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PubMed2002

Treatment of patients with spinal metastases from head and neck neoplasms.

BACKGROUND: Spinal metastases are uncommon in patients with advanced head and neck cancer. Treatment strategies in this patient group have not been defined. Although it has been established that neurologic dysfunction in patients with spinal metastases and cord compression constitutes an oncologic emergency, the role of surgical treatment remains controversial. OBJECTIVE: To clarify the treatment options in patients with head and neck cancer who develop spinal metastases. METHODS: The clinical course of patients seen at our institution with head and neck neoplasms and spinal metastases from January 1992 to January 2000 was reviewed. RESULTS: Eleven patients were identified. Nine developed spinal metastases more than 3 months after the diagnosis of advanced head and neck cancer. The other 2 presented with synchronous spinal involvement and skull base neoplasms. Patients without neurologic symptoms were offered intravenous steroids and palliative radiation. Patients with neurologic symptoms were treated with either intravenous steroids and radiation or surgical decompression and spinal fusion. In 1 patient, no improvement occurred within the first 2 days of radiotherapy, and the patient underwent surgical decompression. Patients with an unstable spine underwent surgical decompression and spinal fusion. Patients with a life expectancy of more than 6 months and neurologic symptoms were offered surgical therapy. In the 9 patients with advanced cancer, the average survival time was 3 months. Two of these patients have survived longer than 6 months. CONCLUSIONS: We propose that surgical decompression is a viable, justifiable option for selected patients with advanced head and neck cancer and spinal cord compression. Furthermore, we recommend surgical decompression as a first option in patients with an unstable bony spine and/or in whom survival is expected to be longer than 6 months. Finally, we propose a patient management algorithm in these cases.

Adult↗

PubMed1993

Plain film clues to the diagnosis of spinal epidural neoplasm and infection.

Radiographs of 22 normal patients and 35 patients with proven epidural disease were correlated with CT scans to determine the range of normal and abnormal appearances of the osseous surfaces marginating the spinal canal. A subtle but useful plain film clue to early epidural disease was indistinctness of the posterior vertebral body margin, which in at least one case was the solitary radiographic sign of epidural metastasis. The radiographic distinctness of each of the bony margins of the spinal canal varied predictably with spinal level in normal individuals owing to systematic variations in obliquity. Indistinctness of an osseous spinal canal margin, interpreted with knowledge of the range of normal anatomy at the appropriate level, may provide the earliest plain film clue to the presence of spinal epidural disease.

Diagnosis, Differential↗

PubMed1993

Dumbbell ganglioneuromas in childhood.

The incidence of dumbbell tumors among spinal neoplasms is between 10% and 15%. Approximately 1% of neoplasms located at or near the spinal cord are ganglioneuromas. Ganglioneuromas are rare, slow-growing, benign tumors arising from sympathetic ganglia. The cases of two children with spinal dumbbell ganglioneuroma are presented. The tumors were totally resected by combined surgery in both patients. The patients are neurologically intact 5 and 4 years respectively after surgery.

Child, Preschool↗

PubMed1984

[Neuroradiology of primary and secondary spinal tumors].

The recent availability of spinal CT has modified the classic diagnostic algorithm of spinal and spinal cord tumors. The most important diagnostic signs given by traditional radiologic study of the spine (postural defects, signs of dysraphism, alterations of peduncles and neural foramina , soft paraspinal tissue changes, intra- and extra-vertebral calcifications, etc.), by myelography with hydrosoluble non ionic contrast medium and by spinal angiography are described. Their complementary indications and their up-to-date role in the diagnosis of site, size and nature of spinal neoplasms are discussed. The neuroradiological pictures of the most frequent spinal and vertebral tumors are summarized.

Angiography↗

PubMed1997

Solitary fibrous tumor presenting as a symptomatic intraspinal mass: case report.

OBJECTIVE AND IMPORTANCE: Mesenchymal, nonmeningeal tumors of the central and peripheral nervous systems are rare. Specifically, the solitary fibrous tumor, which occurs in both benign and malignant forms, was first described in the pleura and more recently in a number of sites, including the mediastinum, abdomen, upper respiratory tract, nasopharynx, and orbit. It has not, however, previously been known to involve the spine or to induce cord compression. CLINICAL PRESENTATION: We describe the case of a 33-year-old man who presented with back pain, progressive myelopathy, and lower extremity dysesthesias. Imaging studies demonstrated an intradural extramedullary mass at T7-T8. INTERVENTION: At surgery, the lesion was found to be firm, fibrous, intimately apposed to the T8 sensory nerve root but emanating from neither root nor dura. Histologically, the tumor was composed of spindle cells in a storiform pattern with extensive collagen deposition in the intercellular matrix. Immunohistochemistry showed diffuse positive staining of tumor cells for CD34 antigen but negative staining for S100 and EMA, a profile that is consistent with a histopathological diagnosis of solitary fibrous tumor and that effectively rules out meningioma and nerve sheath tumor. CONCLUSION: This is the first report of an intraspinal solitary fibrous tumor, a rare entity that should be included in the differential diagnosis of intradural extramedullary spinal neoplasms.

Adult↗

PubMed1977

Computed tomography of intraspinal and paraspinal neoplasms.

Computed tomography (CT) has been used in the evaluation of 36 spinal neoplasms. Eleven of the 19 intraspinal and all of the 17 paraspinal tumors showed positive CT images. Computed tomography is of diagnostic value particularly in detecting calcified meningiomas, lipomas, and neurofibromas with bony changes. The size of the paraspinal tumors and the degree of bone destruction can be precisely demonstrated by CT.

Chordoma↗

PubMed1999

Anterior cervical plating for the treatment of neoplasms in the cervical vertebrae.

OBJECT: To assess clinical outcome and survival in patients with cervical vertebral spinal neoplasms after they have undergone anterior decompression and cervical plate stabilization (ACPS) by using either autologous bone graft or polymethylmethacrylate (PMMA) as the anterior load-bearing support structure. METHODS: This was a retrospective case study composed of 30 patients harboring cervical spinal vertebral neoplasms who underwent anterior cervical decompression and (ACPS) within a 7-year period. Postoperative immobilization included treatment in a halo brace in two cases and in a hard cervical collar for the remaining patients. Postoperatively most patients underwent radio- and/or chemotherapy. All patients except one benefited from a significantly improved quality of life with decreased pain and/or improved neurological status. The mean Kaplan-Meier survivoral estimate was 35.8 months (range 8 days-11.3 years, with 10 patients alive at most recent follow-up contact). Patients achieved long-term or lifelong mechanical stability in the cervical spine, and only one patient required a repeated posterior stabilization procedure. No hardware-related complications occurred. One patient died 8 days postoperatively of pneumonia. A nonsignificant difference in survival (p = 0.2164) was observed between patients harboring metastatic neoplasms (26.8 months) and those harboring lymphomatous and multiple myeloma neoplasms (54 months). CONCLUSIONS: Favorable clinical outcome of both neurological symptoms and pain can be achieved using ACPS after surgery for neoplasms in the cervical vertebrae. Furthermore, long-term or lifelong cervical spine mechanical stability with bone fusion is achieved using this technique even when radiation therapy is delivered to the site of the bone graft.

Adult↗

PubMed1964