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PubMedDate not supplied

Spinal cord compression by solitary plasmocytoma.

A rare case of spinal cord compression caused by a solitary plasmocytoma situated at the level of the 9th and 10th thoracic vertebrae, is described. The solitary plasmocytoma should be included in the differential diagnosis of various types of spinal cord compression and considered as something completely separate from multiple myeloma (Willis, 1941). If operated on adequately, the solitary plasmocytoma can be considered a lesion with benign characteristics.

Adult↗
PubMed1989

[Diagnostic-therapeutic integration in metastatic spinal cord compression. Analysis of a prospective study].

Metastatic Spinal Cord Compression (MSCC), an oncologic emergency, is a frequent complication of many neoplastic diseases in an advanced stage. Our experience is reported, which was obtained with a series of 61 patients following a diagnostic-therapeutic protocol aimed at early diagnosing MSCC and at assigning the major role in therapy to radiotherapy (RT) alone. Fifty-seven patients with an average follow-up of 13 months (range 4-26) were evaluable. Diagnosis was always made by means of myelography and/or myelography plus CT. In 50 cases the treatment consisted in RT alone and the remaining 7 patients had surgery before RT because of diagnostic doubts; in 1 case the patient was operated on because stabilization was necessary. A dose of 30 Gy was delivered, over 2 weeks, (TDF = 62) to those tumors which were considered as radiation-responsive and having a better prognosis (myeloma, lymphoma), whereas all the other histologies were given a split-course regimen (5 Gy x 3 days, stop x 4 days, +/- 3 Gy x 5 days; TDF = 68). All patients received medium or high doses of steroid depending on the degree of neurologic involvement. Patients with chemo/hormone-responsive primary tumors also received chemotherapy and/or hormone therapy. The clinical parameters considered in evaluating the response to treatment were backache, motor performance, and sphincter function. Respectively 86%, 47% and 44% of patients responded. Early diagnosis was the most important prognostic factor, whereas histology of the primary tumor was important in cases with severe neurologic damage only. The results obtained are similar to those reported in literature and confirm the value of the diagnostic-therapeutic approach used, which suggests continuing this trial.

Adult↗
PubMed1998

Costal osteochondroma. A rare cause of spinal cord compression.

STUDY DESIGN: Report of a rare cause of spinal cord compression: costal osteochondroma. OBJECTIVE: To describe a very rare cause of spinal cord compression, costal osteochondroma, which was present in a 16-year-old girl with a history of hereditary multiple exostoses. SUMMARY OF BACKGROUND DATA: Only four cases of expansion of costal osteochondroma into the spinal canal through an intervertebral foramen have been reported previously. METHODS AND RESULTS: The origin of the osteochondroma at the head of the right 12th rib, the invasion of the spinal canal through the right T12-L1 intervertebral foramen, and the compression of the spinal cord were shown on computed tomography and magnetic resonance imaging. The exact extent of the osteochondroma, particularly the cartilage cap, was delineated accurately by magnetic resonance imaging. Complete excision followed by full recovery occurred 19 months after surgery. CONCLUSION: Magnetic resonance imaging is the preferred method of investigation in cases of osteochondroma related to spine, because it allows for better pre-operative planning and helps to prevent incomplete excision of the tumor.

Adolescent↗
PubMed2003

Sustained spinal cord compression: part I: time-dependent effect on long-term pathophysiology.

BACKGROUND: The objective of this study is to determine whether there is a relationship between the duration of sustained spinal cord compression and the extent of spinal cord injury and the capacity for functional recovery after decompression. METHODS: Sixteen dogs underwent sustained spinal cord compression for thirty or 180 minutes. The cords were compressed with use of a loading device with a hydraulic piston. A pressure transducer was attached to the surface of the piston, which transmitted real-time spinal cord interface pressures to a data-acquisition system. Somatosensory evoked potentials were monitored during a sixty-minute recovery period as well as at twenty-eight days after the injury. Functional motor recovery was judged throughout a twenty-six-day period after the injury with use of a battery of motor tasks. The volume of the lesion and damage to the tissue were assessed with both magnetic resonance imaging and histological analysis. RESULTS: Sustained spinal cord compression was associated with a gradual decline in interface pressure. Despite this, there was continuous decline in the amplitude of the somatosensory evoked potentials, which did not return until the cord was decompressed. Within one hour after the decompression, the dogs in the thirty-minute-compression group had recovery of somatosensory evoked potentials, but no animal had such recovery in the 180-minute group. Recovery of the somatosensory evoked potentials in the thirty-minute group was sustained over the twenty-eight days after the injury. Motor tests demonstrated rapid recovery of hindlimb motor function in the thirty-minute group, but there was considerable impairment in the 180-minute group. Within two weeks after the injury, balance, cadence, stair-climbing, and the ability to walk up an inclined plane were significantly better in the thirty-minute group than in the 180-minute group. The longer duration of compression produced lesions of significantly greater volume, which corresponded to the long-term functional outcome. CONCLUSIONS: The relatively rapid viscoelastic relaxation of the spinal cord during the early phase of sustained cord compression suggests that there are mechanisms of secondary injury that are linked to tissue displacement. Longer periods of displacement allow propagation of the secondary injury process, resulting in a lack of recovery of somatosensory evoked potentials, limited functional recovery, and more extensive tissue damage.

Animals↗
PubMed2006

beta(2)-Microglobulin amyloidosis caused spinal cord compression in a long-term haemodialysis patient.

STUDY DESIGN: A case report of cervical myelopathy caused by epidural beta (2)-microglobulin (beta2m) amyloid deposits in a 50-year-old woman with haemodialysis treatment. OBJECTIVE: Long-term haemodialysis in patients with end-stage renal disease leads to several complications based on beta2m deposits, which can affect, in the cervical spine, the intervertebral disk, and in rare cases, they may compress the spinal cord and nerves. The objective of this report is to describe the clinical and radiological follow-up preceding the indispensable surgical excision of an amyloid mass in a 50-year-old woman with haemodialysis treatment. Long-term postoperative cervicalgia owing to subcondylian bone cyst-associated atlanto-occipital instability is also described and discussed. SETTING: Department of Neurosurgery A, Hop Pellegrin, Bordeaux, France. CASE REPORT: We present a clinical case of a patient with spinal cord compression. The patient was treated by surgical excision of an amyloid mass subsequent to a C2-C3 laminectomy. The patient experienced clinical improvement with a regression of all of her neurological symptoms. Histological findings confirm the diagnosis of beta2m amyloid deposition. However, 5 years after surgery the subcondylian bone cysts were still observed and atlanto-occipital instability required her to wear a minerva. CONCLUSION: Our case report confirms that surgical excision of beta2m epidural deposits is necessary and relevant when neurological prognosis is discussed, and that pain is still the major symptom of disease evolution. The use of high-flux synthetic membranes could decrease the beta2m blood level and early renal graft is the only method to prevent such complications.

Amyloidosis↗
PubMed1978

Effect of duration of acute spinal cord compression in a new acute cord injury model in the rat.

The effect of duration of acute compression of the spinal cord was assessed in a new model in the rat. The spinal cord was acutely compressed for varying times by a modified aneurysm clip which produced a compression force of 180 grams. The effect of duration of compression was measured by the inclined plane method of assessing the animals' clinical performance. The results showed a linear relationship between log compression time and clinical performance. Thus, the clinical effect of acute compression of the spinal cord injury is inversely related to duration of compression time and the relationship has been precisely quantified. These results suggest that persisting compression should be relieved as soon as possible in order to improve recovery.

Acute Disease↗
PubMedDate not supplied

Migration of luque rods through a laminectomy defect causing spinal cord compression.

Internal fixation of traumatic spinal injuries has been associated with spinal canal stenosis, spinal cord compression, and nerve root impingement. We present a case of spinal cord/cauda equina compression due to migration of intact, anchored thoracolumbar Luque rods into the spinal canal through a laminectomy defect, leading to neurologic complications 10 years after the original operation.

Adult↗
PubMed1995

Hodgkin's disease with spinal cord compression. A case report and a review of the literature.

BACKGROUND: Spinal cord compression is a rare complication of Hodgkin's disease, occurring in only 5% of cases, usually in the setting of progressive, advanced disease. As the initial symptom of Hodgkin's disease, it is extremely rare, with only a few cases reported in the literature. METHODS: A case report of a 46-year-old man who presented with signs and symptoms of spinal cord compression and was found to have an extradural mass in the cervical and thoracic spine is described. Biopsy revealed Hodgkin's disease. This case report represents a unique case of a patient with Hodgkin's disease presenting with epidural disease, with spinal cord compression as the only apparent site of initial clinical involvement. A review of the literature of patients with Hodgkin's disease presenting with spinal cord compression from 1970 to the present is presented. RESULTS: The patient, whom we report, received chemotherapy followed by external beam radiation therapy and achieved complete resolution of symptoms and a complete response by radiologic criteria. Based on a review of the literature, Hodgkin's disease involving the spinal epidural space is very responsive to radiation therapy and chemotherapy with a good prognosis for both functional recovery (86%), complete response (61%), and long term survival. CONCLUSIONS: Chemotherapy and/or radiation therapy is successful treatment for Hodgkin's disease presenting with spinal cord compression. For the rare patient who presents with spinal cord compression as the initial symptom of Hodgkin's disease, the therapeutic options include chemotherapy alone, radiation therapy alone, or combined modality therapy.

Hodgkin Disease↗
PubMed2005

Mature neuroblastic tumors with spinal cord compression: report of five pediatric cases.

BACKGROUND: Neuroblastic tumors cause spinal cord compression when they arise primarily in the spinal canal or invade it through the radicular foramen. Whereas neuroblastomas (NB) are relatively common and are generally treated with chemotherapy, mature neuroblastic tumors (MNT), which include intermixed ganglioneuroblastomas (iGNB) and ganglioneuromas (GN), are less common and the role of surgery is more prominent. Because MNT are rare and have been separated only recently from NB, their clinical and radiological features as well as the role of surgery are poorly defined. MATERIALS AND METHODS: In order to increase our knowledge on MNT, we reviewed our database for cases operated for spinal cord compression in our department since the introduction of magnetic resonance imaging (MRI). We treated four cases of NB and one case of iGNB presenting primarily with spinal cord compression. REPORT OF CASES: MNT represented 10% of spinal tumors and 1.6% of all tumors of the nervous system in our pediatric neurosurgical practice. The neurological and oncological outcomes were generally favorable after surgical resection, followed by orthotic treatment. In one case with neurofibromatosis type 1, the tumor was inoperable and the child died of tumor progression several years later. CONCLUSION: GN, and some iGNB, are chemo-insensitive and can only be cured by surgical removal. Surgery is an emergency in case of rapidly progressing paraplegia and can be challenging because the tumor is often hard and hemorrhagic. In case of subtotal removal, tumor remnants can stay stable without oncological treatment.

Child↗
PubMed1991

Participation of serotonergic mechanisms in the pathophysiology of experimental neoplastic spinal cord compression.

We evaluated the role of serotonin (5-HT) in neoplastic cord compression in paraplegic rats harboring a thoracolumbar epidural tumor. We measured serotonin and its major metabolite, 5-hydroxyindole-3-acetic acid (5-HIAA), in the C-1 to C-7, T-1 to T-6, T-7 to T-12, and T-13 to L-3 spinal segments of tumor-free and tumor-bearing rats. In normal controls, a consistent rostral-to-caudal gradient for 5-HT and 5-HIAA was evident, but the 5-HIAA/5-HT ratio remained constant. In paralyzed rats, 5-HT levels were unchanged, but the 5-HIAA/5-HT ratio was elevated, especially in the compressed segments. Treatment with either dexamethasone or indomethacin delayed onset of paraplegia but had no effect on 5-HT metabolism. Blocking 5-HT receptors by cyproheptadine, evaluated 30 hours after onset of paralysis and treatment, resulted in a reduction in the high water content, vascular permeability, and prostaglandin E2 synthesis in the compressed cord. Early administration of cyproheptadine effectively delayed the onset of paraplegia. These data indicate that receptor-activated serotonergic mechanisms participate in the disruption of the blood-spinal cord barrier and that these effects can be manipulated pharmacologically.

Animals↗
PubMed1996

[Metastatic spinal cord compression in patients with lung cancer].

Metastatic spinal cord compression (MSCC) is a disabling complication to cancer for which the optimal treatment of choice is not settled. An analysis was performed in patients with MSCC secondary to lung cancer in order to elucidate clinical symptoms and treatment results according to regression of neurological deficits and survival. The total series consisted of 102 retrospectively evaluated patients referred for treatment, in the Eastern part of Denmark in the period 1979-1988. Patients included 40% cases with Small Cell Carcinoma (SCLC), Adeno-carcinoma (ACL) (26%), Squamous Cell Carcinoma (SQLC) (18%) and Large Cell Carcinoma (LCC) (9%). Symptoms, clinical presentations and therapeutic results are described. The outcome of treatment depended fundamentally on the patient's neurological condition at the time of the diagnosis. All patients with SCLC who were able to walk at the time of MSCC remained ambulatory while 15% of the non-ambulatory SCLC patients regained walking ability; in non-SCLC, 95% of patients retained walking ability while 22% regained the ability to walk. No major differences in the immediate outcome of treatment between the various histological types of lung cancer as to the different treatment modalities were observed, however, 82% of the patients with non-SCLC had benefit from treatment with laminectomy followed by radiotherapy compared with either laminectomy (47%) or radiotherapy (39%) alone (p = .03, Chi-square test). The group of patients treated with laminectomy followed by radiotherapy had a better survival (median value 3.5 months, range 0-132 months) than patients treated with either laminectomy (median value 1.5 months, range 0-32 months) or radiotherapy (median value 1 month, range 0-59 months) alone (p = .03, Log-Rank test). No significant difference was observed in survival between the various histological types of lung cancer (p = .18, Log-Rank test). Despite a short survival, early diagnosis and immediate treatment is crucial, since it may preserve the gait function in 97% of lung cancer patients developing malignant spinal cord compression.

Adult↗
PubMed1992

Spinal cord compression in Scheuermann's kyphosis: case report.

Compression of the spinal cord secondary to disc disorders in Scheuermann's kyphosis is rare. This review reports an unusual case emphasizing mechanisms of compression of the spinal cord from this disc disorder. Contrasts and comparisons with previously published cases are included.

Adult↗
PubMed1994

Upper cervical spinal cord compression due to bony stenosis of the spinal canal.

Compression of the upper cervical spinal cord due to stenosis of the bony spinal canal is infrequent. In the first case reported here, stenosis was due to acquired extensive, unilateral osteophytes centered on the left apophyseal joints of C1-C2 in an elderly professional violinist. In the second case, stenosis was secondary to isolated congenital hypertrophy of the laminae of C1 and C2.

Adult↗
PubMed1986

Gait ataxia as a presenting symptom of malignant epidural spinal cord compression.

A 68 year old man with prostatic carcinoma developed spinal cord compression. The sole presenting feature was painless gait ataxia indistinguishable from cerebellar ataxia. He was investigated for cerebellar disease but the correct diagnosis was made when he subsequently presented with paraplegia and classical signs of spinal cord compression. Surgical decompression failed to produce neurological recovery. We discuss the importance of recognizing this unusual presentation of spinal cord compression, its possible mechanism and evidence that it may be under-reported.

Adenocarcinoma↗