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PubMed2004

Results of radiotherapy in non round cell spinal metastasis.

Spinal metastases are commonly encountered by physicians in a variety of clinical fields. There are some controversies in choice of treatment between surgery and radiotherapy. This report is a study of the outcomes of radiotherapy for metastatic nonround cell tumors of the spine. Medical records and films of 31 patients who were treated with radiotherapy at Songklanakarind Hospital were retrospectively reviewed. The most common primary tumors were prostate and breast. One patient had spinal metastases from malignant serous cystadenoma of the fallopian tube of which no previous report has been published. This patient had excellent results after radiotherapy. Back and neck pain were the primary symptoms of the patients, while motor or sensory deficits (or both) were found in 58 per cent of the cases. Seven patients had neurological recovery and 18 patients had pain relief after radiotherapy. Cause of compression is the only factor effecting the result from univariate and multivariate analysis. Spinal cord compressed by a tumor had a better recovery than those which were compressed by a bony fragment or intervertebral disc. The authors concluded that radiotherapy remains a good treatment for patient with non round cell spinal metastasis. Cause of spinal cord compression is the only factor predicting the result of treatment.

Adult↗
PubMed1982

[Neurologic manifestations of spinal plasmacytomas].

Twenty nine cases of plasmocytic spinal cord tumors which were responsible for neurological troubles were collected over the 19 year period between 1962 and 1981. In 25 of the cases, spinal cord compression was the first sign of the tumor. In 4 of the cases, spinal cord compression was a secondary complication of an already known tumor. The various problems associated with this pathological process are discussed. The neurological problem is fairly straight forward: whether the compression is the first sign of the tumor, and whether it is a secondary complication, it must be surgically removed. Subsequent radiotherapy and chemotherapy are advisable. The oncogenous problem is more delicate. If the plasmocyte is a solitary tumor, and surgical removed is complete, the patient is, in theory, "heated", but should be regularly seen an outpatient basis. On the other hand, a multiple myeloma may first show it self as a spinal cord tumor, where as the patient is in reality suffering from a generalized disease.

Adult↗
PubMed2002

Acute phase effects of ATP-MgCl2 on experimental spinal cord injury.

The purpose of this study was to study the acute phase effects of adenosine triphosphate (ATP)-MgCl2 on experimental spinal cord clip compression injury. Spinal cord clip compression injury was performed on 36 albino Wistar rats. The rats were divided into five groups. T4-T8 total laminectomy was performed on all rats. Group 1: sham-operated group. Group 2: clip compression group. In group 3, ATP-MgCl2 (100 micro mol/kg) was given 2 min before the "clip compression injury." In group 4, ATP-MgCl2 (100 micro mol/kg) was given 5 min after the clip compression injury. In group 5, ATP MgCl2 (100 micro mol/kg) was administered 8 h after the injury. The spinal cords were excised for a length of 2 cm and deep frozen at -76 degrees C. Tissue malondialdehyde (MDA) levels were used to determine the effects of ATP-MgCl2 on spinal cord lipid peroxidation. In the groups in which ATP MgCl2 was administered after the clip compression injury (groups 4 and 5), the decrease in spinal cord MDA levels was statistically significant when compared with those of the injury group (group 2). Although MDA levels of group 4 were lower than those of group 5, this difference was not statistically significant. Administration of the ATP-MgCl2 before the clip compression injury (in group 3) did not have a statistically significant effect on lipid peroxidation when compared with the injury group (group 2). In this study, we found that ATP-MgCl2 has decreased lipid peroxidation in spinal cord injury and protected the spinal cord from secondary injury after the trauma. We concluded that ATP-MgCl2 may be used in the treatment of spinal cord injuries in conjunction with the other treatment modalities, but further investigations are mandatory.

Acute-Phase Reaction↗
PubMed1989

[Surgical treatment of cervical spondylotic radiculomyelopathy with abnormal involuntary neck movements. Report of three cases].

Cervical spondylotic myelopathy usually arises in patients in their late 40s or early 50s, most frequently at the C5/6 and C6/7 levels. Recently, excellent results have been attained with microsurgery in cases of cervical spondylosis. On the other hand, treatment of cervical spondylotic myelopathy in patients with athetoid dystonic cerebral palsy entails several problems. The authors report three cases of such troublesome myelopathy. A 34-year-old male with severe athetoid movement showed cervical spondylotic myelopathy. Myelography and magnetic resonance (MR) imaging demonstrated compression of the spinal cord through the C3-C5 levels. A 47-year-old female with athetoid dystonic cerebral palsy presented myelopathy. Myelography and MR imaging showed instability and spinal cord compression at the C5/6 level. A 34-year-old male with spasmodic torticollis showed C6 radiculopathy due to cervical disc hernia at the C5/6 level. Cervical anterior decompression with interbody fusion brought temporary improvement in all the three patients. However, such problems as slippage of Halo-vest, difficulty in eating during Halo-vest fixation, relapse of neurological deficit, were experienced. Due to postoperative cervical instability, cervical laminectomy is considered to be contraindicated in such patients. Anterior decompression with bone fusion has been reported effective, but, if athetoid dystonia continues, there is a potential for myelopathic deterioration due to spondylotic changes adjacent to the fused vertebrae.

Adult↗
PubMed2005

Irreducible anterior atlantoaxial dislocation: one-stage treatment with a transoral atlantoaxial reduction plate fixation and fusion. Report of 5 cases and review of the literature.

STUDY DESIGN: Retrospective report of five surgical cases and review of the literature. OBJECTIVES: To report the clinical application of a novel internal fixation device in the treatment of irreducible atlantoaxial dislocation with ventral spinal cord compression. SUMMARY AND BACKGROUND DATA: Irreducible atlantoaxial dislocation with ventral spinal cord compression is difficult to treat. Traction is not uniformly successful at either reducing the dislocation or decompressing the spinal cord. Direct anterior decompression of the spinal cord may be necessary, in addition to the need for surgical stabilization of the upper cervical spine. Numerous methods have been described for surgical stabilization following transoral decompression, which generally require a second-stage posterior instrumentation and fusion procedure. Complication rates remain noteworthy for any of these strategies. METHODS: A novel transoral atlantoaxial reduction plate (TARP) system was designed to facilitate a one-stage anterior operation capable of simultaneously decompressing the ventral spinal cord as well as reducing and fusing the atlantoaxial segment. The procedure and TARP implant has been employed for five patients with irreducible atlantoaxial dislocation because of trauma or congenital disorders. Following transoral decompression and excision of scar, ligament and osteophytes, the TARP was used to affect reduction and fixation of the atlantoaxial joints. The decorticated atlantoaxial joint surfaces were grafted with autogenous iliac crest bone. The histories of these cases were reported in detail. RESULTS: The five case examples demonstrate the efficacy of this one-stage approach to the surgical treatment of irreducible anterior atlantoaxial dislocation with spinal cord compression. The role of the TARP in affecting and maintaining the reduction while promoting successful fusion is illustrated. CONCLUSION: The authors' one-stage anterior procedure employing their TARP for the surgical treatment of irreducible anterior atlantoaxial subluxation was effective in these five cases. This method was able to avoid the need for interval traction and/or a second stage posterior instrumentation and fusion procedure.

Adult↗
PubMed1995

Experimental incomplete spinal cord injury: treatment with a combination of nimodipine and adrenaline.

The effect of combination of nimodopine and adrenaline treatment on the motility deficits following secondary spinal cord damage was studied. Morphometric axonal analyses were also done. Incomplete spinal compression was induced in albino New Zealand rabbits anesthetized with ketamine. Neurological deficit was assessed by Tarlov's scale. The animals were divided into different groups. In one group the animals were anesthetized and subjected to all procedures except spinal cord injury and pharmacological treatment. Each of the other groups were divided into 2 subgroups; the spinal cord compression was induced for 2 min in one subgroup and 5 min in other subgroup. The pharmacological treatment in different groups consisted of slow intravenous infusions of saline alone, combination of adrenaline and nimodipine, nimodipine alone and adrenaline alone. The evolution of the motor damage was evaluated by comparing scores obtained with Tarlov's scale 1, 24 and 48 hrs after the end of spinal cord compression. In all animals, spinal cord compression for 2 and 5 min induced a 5th degree motor deficit. Treatment with saline improved slightly the motor deficit. The improvement of motor deficit was much better when a combination of nimodipine and adrenaline was used. The animals treated with nimodipine alone showed a better recovery in comparison with the animals treated with saline alone.

Animals↗
PubMed1998

The effect of duration of compression on lipid peroxidation after experimental spinal cord injury.

The present study was performed to evaluate the effect of duration of acute spinal cord compression on tissue lipid peroxidation in rats. A clip compression method (1) was used to produce acute spinal cord injury. Rats were divided into 3 groups, each consisting of 10. At 1 hour after trauma all rats were sacrificed, and MDA content of the injured spinal cord segment was measured. The tissue MDA contents were 3.922 mumolMDA/gww in group 1 (control), 10.192 mumol MDA/gww in group 2 (30 seconds compression), and 12.147 mumolMDA/gww in group 3 (60 seconds compression). These results demonstrate that the length of duration of compression significantly enhances lipid peroxidation. Our study supported the view that persisting compression may cause progression of secondary mechanisms which may irreversibly eliminate any potential for recovery.

Animals↗
PubMed1993

Somatosensory potentials in dogs with naturally acquired thoracolumbar spinal cord disease.

Somatosensory evoked potentials (SEP) were recorded at the scalp and at various levels along the lumbar and caudal thoracic parts of the spine in response to tibial nerve stimulations. The SEP were observed in 24 diseased dogs, 2 with a vertebral fracture, 1 with a spinal cord tumor, 1 with a vertebral tumor, and 20 with disk herniation. Cord compression location was confirmed by myelography, laminectomy, or both. The clinical state had significant (P < 0.0001) influence on SEP characteristics. The scalp-recorded SEP latency changed only in association with the most severe lesions; spine-recorded SEP conduction velocity was lower in association with mild lesions; scalp-recorded SEP amplitude changed with lesions of intermediary severity. Because these 3 electrophysiologic variables were influenced differently by cord damage, it was possible to discriminate the various clinical grades by use of these techniques. However, dogs with signs of pain only could not be differentiated from clinically normal dogs. The evoked injury potential was observed in all but 4 diseased dogs, and its maximal amplitude corresponded, in all cases, with cord damage location. Increased duration (P < 0.05) of the spine-recorded SEP was associated with long-standing problems, but not necessarily with clinically detectable malfunction. Use of SEP and evoked injury potential for identifying lateralized cord damage may be of value.

Animals↗
PubMed2000

Topography and severity of axonal injury in human spinal cord trauma using amyloid precursor protein as a marker of axonal injury.

STUDY DESIGN: Axonal injury was examined in 18 human cases of acute spinal cord compression using amyloid precursor protein as a marker of AI. OBJECTIVES: To topographically map and semiquantitate axonal injury in spinal cord compression of sufficient severity to produce para- or quadriplegia. SUMMARY OF BACKGROUND DATA: Amyloid precursor protein is carried along the axon by fast axoplasmic transport and has been extensively used as a marker of traumatic axonal injury. METHODS: The study group comprised 18 cases of spinal cord compression (17 due to fracture dislocation of the vertebral column and 1 iatrogenic compression from Harrington rods) and two normal control. All the cords were examined according to a standard protocol, and at least 10 segmental levels were immunostained using a monoclonal antibody to amyloid precursor protein and immunopositive AI was semiquantitated using a grading system to provide the axonal injury severity score (AISS). The focal injury at the site of cord compression (haemorrhage, haemorrhagic necrosis, ischaemic necrosis) was also semiquantitated to provide the focal injury area score (FIAS). AI occurring around the site of focal compression (focal axonal injury severity score or FAISS) was distinguished from AI distant to the focal injury (nonfocal axonal injury severity score or NFAISS). RESULTS: All 18 cases showed widespread amyloid precursor protein immunoreactive axonal injury and the AISS ranged from 28 to 60%. In all cases, the FAISS was greater than the NFAISS and there was a statistically significant relationship between the AISS and the FIAS. CONCLUSION: Acute spinal cord compression of sufficient severity to produce permanent paralysis causes widespread axonal damage that is maximal at the site of compression but also present throughout the length of the cord in segments far distant from the site of the focal injury.

Adolescent↗
PubMed1992

[Anterior approach for cervical dumb-bell typed neurinomas].

We experienced three cases of the dumb-bell typed cervical neurinoma. All of them compressed the spinal cord in the spinal canal, and had developed through the intervertebral foramen and compressed and displaced the vertebral artery. The decompression of the vertebral artery and reconstruction of the spine as well as the removal of the tumor were thought to be important. We used the anterior approach and were able to operate safely and completely. The anterior approach was thought to be effective for the surgical treatment of dumb-bell typed cervical neurinoma.

Adult↗
PubMedDate not supplied

Intramedullary tuberculomas of the spinal cord: case report and review.

Intramedullary spinal tuberculomas are a rare cause of spinal cord compression. We report a recent case and review 17 cases described in the literature since 1960. Intramedullary spinal tuberculomas occurred in relatively young patients (mean age, 28.6 years) and more frequently in women (63% of cases) than in men. The commonest symptoms were those of subacute spinal cord compression (mean duration, 2.3 months) with progressive lower-limb weakness (94%), paresthesia, and bowel and bladder dysfunction. The major physical finding was paraplegia, either spastic (61%) or flaccid (33%). The majority of patients (55%) had a thoracic sensory level. Extraspinal tuberculous disease, predominantly pulmonary, occurred in 69% of reported cases. Myelography efficiently localized the lesion. The diagnosis was made surgically in 16 patients (89%) and clinically in two (11%). Eleven (65%) of 17 patients improved. Four deaths occurred, three in the perioperative period. Though rare, intramedullary spinal cord tuberculoma should be considered in the differential diagnosis of spinal cord compression, particularly when clinical disease compatible with tuberculosis is present.

Aged↗
PubMed1991

A field study of eight ovine vertebral body abscess cases.

A vertebral body abscess extending into the epidural space causing spinal cord compression was diagnosed in the cervical spinal cord in four lambs and the thoracic spinal cord in four lambs. The affected lambs were aged between 4 and 10 weeks and clinical signs had been present for 7-21 days before veterinary examination. Treatment with high doses of penicillin did not result in an improvement of the neurological signs and all lambs were destroyed on humane grounds. Collection and analysis of cerebrospinal fluid (CSF) revealed a significant increase in the protein concentration in lumbar compared to cisternal CSF samples. There was a neutrophilic pleocytosis in two lumbar CSF samples. In lambs aged between 4 and 10 weeks with no history of previous locomotor dysfunction, paresis of more than 1 week duration may be suggestive of a vertebral body abscess which has extended into the epidural space causing spinal cord compression. Stagnation of CSF caudal to the lesion results in an increased protein concentration in the lumbar sample.

Journal Article↗
PubMed2003

[The importance of a complete diagnostic workup in patients with nontraumatic (partial) paraplegia].

In two women, aged 86 and 56 years, respectively, who suffered from back pain and loss of strength, and in a 55-year-old man who lost sensation and strength in his left leg, spinal-cord compression in connection with vertebral destruction was seen on radiological examination. When spinal-cord compression is the result of a local malignant tumour, the therapy often entails emergency radiotherapy. In the first two patients, histological examination revealed a solitary plasmocytoma and curative high-dose radiotherapy was applied. The third patient also had a lung tumour and received low-dose palliative radiotherapy to the vertebrae, as a metastasis was suspected. Later, however, histopathologic examination of the vertebral lesion revealed osteomyelitis due to Listeria monocytogenes and the lung tumour was diagnosed as a pT2N0M0 broncho-alveolar carcinoma which was surgically removed. When a patient is referred with a nontraumatic spinal-cord injury, it is important to complete the radiological and histological examinations before starting emergency radiotherapy in order to prevent an inadequate or even incorrect treatment.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1996

Radiotherapeutic management of spinal metastases.

Radiotherapy remains the primary treatment of malignant epidural spinal cord compression. Therapeutic success depends on diagnosis before the development of neurological compromise and the prompt initiation of radiotherapy. Radiotherapy alone is effective in over 85% of cases of spinal cord compression that occur in highly radioresponsive tumors (multiple myeloma, germ cell or lymphoproliferative tumors). In the more common tumors, like breast, prostate, and lung cancer, response to radiotherapy is based on presenting neurologic deficits, extent of disease, duration of symptoms, and overall clinical status, including other sites of metastatic involvement. Surgery is recommended in addition to radiotherapy in selected cases, and further study is needed to better define the prognostic and neurological parameters for the surgical management of spinal cord compression. Improvements in outcome in the treatment of spinal cord compression will require approaches like combined modality therapy because of the limitations primarily imposed by the radiation tolerance of the spinal cord.

Humans↗
PubMed1992

Ossification of the ligamentum flavum induced by bone morphogenetic protein. An experimental study in mice.

Ossification of the ligamentum flavum and secondary spinal-cord compression were produced experimentally in mice by implanting bone morphogenetic protein (BMP) in the lumbar extradural space. The ligamentum flavum became hypertrophied and ossified, and protruded into the spinal canal. The thickness of the ossified ligament increased gradually with time, leading to compression and deformation of the spinal cord which showed various degrees of degeneration. Demyelination occurred in the posterior and lateral white columns and neuronal loss or chromatolysis in the grey matter. The pathological findings in the experimental animals closely resemble those found in the human disease and suggest that BMP may be a causative factor of ossification of the ligamentum flavum in man. This experimental model may be useful for the study of myelopathy caused by gradual spinal-cord compression.

Animals↗
PubMed1981

[Complex neurological investigations of space-occupying lesions in the spinal canal (author's transl)].

Problems of early diagnosis of space-occupying intraspinal lesions are discussed in relation to 335 patients on whom surgery had been carried out. Advances in neuroradiological methods are considered. The development of new contrast media has resulted in a reduction of the risk of invasive procedures and this should lead to diagnosis of space-occupying spinal lesions at a very early stage. It is now possible to diagnosis small tumours before they cause compression of the cord or of nerve roots.

Adolescent↗