The appearance on MRI of vertebrae in acute compression of the spinal cord due to metastases.

Multiple myeloma presenting with acute bony spinal cord compression and mechanical instability successfully managed nonoperatively

We studied MR images of the spine in a consecutive series of 100 patients with acute compression of the spinal cord due to metastases. All patients had documented neurological deficit and histologically proven carcinoma. MRI was used to localise bony metastatic involvement and soft-tissue impingement of the cord. A systematic method of documenting metastatic involvement is described. A total of 43 patients had compression at multiple levels; 160 vertebral levels were studied. In 120 vertebrae (75%), anterior, lateral and posterior bony elements were involved. Soft-tissue impingement of the spinal cord often involved more than one quadrant of its circumference. In 69 vertebrae (43%) there was concomitant anterior and posterior compression. Isolated involvement of a vertebral body was observed in only six vertebrae (3.8%). We have shown that in most cases of acute compression of the spinal cord due to metastases there is coexisting involvement of both anterior and posterior structures.

An evidence-based analysis of published radiologic criteria for assessing spinal canal compromise and cord compression in patients with acute cervical spinal cord injury. This study was conducted to determine whether literature-based guidelines could be established for accurate and objective assessment of spinal canal compromise and spinal cord compression after cervical spinal cord injury. Before conducting multicenter trials to determine the efficacy of surgical decompression in cervical spinal cord injury, reliable and objective radiographic criteria to define and quantify spinal cord compression must be established. A computer-based search of the published English, German, and French language literature from 1966 through 1997 was performed using MEDLINE (U.S. National Library of Medicine database) to identify studies in which cervical spinal canal and cord size were radiographically assessed in a quantitative manner. Thirty-seven references were included for critical analysis. Most studies dealt with degenerative disease, spondylosis, and stenosis; only 13 included patients with acute cervical spinal cord injury. Standard lateral radiographs were the most frequent imaging method used (23 studies). T1- and T2-weighted magnetic resonance imaging were used to assess spinal cord compression in only 7 and 4 studies, respectively. Spinal cord size or compression were not precisely measured in any of the cervical trauma studies. Interobserver or intraobserver reliability of the radiologic measurements was assessed in only 7 (19%) of the 37 studies. To date, there are few quantitative, reliable radiologic outcome measures for assessing spinal canal compromise or cord compression in patients with acute cervical spinal cord injury.

Objective To explore the clinicopathological features, imaging features and treatment of spinal cord myeloma in patients with spinal cord compression as the first symptom. Methods The retrospective cross-sectional study was conducted which the clinical data of five patients with spinal myeloid sarcoma confirmed by bone marrow aspiration and pathology from January 2014 to December 2017 in Changzheng Hospital. There were 3 males and 2 females, aged from 15 to 54 years old. the tumors were located in 3 cases of thoracic vertebrae and 2 cases of lumbar vertebrae. Four cases were treated with open surgery. After discharge, they were treated with chemotherapy and hematological tumors according to bone marrow puncture and pathological results. Another patient underwent conservative treatment (anti-inflammatory analgesia, nutritional support, chemotherapy, etc.). The observation items were analysed. Results All the 5 patients had a low back pain, three of them had a lower limbs weakness, and one of them was accompanied by paralysis of both lower limbs. X-ray examination showed no abnormal findings. CT and MRI showed bone destruction or soft tissue shadow. Bone marrow aspiration and postoperative pathological examination showed that five cases were leukemia including four acute myeloid leukemia(AML)and one chronic myeloid leukemia(CML). All patients' preoperative symptoms were relieved after treatment. All patients were followed up. One patient underwent IA regimen chemotherapy for five courses, and was treated with allogeneic hematopoietic stem cell transplantation. It had been followed up for 28 months after surgery and still in good condition without tumor recurrence. The other four patients relapsed after chemotherapy, all died of infection, and the survival period was from 5 to 26.5 months. Conclusions Spinal cord compression caused by myeloid sarcoma as an initial symptom is rare. The imaging manifestations of the myeloid sarcoma are lack of specificity and and it is easy to be misdiagnosed. Bone marrow aspiration and pathological examination can confirm the diagnosis. When the symptoms of spinal cord compression occur, it is recommended to perform early tumor decompression. The allogeneic hematopoietic stem cell transplantation and systemic chemotherapy should be performed after surgery. Key words: Sarcoma, myeloid; Leukemia; Spinal compression; Diagnosis; Treatment outcome

A multicenter, retrospective study using computed tomographic and magnetic resonance imaging data to establish quantitative, reliable criteria of canal compromise and cord compression in patients with cervical spinal cord injury. To develop and validate a radiologic assessment tool of spinal canal compromise and cord compression in cervical spinal cord injury for use in clinical trials. There are few quantitative, reliable criteria for radiologic measurement of cervical spinal canal compromise or cord compression after acute spinal cord injury. The study included 71 patients (55 men, 16 women; mean age, 39.7 +/- 18.7 years) with acute cervical spinal cord injury. Causes of spinal cord injury included motor vehicle accidents (n = 36), falls (n = 20), water-related injuries (n = 8), sports (n = 5), assault (n = 1), and farm accidents (n = 1). Canal compromise was measured on computed tomographic scan and T1- and T2-weighted magnetic resonance imaging, and cord compression at the level of maximum injury was measured on T1- and T2-weighted magnetic resonance imaging. All films were assessed by two independent observers. There was a strong correlation of canal compromise and/or cord compression measurements between axial and midsagittal computed tomography, and between axial and midsagittal T2-weighted magnetic resonance imaging. Spinal canal compromise assessed by computed tomography showed a significant although moderate correlation with spinal cord compression assessed by T1- and T2-weighted magnetic resonance imaging. Virtually all patients with canal compromise of 25% or more on computed tomographic scan had evidence of some degree of cord compression on magnetic resonance imaging, but a large number of patients with less than 25% canal compromise on computed tomographic scan also had evidence on magnetic resonance imaging of cord compression. In patients with cervical spinal cord injury, the midsagittal T1- and T2-weighted magnetic resonance imaging provides an objective, quantifiable, and reliable assessment of spinal cord compression that cannot be adequately assessed by computed tomography alone.

Acute dorsal compression of the spinal cord was applied to adult cats, and magnetic resonance signal intensity, spinal cord evoked potentials, and morphologic changes of the spinal cord were examined after 5 hours. The present study investigated the correlation of magnetic resonance signal intensity with spinal cord evoked potentials and spinal cord morphology after 5 hours of spinal cord compression in cats. Neurologic prognosis of the injury might be predicted by an analysis of magnetic resonance signal intensity pattern. Little information is available on relationships between magnetic resonance images and functional or morphologic damage of spinal cord in acute animal experiments. Acute dorsal compression of the spinal cord was performed in 24 anesthetized cats. After laminectomy, the L2 segment was compressed for 5 hours. Spinal cord evoked potentials were recorded by electrodes placed in the epidural space at L4, and the spinal cord was stimulated at T12. The animals were divided into four groups based on changes in the amplitude of spinal cord evoked potentials. Immediately after compression for 5 hours, magnetic resonance images were obtained. Signal intensity of the spinal cord was measured on sagittal midline images. Morphologic changes were assessed. Spinal compression significantly increased the signal intensity of the L1, L2, and L3 segments on T2-weighted and proton density-weighted images. The increase in signal intensity was remarkable in the animals whose spinal cord evoked potentials were reduced greatly (< 40% of the control group). Histologically, edema was present in the high intensity area on T2-weighted and proton density-weighted images. In summary, the present study documents that spinal compression causes tissue edema, which produces high signal intensity on magnetic resonance imaging. The magnetic resonance signal intensity is correlated closely with decreased amplitude of spinal cord evoked potentials.

目的 评价MRI在地方性氟骨症脊柱病变诊断中的作用.方法对81例地方性氟骨症的脊柱MRI进行分析和与X线比较.结果所有椎体内脂肪含量减少和分布不均,在T1WI上信号强度表现为均匀或不均匀性减低,其信号减低程度与X线骨密度的增高程度相比较无明确相关性.32例C3～7椎体的T1WI信号强度平均值明显低于100例对照组(P<0.001).81例中后纵韧带和黄韧带骨化71例(88%),其中后纵韧带骨化35例(43%),黄韧带骨化8例(10%),后纵韧带和黄韧带骨化28例(35%),与X平片所显示的相同.在T1WI上63例后纵韧带骨化和36例黄韧带骨化有中等信号强度区者分别为32例(51%)和31例(86%).81例中椎间盘突出68例(84%),椎间盘变性57例(70%),椎管狭窄75例(92%),脊髓受压63例(78%),其中脊髓内有病理学改变28例(35%).X线测量57例颈椎椎管前后径<9 mm(以此推断脊髓受压)41例(71.92%),MRI显示脊髓受压48例(84.21%,P=0.115).57例颈椎椎间盘后突出51例(89.47%),明显高于对照组(62%)(P<0.001);椎间盘变性37例(64.91%),与对照组(37%)相比较差异有非常显著性意义(P=0.001).结论 MRI显示地方性氟骨症的椎体信号强度均匀或不均匀性减低,可反应成骨活动增强程度和氟化钙及骨髓内脂肪含量及分布.MRI对显示脊髓受压,脊髓内病理学改变和椎间盘突出、变性优于X线。

Graded posterior spinal cord compression and partial sectioning of the spinal cord were performed, and magnetically induced descending spinal cord potentials were recorded. To compare the sensitivity of transcranial magnetic motor-evoked potentials in the spinal cord and other spinal cord evoked potentials to spinal cord lesions. Somatosensory-evoked potentials have been the standard technique for monitoring spinal cord function during spinal surgery. These potentials, however, do not necessarily reflect descending motor tract function. Transcranial electric or magnetic stimulation for motor-evoked potentials is a more direct measure of motor tract function. However, more research on magnetic motor-evoked potentials is needed. Fifteen adult cats were used. Graded posterior spinal cord compression was performed at L2 in 10 cats, and partial sectioning of the spinal cord was performed at L2 in five cats. The location sequence of lesioning was dorsal column section, dorsal 1/2 section, dorsal 2/3 section, and total spinal cord section. Magnetic motor-evoked potentials were recorded by epidural catheter electrodes placed above at, and below the lesion. Electric motor evoked potentials and spinal and cortical somatosensory-evoked potentials were recorded serially for a comparison of their sensitivity to spinal cord dysfunction. In posterior spinal cord compression, N1 amplitude of magnetic motor-evoked potentials at and below the lesion decreased after 1 minute of compression with a 70 g weight, and N1 and N2 amplitude disappeared after 1 minute of compression with a 100 to 120-g weight. Electric motor-evoked potentials changed at amplitudes comparable with those shown by magnetic motor-evoked potentials. Spinal somatosensory-evoked potentials showed the most sensitive changes to spinal cord posterior compression and disappeared after 1 minute of compression with 80 g Cortical somatosensory-evoked potentials in five cats were not sensitive enough for spinal cord posterior compression injury and did not disappear even after 1 minute of compression with 120 g. In magnetic motor-evoked potentials, after dorsal hemisectioning of the spinal cord only N3 disappeared; N1 and N2 disappeared after ventral spinal cord sectioning in spinal somatosensory-evoked potentials, amplitudes decreased after dorsal column sectioning, and all negative peaks disappeared after dorsal hemisectioning of the spinal cord. Posterior compression injuries are diagnosed more easily with spinal somatosensory-evoked potentials. Motor-evoked potentials were slightly less sensitive, but they were significantly more useful in diagnosing posterior compression injuries than were cortical somatosensory-evoked potentials.

Spinal cord compression secondary to spinal extradural myeloid sarcoma in acute myeloid leukaemia: A case report and literature review

Acute compression of the spinal cord is a devastating but treatable disorder. Diseases that cause acute spinal cord compression constitute a special category because they originate in the spinal column and narrow the spinal canal. This review addresses the disorders that account for most instances of acute spinal cord compression: trauma, tumor, epidural abscess, and epidural hematoma. The pathophysiological features and management of these disorders are similar to those of other acute and serious spinal conditions. The medical context of spinal cord compression determines the diagnosis and directs treatment. Traumatic cord compression is often self-evident. Cord compression in patients with . . .

In this study, we aim to describe the radiological characteristics of degenerative cervical kyphosis (DCK) with cervical spondylotic myelopathy (CSM) and discuss the relationship between DCK and the pathogenesis of spinal cord dysfunction. In total, 90 patients with CSM hospitalized in our center from September 2017 to August 2022 were retrospectively examined in this study; they were then divided into the kyphosis group and the nonkyphosis group. The patients' demographics, clinical features, and radiological data were obtained, including gender, age, duration of illness, cervical Japanese Orthopaedic Association (JOA) score, cervical lordosis (CL), height of intervertebral space, degree of wedging vertebral body, degree of osteophyte formation, degree of disc herniation, degree of spinal cord compression, and anteroposterior diameter of the spinal cord. In the kyphosis group, kyphotic segments, apex of kyphosis, and segmental kyphosis angle were recorded. Radiological characteristics between the two groups were also compared. Correlation analysis was performed for different spinal cord compression types. As per our findings, the patients in the kyphosis group showed more remarkable wedging of the vertebral body, more severe anterior compression of the spinal cord, and a higher degree of disc herniation, while the posterior compression of the spinal cord was relatively mild when compared with the nonkyphosis group. CL was related to the type of spinal cord compression, as cervical kyphosis is an independent risk factor for anterior spinal cord compression. DCK might play a vital role in the pathogenesis of spinal cord dysfunction. In patients with DCK, it was determined that the anterior column is less supported, and more severe anterior spinal cord compression is present. The anterior approach is supposed to be preferred for CSM patients with DCK.

Vertebral hemangioma is common, benign lesion that occurs mostly in the body of vertebral bones and is mostly asymptomatic although they may occasionally extend into the posterior elements. An isolated location in the neural arch of vertebrae is extremely rare. An acute spinal cord compression by an exceptional hemangioma involving spinous process of the seventh thoracic vertebra and respecting vertebral body in a 40-year-old woman is reported. On magnetic resonance imaging of the spine, the lesion was hypointense on T1-weighted image, hyperintense on T2-weited image, and enhancing avidly, causing compression of spinal cord. Our case is exceptional by the rapidly character of symptom installation and by atypical and elective involvement of spinous process.

Acute spinal cord compression with myelopathy is a neurologic emergency. Recognition of spinal cord compression, timely imaging, and treatment are important to restore and preserve neurologic function. This chapter reviews the causes and clinical approach to spinal cord compression. Traumatic and nontraumatic causes of spinal cord compression are addressed together because of their overlapping symptoms and management. The chapter concludes with a brief discussion of peripheral nerve injury.

Intradural spinal cord compression impairs perfusion pressure and is putatively rate-limiting for recovery after traumatic spinal cord injury (tSCI). After cervical tSCI, even minimally improved tissue preservation may help promote neurological recovery. To assess the nature and extent of spinal cord swelling and compression post-acute cervical tSCI, we evaluated several baseline MRI parameters including BASIC score, intramedullary lesion (IML) length, maximal canal compromise (MCC), maximal spinal cord compression (MSCC), extent of cord compression (ECC), maximal swollen anteroposterior diameter adjacent to injury site (Dmax), and maximal cord swelling (MCS) in 169 consecutive patients across 2 centers. In patients with either primarily intradural or combined (MSCC ≤5% or >5%, respectively) cord compression, we examined the predictive value of clinical and imaging admission parameters on American Spinal Injury Association Impairment Scale (AIS) severity and conversion up to 1-year follow-up. 37 (21.9%) patients presented with primarily intradural while 132 (78.1%) had combined cord compression. MSCC, MCS, and Dmax values differed significantly between the two groups (p < 0.0001, < 0.01 and < 0.001, respectively). MSCC was associated with age, MCC and MCS at baseline, while MCS was associated with age, MSCC and Dmax, on multivariable analysis. Logistic regression analysis of areas under receiver operating characteristic curve (AUROC) confirmed ECC (AUC 0.678) and MCS (AUC 0.922) as good and excellent predictors, respectively of AIS-conversion at 1-year for intradural compression participants. Additionally, MCS was significantly more accurate in predicting AIS-conversion in intradural group and the probability of AIS-conversion significantly decreased with each 1% increase in MCS (p = 0.003; OR 0.949), for both compression subtypes. In conclusion, baseline measures of cord swelling predict AIS-conversion likelihood up to 1-year. The deleterious effects of intradural cord compression, either isolated or presenting with extradural compression, may benefit from supplemental decompression strategies in addition to current standard-of-care.

Whether they are spinal metastases or primary spinal neoplasms, spinal tumors cause a myriad of complications given their critical location. Spinal tumors can be extradural, intradural extramedullary, or intramedullary, with extradural metastatic tumors the most commonly encountered. Spinal cord and/or cauda equina compression is one of the most devastating complications of cancer and represents a true oncologic emergency. Patients present with progressive paralysis, paresthesiae, and/or autonomic dysfunction. In addition to spinal cord compression (SCC), extradural spinal tumors can cause mechanical spinal instability and axial loading pain which often warrant surgical consultation. The diagnosis of SCC begins with clinical suspicion even before neurological deficits ensue. Patients presenting with back or neck pain who have a history of cancer should be evaluated carefully for SCC. MRI is the imaging modality of choice. Management of SCC generally requires a multidisciplinary approach, with goals of symptom control and prevention of irreversible functional loss. Patients with metastatic epidural SCC who undergo surgical decompression and reconstruction followed by radiotherapy exhibit better outcomes in preservation of function and symptom control than do those undergoing radiotherapy alone. Recent advances in the surgical management of SCC include minimally invasive spinal surgery (MISS), spinal laser interstitial thermotherapy (SLITT), and vertebral augmentation of pathologic vertebral compression fractures. Generally, SCC in patients with cancer serves as evidence of uncontrolled and aggressive disease. Although it is associated with poor outcome in most patients, effective palliation is possible with early diagnosis and careful application of modern surgical techniques for the elimination of cord compression, prevention or reversal of neurological deficits, and restoration of mechanical spinal stability. In addition to SCC from spinal tumors, other spinal complications can be seen in cancer patients who develop spine infections such as surgical site infection (SSI), spinal epidural abscesses (SEA), subdural empyema (SDE), or vertebral osteomyelitis. These complications can be due to inoculation from the spinal surgery itself or as a result of the patients’ immunocompromised state. This article provides a scoping review of the clinical presentation, pathophysiology, and diagnosis of major spinal oncologic emergencies and summarizes current modes of surgical and nonsurgical management.