in 15 patients with spinal cord tumors (mostly ependymomas) and in 5 patients with cord compression due to meningiomas (3 cas), neuromas (1 case) or neurosarcoma (1 cas). All the patients have been operated on so that precise informations were available on the histology and the location of the tumor. SEPs were monitored during surgery in 8 patients. The main conclusions of this study are as follows: There was a good correlation between the somatosensory troubles for touch, vibration sense and joint position sense, and SEPs abnormalities, however, SEPs may be clearly abnormal in the absence of any somatosensory deficit when the dorsal columns are compressed and not infiltrated by the tumor. In the latter situation the reverse dissociation (i.e., normal SEPs with somatosensory troubles) may be observed. The possibility of a dissociation between normal N11 and N13 cervical components and absent P14 far field components (non-cephalic reference) has been confirmed in 6 patients with cervicomedullary tumors. In 3 of them, this dissociation was found to be reversible and early SEPs returned to normal after surgery. Peroperative monitoring of scalp SEPs recorded with a non-cephalic reference electrode allowed the detection of transient SEP abnormalities related with a traction on the dorsal columns of the cord. SEP monitoring is recommended for any surgical removal of tumor that needs a posterior myelotomy.

Adult↗
PubMed1996

Multiple-level compression myelopathy: concomitant asymptomatic cervical compression adversely affects surgical outcome for thoracic compression myelopathy.

To determine whether asymptomatic spinal cord compression affects surgical outcome for another compression, we retrospectively reviewed the outcome for thoracic myelopathy due to spinal ligament ossification. Improvement assessed by changes in motor function of the lower extremity using the Japanese Orthopedic Association Classification was significantly less in cases associated with asymptomatic cervical ligament ossification (C+T group, N = 5) than in cases without cervical ligament ossification (T group, N = 13) (p < 0.05, Mann- Whitney U test). The "no disability" recovery rate was 61.5% in the T group and none in the C+T group (p < 0.05, Fisher's exact probability test). There was no significant difference in background parameters between the two groups. This study showed that concomitant spinal cord compression, even if asymptomatic itself, can adversely affect surgical outcome at a separate segment.

Aged↗
PubMed1988

The pathogenesis of spinal epidural abscess: microangiographic studies in an experimental model.

An experimental model of spinal epidural abscess was developed in rabbits by injecting Staphylococcus aureus into the posterior thoracolumbar epidural space. This model has been shown to reproduce the neurological, bacteriological, and radiological aspects of the human disease. In this study, the effect of the infectious epidural mass on the vasculature of the spinal cord in paraplegic rabbits was studied using microangiographic techniques. The normal vascular anatomy of the rabbit spinal cord was defined in control experiments. Vascular proliferation was demonstrated in the epidural space surrounding the abscesses. Anterior and paired posterior spinal arteries remained patent in paraplegic rabbits with mild or moderate spinal cord compression and in some cases of severe compression. In animals with severe compression, the anterior epidural venous plexus remained patent, but the dorsal spinal vein was occluded. Occlusion of perforating arteries occurred only with extreme spinal cord compression. These data indicate that the initial neurological deficit associated with experimental spinal epidural abscess is not due to vascular thrombosis.

Abscess↗
PubMed1994

Does increased signal intensity of the spinal cord on MR images due to cervical myelopathy predict prognosis?

We examined whether or not high signal intensity change on magnetic resonance imaging of the spinal cord of patients with cervical myelopathy is related to the clinical symptoms and prognosis. Twenty-five patients with cervical myelopathy were treated by decompressive surgery which involved laminoplasty or decompressive anterior interbody fusion. The pathological conditions were cervical disc herniation (n = 8), ossification of the posterior longitudinal ligament in the cervical spine (n = 7), and cervical spondylotic myelopathy (n = 10). The spinal cord compression and the intramedullary signal intensity at the site of maximum compression were evaluated pre- and postoperatively using T1- and T2-weighted images. There was no significant relationship between spinal cord compressive change and clinical symptoms. Patients in whom the high signal change of the spinal cord on T2-weighted sequence recovered after decompressive surgery had better recovery from clinical symptoms, but a statistical significance was not found. We suggest that signal changes on T2-weighted images may reflect pathological changes but cannot be used to predict prognosis at present.

Adult↗
PubMedDate not supplied

Failure of magnetic resonance imaging to reveal the cause of a progressive cervical myelopathy related to postoperative spinal deformity: a case report.

Imaging studies have achieved a high degree of diagnostic accuracy for many disorders of the spinal cord but have significant limitations. We report on the case of a 49-yr-old man who developed neck pain and arm numbness. He was found to have extensive cervical spondylosis, with spinal cord impingement at C3-4 and cervical radiculopathy. He underwent a C3-7 laminectomy, with transient improvement in his symptoms. During the ensuing year, he developed increased weakness of the upper limbs, evidence of cervical myelopathy, and a severely flexed posture of the cervical spine. Magnetic resonance imaging (MRI) revealed cervical spinal cord atrophy but no evidence of extrinsic spinal cord compression. Cervical flexion and extension films revealed reversal of the normal cervical lordosis without segmental instability. Despite the absence of confirmatory radiologic studies, the patient was felt to have clinical evidence of intermittent compression of his cervical spinal cord attributable to excessive cervical kyphosis, was provided with a cervical collar, and subsequently underwent surgical stabilization. His cervical myelopathy showed marked improvement with these treatments. We conclude that intermittent compression of the spinal cord, occurring in the erect position, was not apparent on the MRI films obtained in the supine position. Flexion and extension films, obtained in the upright position, documented his abnormal cervical anatomy but did not reveal substantial segmental instability. Spinal deformity without segmental instability may cause cervical myelopathy after multilevel cervical laminectomies without evidence of extrinsic compression on MRI.

Braces↗
PubMed2007

[Retroodontoid mass without atlantoaxial subluxation in an elderly patient: case report].

A Mass at the craniovertebral junction is relatively rare. We report a case of retroodontoid mass without atlantoaxial subluxation. An 84-year-old female presented to our hospital with paresthesia in the right upper and lower limb. She had no history of head or spine injury. Neurological examination revealed slight motor weakness of the right upper and lower limb. Cervical radiographs showed osteoarthrosis without atlantoaxial subluxation. MRI revealed retroodontoid, extra-dural mass that severely compressed the adjacent spinal cord. The patient underwent C1 laminectomy and posterior C1-C2 fusion with polyaxial screw and rod fixation. Simultaneously, the mass was resected partially. Histopathologically, the surgical specimen was a non-neoplastic fibrocartliginous mass and inflammatory cells were not seen. Postoperative course was uneventful and her neurological condition gradually improved. MRI revealed marked reduction of the mass and improvement of the spinal cord compression six months after the operation. We discuss the genesis of the retroodontoid mass and the strategy for surgical treatment.

Aged, 80 and over↗
PubMed1990

Paraplegia after a routine lumbar laminectomy: report of a rare complication and successful management.

Arachnoid cysts of the spinal canal are relatively common lesions that may be either intra- or extradural. These cysts are usually asymptomatic but may produce symptoms by compressing the spinal cord or nerve roots. We report a case in which an intradural thoracic arachnoid cyst became symptomatic after a routine decompressive lumbar laminectomy for spinal stenosis. Myelography revealed no abnormality, although magnetic resonance imaging and computed tomography after myelography demonstrated a mass within the posterior aspect of the thoracic spinal canal associated with anterior displacement and compression of the spinal cord. A change in the flow dynamics of the cerebrospinal fluid probably allowed the development of spinal cord compression due to one of the following: expansion of the cyst, decreased cerebrospinal fluid buffer between the cord and the cyst, or epidural venous engorgement. A concomitant and more cephalad lesion such as an arachnoid cyst should be considered when myelopathic complications arise after lumbar surgery. Magnetic resonance imaging and computed tomography after myelography are useful to demonstrate the additional pathological processes.

Aged↗