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Neoplastic disease of the spine.

In summary, MR imaging has become the single most effective modality for the evaluation of spinal neoplasms by virtue of its ability to image the spinal cord directly and noninvasively. In this fashion, one can localize mass lesions relative to the spinal cord; in conjunction with the patient's clinical history, it is thus possible to provide a brief yet accurate differential diagnosis. Intravenous paramagnetic contrast enhancement also may prove extremely useful in further delineating such lesions. In addition, it has demonstrated a high sensitivity to primary and secondary tumors of the bony spine through its ability to detect subtle T1 signal changes in the vertebral marrow space.

Bone Cysts↗

Treatment of experimental spinal cord compression caused by extradural neoplasms.

Epidural spinal cord compression was produced in rats by injection of Walker 256 carcinoma cell suspension anterior to the T-12 or T-13 vertebral body. The tumor grows through the intervertebral foramina to compress the spinal cord and produce paraplegia in 3 to 4 weeks. The effect of several treatments upon clinical signs was assessed. Dexamethasone caused a significant but transient improvement in neurological function. Radiation therapy likewise improved neurological function, and was more effective when given by a high-dose protracted course than when given either in a single dose or a low-dose protracted course. Laminectomy was not helpful in relieving neurological symptoms. Dimethyl sulfoxide did not relieve neurological symptoms. Cyclophosphamide was most effective in relieving neurological symptoms, and most of the animals that were treated with that drug when they were severely weak but still able to move their hind limbs recovered fully. Some animals that were totally paraplegic when treatment began recovered function after radiation therapy or cyclophosphamide treatment, but recovery was better if treatment was started when animals could still move their hind limbs. This animal model appears to be a useful way of studying the treatment of human spinal cord compression produced by epidural neoplasms.

Animals↗

The fate of anterior vertebral bone grafts in patients irradiated for neoplasm.

Perioperative irradiation is often used with anterior decompression and vertebral interbody fusion for the treatment of spinal neoplasms, yet little is known regarding the healing potential of these grafts. This review of 25 patients with neoplasm who had anterior vertebrectomy, bone strut insertion, and perioperative irradiation was performed to look specifically for evidence of radiographic fusion as determined by plain radiographs, tomograms, or computed tomography reconstruction. Four of 25 patients (16%) were judged to have a pseudarthrosis. All four pseudarthrosis patients but only four of 21 fusion patients had 4000 cg or more of irradiation, a statistically significant difference. There was a trend for lumbar lesions to have a higher risk for nonunion. Concomitant posterior stabilization did not necessarily prevent pseudarthrosis. Two iliac strut grafts with a pseudoarthrosis developed late fracture and one went on to collapse into kyphosis. The pseudarthrosis rate of anterior vertebral strut grafts in the face of irradiation for tumor is relatively high, and late graft fracture can occur if pseudarthrosis develops. Probable risk factors include irradiation greater than 4000 cg and lumbar lesions. Posterior stabilization to protect the graft may be warranted in the highest-risk patients.

Bone Transplantation↗

Spinal meningiomas: evaluation of 41 patients.

AIM: Spinal meningiomas are relatively frequent intraspinal tumors. They constitute 25-46% of all primary spinal neoplasms. METHODS: Forty-one patients with spinal meningiomas surgically treated between 1986 and 2001 are reviewed in this report. There were 32 females and 9 males, aged 16 to 73 years old. Tumor location was cervical in 7 cases and thoracic in 34 cases. All tumors were intradural. All of the patients were operated by laminectomy in prone position. RESULTS: Total excision was achieved in 40 (98%) patients and subtotal excision in 1(2%). The majority of the tumors were meningothelial (42%) or psammomatous (25%). There was no surgical mortality. Four patients (10%) suffered from morbidity: One patient with CSF fistula, 1 deep venous thrombosis, 1 case with paraparesis and 1 wound infection was seen. Neither multiple meningiomas nor malign meningiomas were seen in our series. CONCLUSIONS: Spinal meningiomas are benign tumors and should be excised totally. If the preoperative neurological status is not complicated, fairly good outcome can be achieved.

Adolescent↗

Spinal tumors in 37 dogs: clinical outcome and long-term survival (1987-1994).

The current management of dogs with spinal canal neoplasia in a large veterinary institution was evaluated. Postoperative survival time and prognostic indicators for survival were examined. Spinal neoplasms in dogs and humans also were compared. Thirty-seven cases with histologically confirmed spinal tumors were included in the study. The cervical region was affected most commonly, and 23 (62%) of 37 cases had extradural tumors. A hemilaminectomy or a dorsal laminectomy was performed in each case; three cases received adjuvant treatment. Twelve (32%) cases were euthanized at the time of surgery, and two died immediately after surgery. One dog was euthanized 20 days after surgery because of persistent clinical signs. Twenty-two cases were followed postoperatively; nine different types of primary tumors were confirmed by histological examination of tissue specimens from these 22 cases, and three cases had metastatic lesions. The median survival time of these 22 cases was 240 days. Twelve (32%) of the 37 cases had nerve-sheath tumors; the median survival time for these 12 cases was 180 days. No prognostic indicators were identified. However, median survival times of cases with benign versus malignant tumor types were 1,410 days and 180 days, respectively (p of 0.07). Four cases each had a myxoma/myxosarcoma, a tumor previously unreported in the spinal canal in dogs.

Animals↗

[Intradural spinal metastasis from visceral neoplasms. Apropos of 4 cases. Review of the literature].

Four patients were referred during the last year for treatment of an intradural metastasis. Primary sites were a bronchogenic carcinoma (one case), a prostatic carcinoma (one case) and in the two other cases the primary tumor was not found. In all cases Noot pain had lasted 1 to 5 months, despite CT examination during this painful period. Except in case n.4, diagnosis was not established until the onset of myelopathy. Surgical removal was complete in one case and subtotal in the three other cases, with complete postoperative relief of the pain in all cases and significative improvement of neurological status. The authors emphasize the importance of root pain as an early sign in these patients as well as the difficulty in establishing diagnosis. They discuss the different pathogenic mechanisms and the methods of treatment.

Aged↗

[Combination therapy of 91 cases of spinal metastases].

The majority of spinal neoplasms are metastatic lesions. This paper reports results of combination therapy of ninety-one cases of spinal metastasis verified by pathology. Most of them were metastases from breast, lung, thyroid and gastrointestinal cancers. Multiple metastatic lesions were mainly treated by chemotherapy. Radiotherapy was for radio-sensitive solitary lesions. Indication for operation included: (1) isolated spinal focus with unknown site of primary tumor; (2) recurrence or aggravation of tumor after chemotherapy or radiotherapy; (3) isolated radioresistant focus; and (4) the patients having paraplegia or an instable spine. Thirty cases were mainly treated by chemotherapy, 10 by radiotherapy, and 51 by operation. After the combination therapy, 13 cases were completely free of symptoms, 44 alleviated and 11 invalid. Of the 39 cases having paraplegia, 3 had complete recovery, 15 partial recovery and 21 no improvement. Of 85 cases having been followed up for 1-4 years, 51 cases (59.3%) survived for 3-11 months, 25 (29.1%) for 1-2 years and 10 (11.6%) for 2-3 years. The average survival time was 10.5 months. Analyzing the clinical and radiographic manifestations of the tumors and their treatment and prognosis, we consider that early diagnosis and combination therapy are the major factors influencing the therapeutic effect of spinal metastatic tumors.

Adenocarcinoma↗

Diagnostic role of gadolinium-DTPA in pediatric neuroradiology. A retrospective review of 655 cases.

We retrospectively reviewed the findings in 655 consecutive young patients who underwent contrast-enhanced MR examinations (1.5T) of the head or spine. Their ages ranged from 4 months to 20 years (mean 10 years). There was a 1.7% incidence of minor adverse reactions to gadolinium (Gd)-DTPA, none of which required treatment; no serious adverse reactions were encountered. Based on the radiologic diagnosis the patients were divided into three groups: (1) normal, (2) CNS neoplasm, (3) abnormal but not neoplasm. There were 178 patients thought to have CNS neoplasms and of these 156 (88%) enhanced. Of 124 histologically confirmed neoplasms 115 (93%) showed enhancement after Gd-DTPA. Eight children had histologically confirmed spinal neoplasms; 5 of 6 neurofibromas and 2 ependymomas enhanced. In the 216 patients with abnormalities thought not to be neoplastic, the enhancement rate was 11%; most of the enhancing lesions were vascular malformations. There were very few examples of inflammatory disease, acute trauma or stroke among our patients.

Adolescent↗