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PubMed1999

Effect of graded spinal cord compression on cardiovascular neurons in the rostro-ventro-lateral medulla.

In patients with spinal cord injury, cardiovascular disturbances such as hypotension, bradycardia and autonomic dysreflexia can be directly linked to abnormalities of central autonomic control. To date, the changes in bulbospinal innervation of sympathetic preganglionic neurons after compressive spinal cord injury have not been investigated. Thus, we examined the effect of varying severity of compressive spinal cord injury on neurons of the rostro-ventro-lateral medulla, a nucleus of key importance in cardiovascular control. Adult rats with 20 g, 35 g and 50 g clip compression injuries (n= 18) of the cord at T1 and uninjured controls (n=13) were studied. Neurons in the rostro-ventro-lateral medulla with preserved spinal connections eight weeks after spinal cord injury were identified by retrograde labelling with 4% FluoroGold introduced into the cord at T6. Bulbospinal neurons in the rostro-ventro-lateral medulla were also examined immunocytochemically for the adrenaline-synthesizing enzyme phenylethanolamine-N-methyltransferase. In control rats an average of 451+/-12 rostro-ventrolateral medulla neurons were phenylethanolamine-N-methyltransferase positive. Of these, 213+/-6 projected to the T6 spinal cord. The number of rostro-ventro-lateral medulla neurons retrogradely labelled by FluoroGold decreased as a linear function of severity of spinal cord injury (r= -0.95; P<0.0001). After 50g spinal cord injury at T1, only 7+/-1 rostro-ventro-lateral medulla neurons were labelled by FluoroGold, of which 6+/-1 were phenylethanolamine-N-methyltransferase positive. Moreover, the number of phenylethanolamine-N-methyltransferase positive rostro-ventro-lateral medulla neurons decreased to 361+/-16 after 50 g spinal cord injury. We conclude that compressive spinal cord injury results in disconnection of rostro-ventro-lateral medulla neurons, which project to the thoracic spinal cord, and that these changes vary with the severity of injury. The majority of these axotomized rostro-ventro-lateral medulla neurons maintain their immunopositivity for the adrenaline-synthesizing enzyme phenylethanolamine-N-methyltransferase.

Animals↗

PubMed1986

Impact of myelography on the radiotherapeutic management of malignant spinal cord compression.

From December 1981 through August 1984, 24 patients with spinal cord compression syndrome due to epidural neoplasms were evaluated for radiotherapy with clinical examination, radiographs of the spine, and myelography. All plain films were reviewed, and mock radiotherapy fields designed using specific criteria for margins. The same patients were reviewed a second time considering the additional information provided by myelography. The initial treatment fields were found to be inadequate in 69% of the patients. Even in patients with discrete bony lesions, the results of myelography affected the treatment 45% of the time. A history of previous spinal irradiation significantly influenced port design in only 1 of the 7 patients who had received previous radiotherapy. Although invasive, myelography is essential in planning the treatment of spinal cord compression.

Adult↗

PubMed1993

Malignant epidural spinal cord compression associated with a paravertebral mass: its radiotherapeutic outcome on radiosensitivity.

PURPOSE: To evaluate clinical characteristics and functional outcome of malignant epidural spinal cord compression associated with a paravertebral mass. METHODS AND MATERIALS: Between 1987 and 1990, 136 patients with epidural spinal cord compression were treated with irradiation. Of these, 25 patients (18%) had epidural spinal cord compression associated with a paravertebral mass. This report is based on analysis of these 25 patients. Fourteen patients received 3000 cGy in 10 fractions. Seven received 4000 cGy in 16 fractions. Four received 2000 cGy in 5 fractions. Motor function was evaluated by five grades. RESULTS: Lung cancer accounted for the majority of epidural spinal cord compression with a paravertebral mass (60%) followed by lymphoma (8%) and kidney tumor (8%). This pattern of epidural spinal cord compression has a longer duration of pain before developing neurologic symptoms and has a high propensity of the upper thoracic spine involvement by an apical lung cancers. The functional outcome of radiation treatment reveals a significant difference between moderately radiosensitive tumors (lung, prostate, cervix, esophagus) and very radiosensitive tumor (lymphoma). None of the nonambulatory patients became ambulatory following radiotherapy except for the very radiosensitive tumors. Higher doses of radiation treatment (4000 cGy in 16 fractions) did not improve functional outcome. CONCLUSION: Due to the larger tumor burden, radiation treatment for epidural spinal cord compression associated with a paravertebral mass is not as effective as treatment of epidural spinal cord compression without a paravertebral mass except for the very radiosensitive tumor. Therefore, combined treatment modality might be beneficial for improving functional outcome.

Female↗

PubMedDate not supplied

Spinal cord compression in beta-thalassemia: follow-up after radiotherapy.

CONTEXT: Spinal cord compression due to extramedullary hematopoiesis is a well-described but rare syndrome encountered in several clinical hematologic disorders, including beta-thalassemia. CASE REPORT: We report the case of a patient with intermediate beta-thalassemia and crural paraparesis due to spinal cord compression by a paravertebral extramedullary mass. She was successfully treated with low-dose radiotherapy and transfusions. After splenectomy, she was regularly followed up for over four years without transfusion or recurrence of spinal cord compression. DISCUSSION: Extramedullary hematopoiesis should be investigated in patients with hematologic disorders and spinal cord symptoms. The rapid recognition and treatment with radiotherapy can dramatically alleviate symptoms.

Adult↗

PubMed1977

Mediastinal paraganglioma causing spinal cord compression.

An invasive paraganglioma of the posterior mediastinum caused spinal cord compression in a 31 year old women. Electron microscopic examination of the paraganglioma invading the epidural space revealed numerous dense-cored granules in the cytoplasm of the tumour cells. We are reporting this case to present the ultrastructure of mediastinal paraganglioma, and to call attention to an unusual cause of spinal cord compression.

Adult↗

PubMed2005

Extramedullary hematopoiesis with spinal cord compression in beta-thalassemia intermedia.

Spinal cord compression due to extramedullary hematopoiesis is a rare manifestation of thalassemia. We present a 28-year-old woman with beta-thalassemia intermedia and progressive paraparesis. She had a thoracic extradural extramedullary mass lesion on MRI. She improved after receiving multiple transfusions. Clinical awareness of this phenomenon with early treatment is essential for a successful outcome.

Journal Article↗

PubMed1991

Management of spinal cord compression secondary to metastatic prostatic carcinoma.

Spinal cord or cauda equina compression from prostatic cancer is an oncologic emergency necessitating prompt evaluation and treatment. The strong correlation between pretreatment motor status and treatment outcome underscores the importance of immediate treatment before further neurologic deterioration and before the damage to the spinal cord becomes permanent. Patients with known osseous metastases should be alerted by their clinicians to seek medical help within hours should they develop weakness in an extremity. Prompt MRI of the entire spine should be done prior to treatment. Myelography should be reserved for those patients who cannot undergo a technically adequate or expeditious MRI study. The convenience of MRI relative to myelography allows clinicians to diagnose actual or impending spinal cord compression earlier. High-dose steroids (dexamethasone) should be instituted immediately, and endocrine therapy should be started if not already in use. Ambulatory and moderately paraparetic patients seem best treated initially with radiation alone. Immediate surgical decompression should be used in patients with an expected lifespan of at least 6 months who deteriorate during radiation, who have had previous radiation to the involved site, or who have a potentially correctable unstable spine. In addition, paraplegic patients or severely paraparetic patients with recent neurologic deterioration should be treated with immediate surgical decompression if they are judged reasonably able to tolerate the surgery. These patients should then receive postoperative radiation treatment.

Humans↗

PubMed1999

Sciatica caused by cervical and thoracic spinal cord compression.

STUDY DESIGN: Two case reports of sciatica that was considered to be caused by cervical and thoracic spinal cord compression. OBJECTIVES: To point out that sciatica can be an initial major symptom in patients with cervical or thoracic spinal cord lesions. SUMMARY OF BACKGROUND DATA: Usually, tract pain caused by cord compression is considered to be diffuse and does not resemble sciatica. METHODS: Medical history, physical findings, and the results of imaging studies were reviewed in one case of cervical cord tumor and one case of thoracic kyphosis. RESULTS: In both cases, sciatica was the initial and major symptom. Imaging studies showed no lesion in the lumbar spine. In one patient, a cervical dumbbell tumor was found to compress the cervical cord, and in the other the spinal cord was severely compressed at the thoracic kyphosis. The sciatica disappeared immediately after decompression surgery in both cases. CONCLUSIONS: Leg pain resembling sciatica can be caused by cord compression at the cervical and thoracic level. Thoracic kyphosis may be a causative factor in sciatica, in addition to spinal cord tumor and disc herniation, which have been reported previously.

Adult↗

PubMed2002

Spinal cord compression--a personal and palliative care perspective.

Malignant spinal cord compression is recognized as an oncological emergency. In spite of this, treatment in the U.K. varies widely from one area of the country to another. The reported survey shows that this variation is especially noticeable at weekends. Palliative care physicians and clinical nurse specialists working in the community are trained in the recognition of cord compression and are able to improve the early diagnosis and referral of these patients. In addition, they have an essential role in the follow-up of those who remain paraplegic.

Aged↗

PubMed2005

Noncommunicating spinal extradural arachnoid cyst causing spinal cord compression in a child.

Extradural arachnoid cysts in the spine are relatively uncommon causes of spinal cord compression in the pediatric population that are thought to arise from congenital defects in the dura mater. Most reports describe such cysts communicating with the intrathecal subarachnoid space through a small defect in the dura. The authors describe the case of a child who presented with spinal cord compression caused by a large spinal extradural arachnoid cyst that did not communicate with the intradural subarachnoid space. An 11-year-old girl presented with urinary urgency, progressive lower-extremity weakness, myelopathy, and severe gait ataxia. Magnetic resonance imaging of the spine demonstrated a large extradural arachnoid cyst extending from T-8 to T-12. The patient underwent a thoracic laminoplasty for en bloc resection of the spinal extradural arachnoid cyst. Intraoperatively, the dura was intact and there was no evidence of communication into the intradural subarachnoid space. Postoperatively, the patient's motor strength and ambulation improved immediately, and no subsequent cerebrospinal fluid leak occurred. Noncommunicating spinal extradural arachnoid cysts are extremely rare lesions that can cause spinal cord compression in children. Because the dura remains intact, they can be removed entirely without subsequent dural repair. The authors review the literature and discuss the proposed underlying mechanisms of formation of these arachnoid cysts.

Arachnoid Cysts↗

PubMed2005

Detection of unsuspected spinal cord compression in melanoma patients by 18F-fluorodeoxyglucose-positron emission tomography.

AIM: Positron emission tomography (PET) using (18)F-fluorodeoxyglucose can detect early or small metastatic deposits of melanoma and guide subsequent correlative anatomical imaging and treatment. The aim of this study was to assess the value of PET in demonstrating spinal cord compression by otherwise unsuspected metastatic disease. METHODS: Reports of 1365 PET studies performed on patients with melanoma were reviewed. Fifty patients considered to be at risk of spinal cord compression on the basis of PET were identified and 35 patients were analysed. Magnetic resonance imaging and computed tomography were used to confirm or refute the diagnosis. The symptoms and signs at the time of PET and follow-up status were compared between patients with and without confirmed spinal cord compression. RESULTS: In nine patients (26%) compression of the spinal cord or adjacent neurological structures was confirmed and eight of these patients had immediate treatment. Survival was poor in both patient groups, but three patients with confirmed compression maintained good neurological functional status following treatment. CONCLUSION: PET can detect imminent, unsuspected spinal cord compression in patients with metastatic melanoma. Immediate anatomical imaging of the spine is recommended in patients who have evidence of spinal cord compression on PET.

Adult↗

PubMed1972

Spinal cord compression in Paget's disease.

Three cases of spinal cord compression secondary to Paget's disease of the spine are reported. In two of the cases a relatively short history with pain as a prominent feature suggested initially a diagnosis of extradural malignancy. The usual clinical features of this rare disorder are discussed and the characteristic radiological findings are emphasized.

Humans↗

PubMed1979

Spinal cord compression from metastatic breast carcinoma: treatment by radiation therapy alone.

There are few reports in the medical literature of treatment of compression of the spinal cord by the use of radiation therapy alone. Laminectomy has been the standard procedure to relieve compression of the spinal cord and should be performed within 48 hours of initial symptoms. In this patient, radiation therapy was the only modality used. It was supplemented by diethylstilbestrol in the course of follow-up. The result of radiotherapy so far has been excellent. The authors emphasize that radiotherapy was begun three months after development of paraplegia, which makes this an interesting case for presentation.

Adenocarcinoma, Scirrhous↗

PubMed1987

Spinal cord compression from metastasizing cicatrial carcinoma: a case report.

Spinal cord compression from a metastasizing burn scar cancer has not previously been reported. A patient with rapidly progressive paraparesis associated with vertebral collapse and an extradural soft tissue mass of undetermined origin is presented. The clinical history, radiological diagnosis, and histological features of cicatrial carcinoma are discussed along with a brief review of the relevant literature.

Burns↗

PubMedDate not supplied

The surgical treatment of spinal cord compression caused by tumorous metastases. A review of 91 cases.

Spinal cord compressions as a result of metastases are of considerable importance with regard to the quality of life and life expectancy of the cancer patient. Although surgical treatment has contributed to a considerable improvement in the life conditions of these patients, some questions still exist, particularly with regard to the choice of the time to operate. Thus, a total of 91 patients submitted to decompression were studied, taking into consideration different factors such as anatomo-radiographic findings, temporal parameters regarding occurrence of compression, and relative neurologic findings. Compression was incomplete in 44% of cases, complete in 45%, and complete with vertebral collapse in only 11%. Furthermore, it was observed that the group with partial compression included the lowest percentage of patients who resumed walking (57.5%), as compared to those with complete block (65.85%), or complete block associated with vertebral collapse (70%). This contradiction is confirmed by the observation that the resumption of walking was longer in cases with total block as compared to those with partial block. These results, apparently paradoxical ones, may be explained on the basis of the different duration of compression in the two groups. In fact, if we analyze the data relative to the interval of time between the occurrence of neurologic symptoms and surgery, we observed that patients with partial block were those in which surgical indications were made a longer period of time after the onset of symptoms. Surgical indications must be made at the first sign of deficit, regardless of the degree of compression present in the radiologic documentation, in order to avoid the transformation of reversible functional medullary changes into irreversible structural lesions.

Adolescent↗

PubMed1988

Spinal cord compression caused by dual pathology: a close shave with Ockham's razor.

A case of spinal cord compression in an oncology patient is presented. The compression was caused by minimal expansion of a vertebral body involved by a metastatic deposit impinging on a previously asymptomatic lipomatous spinal cord tumour. Nuclear magnetic resonance imaging clearly demonstrated both the vertebral metastasis and the intramedullary and extramedullary components of the lipomatous tumour in a single noninvasive investigation.

Aged↗

PubMed1983

Prognostic factors in the management of metastatic epidural spinal cord compression.

The results of 51 patients with metastatic spinal cord compression were analyzed. There were seven paralyzed patients, three received radiotherapy (RT) alone and four received laminectomy (L) + RT. No patient regained any motor function. Of six ambulatory patients, half received RT and half L + RT. All remained ambulatory after the treatment. Of 38 paraparetic patients, 20 underwent L + RT. Their complete, partial and nonresponse (CR, PR, NR respectively) rates were 25%, 60% and 15%, respectively. This result was clearly better than 18 other patients treated by RT alone of which only 22% regained ambulation (CR = 22%) while 67% were NR and 11% had a PR. In this series combined modality therapy appears better in paraparetic patients. Five patients with radiosensitive tumors all had CR/PR whether treated by RT or L + RT. Patients with epithelial tumors treated by L + RT had a PR (CR + PR) of 71% while RT alone gave only 25%. On the basis of this analysis we conclude: (1) ambulatory patients respond satisfactorily to RT alone; (2) paraparetic patients with radiosensitive tumors do well with RT alone while such patients with epithelial tumors merit L + RT; but (3) paraplegic patients rarely benefit from either modality; (4) pain control appears a useful measure of minimally adequate radiation dose in individual patients.

Combined Modality Therapy↗

PubMed1992

The role of laminectomy in the combined treatment of metastatic spinal cord compression.

A retrospective analysis of clinical data concerning 140 patients with spinal cord compression is presented. Treatment consisted of a surgical decompressive laminectomy followed by radiation therapy in 127 cases. Primary radiation therapy supported by steroids was applied in only 26 cases. A dose of 30-40 Gy in 15-20 fractions was delivered to all patients. Treatment outcome was analyzed by comparing motor function (categories: no deficit, mild deficit ambulatory, paraparetic not ambulatory, paraplegic), sphincter function, and pain relief before and after treatment in both modalities. Following laminectomy and radiation therapy, 82% of paraparetic patients regained their ability to walk, sphincter function improved in 68%, pain relief was achieved in 88%. Following radiation therapy alone, 64% of paraparetic patients became ambulatory, 33% showed a normalization of sphincter function, and 72% became pain free. Our results indicate that laminectomy should play a major role in the treatment of patients with metastatic spinal cord compression. The decision as to the treatment of choice has to be made individually for each patient taking into consideration his general condition, life expectancy, and origin of the primary.

Adult↗