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PubMed1986

Surgical treatment of spinal cord compression in kidney cancer.

Forty-three patients with renal-cell carcinoma underwent treatment for spinal cord compression over a 7-year period. Of these, 32 patients underwent surgery, while 11 patients underwent radiation alone. Before operation, 25 patients had relapsed following prior radiation, while seven others received postoperative radiation. A more aggressive surgical approach, tailored to the site of compression within the spinal canal, was used with the majority undergoing gross total tumor resection by an anterior approach. Immediate stability of the spine was achieved with methyl-methacrylate reconstruction of the resected segments. Preoperative spinal angiography with embolization of hypervascular tumors was carried out in eight patients. Patient parameters in the surgical and irradiated groups were comparable, except that a greater proportion of the radiation alone group had more than one organ system involved (64% v 44%). The median survival of the surgically treated patients was 13 months, compared with 3 months for those treated by radiation alone. In addition, a greater proportion of the surgically treated patients were benefitted neurologically (70%) compared with those treated by radiation (45%). With the development of effective surgical treatment for spinal metastases, early consideration for surgical treatment (before radiation) should be considered in selected patients. Preoperative spinal angiography and embolization are recommended whenever feasible to minimize intraoperative blood loss.

Adult↗
PubMed2003

Influence of spinal cord compression on the C3-C4 propriospinal neurons in cats.

The C3-C4 propriospinal neurons (PNs) transmit motor signals to forelimb motoneurons. Stem axons of the PNs bifurcate in the same segments and send ascending axons to the lateral reticular nucleus (LRN) as well as descending axons to the cervical motor nucleus. After laminectomy of decerebrated cats, ascending axons were stimulated by tungsten electrodes placed in the LRN. The N1 descending incoming volleys via axon reflexes with a latency of approximately 1.5 ms (N1 potential) were recorded in the forelimb motoneuron pools at C8 segment. We compressed the spinal cord at C3 or C6 segment by 6 x 5 mm plastic material and analyzed amplitudes of the N1 potentials at C8 motoneuron pools. After spinal compression step by step until 3000 microm from the surface for 30 min at the C3 segment, the amplitude of N1 potentials decreased to approximately 39.7% of the control. On the other hand, the amplitude of N1 potentials changed little after the same compression of the C6 segment. The N1 potentials during compression of the C3 segment did not recover to the initial amplitude of 63.5% after decompression. It is concluded that activities of axons at C3 segment are more sensitive than those at C6 to compression of the spinal cord. We discuss the properties of the bifurcation of the stem axons and the central spinal cord injury.

Animals↗
PubMed1996

Rehabilitative functional outcome of patients with neoplastic spinal cord compressions.

OBJECTIVE: To examine functional outcome and descriptive data of individuals with neoplastic spinal cord compression admitted to a rehabilitation unit. DESIGN: A 5-year review of consecutive patients admitted to a spinal cord injury rehabilitation unit with a diagnosis of neoplastic spinal cord compression. SETTING: A tertiary university medical center. PATIENTS: Thirty-two consecutive patients with neoplastic spinal cord compression who met standard rehabilitation admission criteria and had a prognosis of no less than 3 months' survival. MAIN OUTCOME MEASURES: Functional data, including length of stay, functional outcomes (utilizing Functional Independent Measurement scores in mobility and self-care), bladder management, and disposition. RESULTS: Lung (28%) and prostate (17%) were the most common tumor types, and upper thoracic (40%) was the most common level of spinal cord involvement. Functional Independent Measure improvements were found in all areas, with significant improvements (paired t test, p < .005) noted in the areas of upper and lower extremity dressing, grooming, toilet and tub transfers, wheelchair use and transfers, ambulation, and stair climbing. Average length of rehabilitation stay was 27 days, and 84% of the patients were discharged to home. Seventy-five percent of the 20 responders to a follow-up survey had maintained or improved their discharge functional abilities at 3 months after discharge. CONCLUSIONS: These data suggest that in individuals with spinal cord compression caused by neoplastic invasion, functional improvements in mobility and self-care can be achieved and maintained for at least 3 months after discharge.

Activities of Daily Living↗
PubMed1989

Spinal cord compression in myelomatosis: response to chemotherapy alone.

Current management of spinal cord compression due to multiple myeloma usually involves irradiation with or without decompressive surgery. We report five patients (three of whom were severely affected) with a neurological deficit due to spinal cord compression by multiple myeloma, who regained ambulation and sphincter control with melphalan and prednisone alone. The dramatic response in these cases, as well as other evidence presented, suggests that systemic treatment may have a major role in the management of spinal cord compression by sensitive malignant tumours.

Adult↗
PubMed1996

Primary vertebral and spinal epidural non-Hodgkin's lymphoma with spinal cord compression.

We examined eight patients with primary spinal epidural non-Hodgkin's lymphoma presenting with spinal cord compression and proven histologically after laminectomy (7 cases) or biopsy (1 case) by MRI. The most common findings were an isointense or low signal relative to the spinal cord on T1-weighted images (T1WI) and high signal on T2-weighted images (T2WI). Spinal cord compression, vertebral bone marrow and paravertebral extension were assessed. Contrast enhancement was intense in seven of the eight cases and homogeneous in all of them. T2WI (performed in 2 cases) may be useful to distinguish metastatic carcinomas and sarcomas. T1WI demonstrated the full extent of the epidural lesion, which was well-delineated in all cases. When the paravertebral extension is not well-defined, a study with contrast medium should be performed.

Adult↗
PubMed1996

Metastatic epidural bony tumor causing spinal cord compression: a case report.

The authors report the case of a patient with breast cancer who developed spinal cord compression due to the expansion of an epidural bony tumor from an osteoblastic vertebral metastasis into the spinal canal. Magnetic resonance imaging revealed an epidural mass that was compressing the spinal cord but that did not demonstrate the bony elements contained within the epidural mass. These bony elements were demonstrable only by computed tomography. The patient did not respond to radiotherapy but did recover after surgical decompression. Therefore, the authors recommend the use of computed tomography for patients who have osteoblastic vertebral metastases and epidural spinal cord compression diagnosed by MRI. Once an epidural bony mass expanding from a vertebral metastasis into the spinal canal is demonstrated by computed tomography, surgical decompression is indicated.

Breast Neoplasms↗
PubMed1995

[Spinal cord compression as the presenting form of non-Hodgkin's lymphoma].

Spinal cord compression as first presentation of non-Hodgkin's lymphoma (NHL) is an uncommon event. Diagnosis of NHL usually is performed on a laminectomy specimen. Spinal cord compression has been reported in 5% of patients with solid tumors. Although this clinical picture has been considered as very unusual among NHL patients, some series regarding descompresive laminectomy indicate that NHL was the underlying cause in 15% of these cases. We report two cases of patients with NHL who presented paraparesia secondary to spinal cord compression due to lymphomatous mass in the epidural region which was showed by magnetic resonance imaging. The emergency laminectomy and treatment with chemotherapy allowed the clinical recuperation of both patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1980

Neuroblastoma: a review of 21 cases presenting with spinal cord compression.

The records of 21 children with neuroblastoma presenting with spinal cord compression, encountered over 17 years, were reviewed. Thirteen patients (61%) survive, free of neuroblastoma, at intervals ranging from nine months to 192 months (median, 78 months) from the time of diagnosis. The explanation for this relatively high survival rate was sought in an analysis of the cases which took into account age, site, extent of disease, and histology. The most significant features to emerge were the unusually high proportion of children under 12 months of age at presentation (11 of 21) most of whom survive (9 of 11) and the low incidence (3 of 21) of detectable at the time of diagnosis. The absence of a paraspinal mass was an unfavourable prognostic features (1 of 6 survives) whilst if a paraspinal mass was present, its anatomical level did not influence survival. In particular, children with retroperitoneal tumors fared no worse (survival, 6 of 7) than those with primary tumors at other sites (survival, 6 of 8). Morbidity was high (6 of 13), principally in infants with spinal cord compression from birth. Survival was also related to the histologic maturity of the tumor, even in the presence of metastases. Recommendations for management are made.

Catecholamines↗
PubMed1995

Characterization of axonal ultrastructural pathology following experimental spinal cord compression injury.

The present study characterizes axonal pathology associated with traumatic compression injuries of the spinal cord and quantitatively assesses subtypes of axonal pathology in the acute, post-injury period. Eighteen adult female Wistar rats underwent spinal cord compression injury with a 53 g modified aneurysm clip at the C8-T1 segment. Six additional rats served as sham controls. Six experimental animals were sacrificed at each of the three post-injury time points: 15 min, 2 h and 24 h. From all animals, the C8-T1 spinal cord was dissected and processed for both light and electron microscopy. Axonal pathology included periaxonal swelling, organelle accumulation, vesicular myelin, myelin invagination, myelin rupture, and giant axons. Early myelin rupture and the ultrastructural features of giant axons are described here for the first time in the context of spinal cord compression injury. The quantitative analysis characterizes the prevalence of types of axonal pathology over the acute post-injury period and provides evidence for the secondary injury hypothesis regarding the evolution of axonal pathophysiology following trauma.

Animals↗
PubMed1997

Viscoelastic relaxation and regional blood flow response to spinal cord compression and decompression.

STUDY DESIGN: To better understand the relationships between primary mechanical factors of spinal cord trauma and secondary mechanisms of injury, this study evaluated regional blood flow and somatosensory evoked potential function in an in vivo canine model with controlled velocity spinal cord displacement and real-time piston-spinal cord interface pressure feedback. OBJECTIVES: To determine the effect of regional spinal cord blood flow and viscoelastic cord relaxation on recovery of neural conduction, with and without spinal cord decompression. SUMMARY OF BACKGROUND DATA: The relative contribution of mechanical and vascular factors on spinal cord injury remains undefined. METHODS: Twelve beagles were anesthetized and underwent T13 laminectomy. A constant velocity spinal cord compression was applied using a hydraulic loading piston with a subminiature pressure transducer rigidly attached to the spinal column. Spinal cord displacement was stopped when somatosensory evoked potential amplitudes decreased by 50% (maximum compression). Six animals were decompressed 5 minutes after maximum compression and were compared with six animals who had spinal cord displacement maintained for 3 hours and were not decompressed. Regional spinal cord blood flow was measured with a fluorescent microsphere technique. RESULTS: At maximum compression, regional spinal cord blood flow at the injury site fell from 19.0 +/- 1.3 mL/100 g/min to 12.6 +/- 1.0 mL/100 g/min, whereas piston-spinal cord interface pressure was 30.5 +/- 1.8 kPa, and cord displacement measured 2.1 +/- 0.1 mm (mean +/- SE). Five minutes after the piston translation was stopped, the spinal cord interface pressure had dissipated 51%, whereas the somatosensory evoked potential amplitudes continued to decrease to 16% of baseline. In the sustained compression group, cord interface pressure relaxed to 13% of maximum within 90 minutes; however, no recovery of somatosensory evoked potential function occurred, and regional spinal cord blood flow remained significantly lower than baseline at 30 and 180 minutes after maximum compression. In the six animals that underwent spinal cord decompression, somatosensory evoked potential function and regional spinal cord blood flow recovered to baseline 30 minutes after maximum compression. CONCLUSIONS: Despite rapid cord relaxation of more than 50% within 5 minutes after maximum compression, somatosensory evoked potential conduction recovered only with early decompression. Spinal cord decompression was associated with an early recovery of regional spinal cord blood flow and somatosensory evoked potential recovery. By 3 hours, spinal cord blood flow was similar in both the compressed and decompressed groups, despite that somatosensory evoked potential recovery occurred only in the decompressed group.

Animals↗
PubMedDate not supplied

[Spinal cord compression: an unusual clinical manifestation of retroperitoneal fibrosis].

INTRODUCTION: Retroperitoneal fibrosis is a rare disorder consisted of a periaortic fibrous mass that compresses retroperitoneal organs. CASE REPORT: We report a case of retroperitoneal fibrosis diagnosed after a spinal cord compression. Magnetic resonance imaging scan showed a prevertebral mass which affected a vertebral body. It extended to the epidural space and compressed the spinal cord. The final diagnosis was established through the mass biopsy by means of mediastinoscopy. After prednisone treatment, both clinical remission and mass reduction in the follow-up MRI were observed. CONCLUSIONS: The spinal cord compression is an extremely unusual initial manifestation of retroperitoneal fibrosis. Nevertheless, it should be considered in the differential diagnosis of spinal cord compression syndrome, specially given the possibility of its medical treatment instead of aggressive surgical treatment.

Aged↗
PubMed1997

[Spinal cord compression in non-Hodgkin's lymphoma. A study of 10 patients].

Spinal cord compression is an infrequent event in patients with non-Hodgkin's lymphomas (NHL) and early diagnosis and therapy are required. The main clinical and histologic characteristics as well as the response to therapy in 10 NHL patients with spinal cord compression diagnosed at a single center in a 7-year period are referred. The main initial clinical manifestations were pain in dorsal or lumbar regions (5 cases) and paraparesia or paraplegia (5 patients). Infection by human immunodeficiency virus (HIV) was present in four cases. In 8 patients spinal cord compression was the initial manifestation of NHL. Pathologic diagnosis showed intermediate or high-grade lymphoma in 8 out of 10 cases and immunologic phenotype was B-cell in all cases. Laminectomy followed by radiation therapy and chemotherapy was performed in 4 cases, radiotherapy and chemotherapy in two, isolated chemotherapy in 3 and radiation therapy was administered to the remaining case. Complete response was observed in 4 cases and 6 cases were resistant to treatment. No patient with HIV infection responded to treatment. Six patients had died, median survival time for the whole series being 4 months, and the actuarial probability of survival was 40% at the first year.

Adult↗
PubMed1996

Clinical outcome in metastatic spinal cord compression. A prospective study of 153 patients.

BACKGROUND: Despite many reports on metastatic spinal cord compression, only very few prospective studies of the clinical outcome of spinal cord compression have been carried out. METHODS: 153 consecutive patients with a known malignant solid tumor and a myelographically verified diagnosis of spinal cord compression were followed with regular neurological examination. RESULTS: At time of diagnosis 79 patients were walking, while the remaining were bedridden. In total 21 of the 74 initially non-walking patients began walking after therapy. There was a need for urinary catheter in 57 (37%) patients at the time of diagnosis. During follow-up, 10 of 57 patients (18%) dispensed with the catheter. A total of 116 patients experienced radicular pain at the time of diagnosis, while in 95 of 116 patients (83%) the pain disappeared after therapy. CONCLUSION: the present study confirms, that early diagnosis, i.e., while the patients are still ambulatory, is most important, but the prognosis for recovery of ambulatory function is not as pessimistic as earlier described. In addition the results indicate that supplementary systemic therapy, when available, may have a positive influence on recovery.

Adult↗
PubMed1986

[Clinical study of spinal cord compression due to metastatic epidural tumors].

Eleven patients with spinal cord compression due to metastatic epidural tumors were analyzed. Primary tumors were Hodgkin's disease, non-Hodgkin's lymphoma, multiple myeloma (two patients each), cervical cancer, malignant melanoma, gastric cancer, lung cancer, and neuroblastoma (one patient each). It was felt that myelography is the most important diagnostic test, although CT scan and bone scan may give further diagnostic information in some patients. Six patients were treated with decompressive laminectomy and postoperative radiotherapy, and five with radiotherapy alone. Regardless of the pretreatment neurological status and the type of treatment given, the functional prognosis in our small series of patients appeared to be favorable for radiosensitive tumors such as malignant lymphoma and multiple myeloma.

Adult↗
PubMed2002

Osteological features in pure-bred dogs predisposing to thoracic or lumbar spinal cord compression.

Consistent with those vertebral sites most commonly clinically affected by spinal cord compression, body size normalised midsagittal diameters of the caudal vertebral foramen limits T10-T12 were significantly (P<0.05) lower in Dachshunds relative to other breeds. Minimal midsagittal diameters in Yorkshire Terriers and Maltese were noted at T11cd/12cr. However, these diameters were always larger (P<0.05) in small breeds compared to those in Dachshunds and large breeds suggesting that the small breeds investigated are at lower risk of developing clinical signs if a compressive disease occurs at that site. In large breeds, minimal values were present at L1cd/L2cr and in agreement with clinical findings correlate with those spinal sites most susceptible to spinal cord compression in nonchondrodystrophic large breeds. Caudal displacement of the lumbosacral enlargement of the spinal cord relative to the position previously noted in large breeds was confirmed for the Dachshunds and 50% of small breeds. However, caudal displacement was also noticed in the German Shepherd dogs.

Aging↗
PubMed1997

Frequency of unexpected multifocal metastasis in patients with acute spinal cord compression. Evaluation by low-field MR imaging in cancer patients.

PURPOSE: The aim of the study was to estimate, in an acute care service, the frequency of multiple-level lesion involvement in patients with clinically suspected spinal cord compression or spinal blockage. MATERIAL AND METHODS: Over a period of 17 months, 240 patients with symptoms of acute spinal cord compression underwent acute MR examination of the spine in a 0.1 T MR unit. The cervical spine was only added to the examination if there was clinical suspicion of cord compression above Th1. RESULTS: In 65 (27%) of the 240 patients, involvement of at least one level was found. Of these patients, 32 (49%) showed involvement of more than one level. This high rate was surprising, since only 14 (44%) of the 32 multiple lesions had been clinically suspected. There was no correlation to age or original type of cancer. CONCLUSION: MR accurately demonstrates the anatomy of the spine and spinal cord, showing the level and complexity of spinal lesions. Multiple lesions may be underestimated when the combination of myelography/radiculography and CT is used.

Acute Disease↗
PubMed2003

Sustained spinal cord compression: part II: effect of methylprednisolone on regional blood flow and recovery of somatosensory evoked potentials.

BACKGROUND: The efficacy of methylprednisolone in the treatment of traumatic spinal cord injury is controversial. We examined the effect of methylprednisolone on regional spinal cord blood flow and attempted to determine whether recovery of electrophysiological function is dependent on reperfusion, either during sustained spinal cord compression or after decompression. METHODS: The effects of methylprednisolone therapy on recovery of somatosensory evoked potentials and on spinal cord blood flow were examined in a canine model of dynamic spinal cord compression. Methylprednisolone (30 mg/kg intravenous loading dose followed by 5.4 mg/kg/hr intravenous infusion) or saline solution was administered to thirty-six beagles (eighteen in each group) five minutes after cessation of dynamic spinal cord compression and loss of all somatosensory evoked potentials. After ninety minutes of sustained compression, the spinal cords were decompressed. Somatosensory evoked potentials and spinal cord blood flow were evaluated throughout the period of sustained compression and for three hours after decompression. RESULTS: Seven dogs treated with methylprednisolone and none treated with saline solution recovered measurable somatosensory evoked potentials during sustained compression. After decompression, three more dogs treated with methylprednisolone and seven dogs treated with saline solution recovered somatosensory evoked potentials. Four dogs treated with methylprednisolone lost their previously measurable somatosensory evoked potentials. In the methylprednisolone group, spinal cord blood flow was significantly higher (p < 0.05) in the dogs that had recovered somatosensory evoked potentials than it was in the dogs that had not. Reperfusion blood flow was significantly higher (p < 0.05) in the saline-solution group than it was in the methylprednisolone group. Spinal cord blood flow in the saline-solution group returned to baseline levels within five minutes after decompression. It did not return to baseline levels in the dogs treated with methylprednisolone. CONCLUSIONS: The methylprednisolone administered in this study did not provide a large or significant lasting benefit with regard to neurological preservation or restoration. Methylprednisolone may reduce regional spinal cord blood flow through mechanisms affecting normal autoregulatory blood-flow function.

Animals↗