Cause Of Spinal Cord Compression Research Articles

Risk and clinical characteristics of spinal cord compression across different mucopolysaccharidosis types: A retrospective cohort study.

In patients with mucopolysaccharidosis (MPS), the accumulation of glycosaminoglycans leads to various complications, including spinal cord compression (SCC). Although SCC is a well-known complication in MPS, data comparing its clinical features across different MPS types remain limited. This study aimed to investigate the timing, location, and underlying causes of SCC in MPS, as well as to compare the risk and clinical characteristics by MPS type. We conducted a retrospective cohort study, reviewing the medical records of 183 patients with all types of MPS who were followed at Samsung Medical Center from January 1995 to March 2024. The distribution of patients diagnosed with SCC by MPS type was 33.3% for type I, 10.5% for type II, 55.0% for type IV, and 100% for type VI. The median age at SCC diagnosis was 16.3 years. Compared to type II, the risk of SCC was higher for type I (2.4 times, 95% confidence interval [CI]: 0.9-6.2), type IV (3.5 times; 95% CI: 1.5-8.1), and type VI (4.5 times, 95% CI: 1.2-16.4). Enzyme replacement therapy did not reduce the risk of SCC (P = .70). Moreover, SCC most frequently occurred at the C0 to C4 and T11 to L2 spinal levels. In the cervical spine, ligament thickening, and skeletal deformities were the predominant causes, whereas in the thoracolumbar spine, kyphoscoliosis and intervertebral disc issues were the main contributors. Although there was no significant difference in the location of SCC (P = .99), the underlying causes varied significantly by MPS type (P < .001). SCC is a common complication in MPS, but its risk and pathophysiology vary by MPS type. Therefore, an individualized approach is needed for early detection and appropriate intervention.

Accurate Preoperative Localization of Thoracolumbar Disc Extrusion in Dogs: A Prospective Controlled Study.

Intervertebral disc disease (IVDD) is a very common cause of spinal cord compression in dogs. The errors of human surgeons operating on the wrong level or wrong side is a recognized problem and has been largely analyzed. To date, little information is available regarding these errors in dogs. The objective of this study was to assess the accuracy of disc localization prior to possible surgery for IVDD to ensure the surgeon begins their incision directly over the extruded disc. Eighty-five chondrodystrophic or brachycephalic dogs that presented with IVDD confirmed by CT or MRI scan were included in the study. Two small Backhaus clamps were placed cranial and caudal to the lesion site and a control clamp placed at the wing of the ilium. The main interest was whether the surgeon was able to preoperatively pinpoint the correct site for the surgery. Dorsoventral radiographs were taken to verify by another person if the clamps had been placed in the correct position. If the result was incorrect, the surgeon was asked to try again without knowing that the clamps were incorrect, and another radiograph was taken. This was repeated until the position was correct. The results were recorded as correct or incorrect and the number of attempts were registered. The results suggested no significant trend over time for any of the outcomes examined. There were some slight improvements over time, but none of the results was close to statistical significance. The findings of the study showed that in the thoracolumbar region the surgeon has a higher chance of incorrectly marking the exact site for surgery.

Early detection of spinal cord compression: screening, clinical presentation, outcome and prognosis

Spinal cord compression (SCC) is a critical medical condition characterized by pressure on the spinal cord, which can lead to severe and potentially irreversible neurological damage if not promptly addressed. The causes of SCC are varied, including primary and metastatic tumors, traumatic injuries, degenerative diseases, and infections. Early detection of SCC is paramount for improving patient outcomes, minimizing risk of permanent deficits, and enhancing quality of life. This review examines etiology and clinical presentation of SCC, highlighting the significance of early screening and detection. Effective screening involves identifying high-risk individuals through risk stratification, utilizing advanced imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT) scans, and maintaining clinical vigilance. Recognizing early symptoms, such as localized pain, neurological deficits, and autonomic dysfunction, is crucial for timely intervention. Prognosis of SCC improves significantly with early diagnosis and intervention. Treatment options include surgical decompression to relieve pressure, radiation therapy for tumor-related compression, and corticosteroids to reduce inflammation. Early intervention can prevent irreversible neurological damage and enhance recovery potential. Comprehensive rehabilitation, involving physical and occupational therapy, is critical for restoring function and improving quality of life.

Comprehensive Insights into Metastasis-Associated Spinal Cord Compression: Pathophysiology, Diagnosis, Treatment, and Prognosis: A State-of-the-Art Systematic Review.

Background: Spinal cord compression is a formidable complication of advanced cancer, and clinicians of copious specialities often have to encounter significant complex challenges in terms of diagnosis, management, and prognosis. Metastatic lesions from cancer are a common cause of spinal cord compression, affecting a substantial portion of oncology patients, and only in the US has the percentage risen to 10%. Acute metastasis-correlated spinal cord compression poses a considerable clinical challenge, necessitating timely diagnosis and intervention to prevent neurological deficits. Clinical presentation is often non-specific, emphasizing the importance of thorough evaluation and appropriate differential diagnosis. Diagnostic workup involves various imaging modalities and laboratory studies to confirm the diagnosis and assess the extent of compression. Treatment strategies focus on pain management and preserving spinal cord function without significantly increasing patient life expectancy, while multidisciplinary approaches are often required for optimal outcomes. Prognosis depends on several factors, highlighting the importance of early intervention. We provide an up-to-date overview of acute spinal cord compression in metastases, accentuating the importance of comprehensive management strategies. Objectives: This paper extensively explores the pathophysiology, clinical presentation, diagnostic strategies, treatment modalities, and prognosis associated with spinal cord metastases. Materials and Methods: A systematic literature review was conducted in accordance with the PRISMA guidelines. Conclusions: We aim to help healthcare professionals make informed clinical decisions when treating patients with spinal cord metastases by synthesizing current evidence and clinical insights.

Contribution of Myélo-Computed Tomography in the assessment of slow spinal cord compressions: Retrospective study of 33 cases in Niamey

Purpose: To describe the contribution of Myélo-computed tomography during the assessment of slow spinal cord compressions and to determine the etiological profile. Patients and methods: This is a retrospective, cross-sectional, analytical and descriptive study of 33 cases collected in the radiology and imaging department of the National Hospital of Niamey (HNN) over a period of 14 months (from 31/12/2015 to 10/02/2017). Were included in the study all patients with slow spinal cord compression occurred in a non-traumatic setting, admitted to the service for a Myélo-computed tomography. Results: The mean age of the patients was 47.03 years with extremes ranging from 27 to 75 years. The 30-35 age group was the most affected with 23.2% of cases. In our study, Myélo-computed tomography detected medullary compression in 33 patients (33%). The extra-dural compartment was the most common site of slow medullary compression with 97% and intra dural extra marrow with 3%. The dorsal spine was the most affected stage by slow spinal compression with 52% followed by the cervical (27%) and lumbar (22%) stage. Infectious pathology was the most common cause of spinal cord compression with a frequency of 63.6%, followed by degenerative (27.3%) and tumoral (9.1%) pathology. Conclusion: Myélo-computed tomography plays an important role in topographic and etiologic diagnosis of slow spinal cord compression in the absence of MRI.

Spinal Epidural Hematoma Caused by Pure Epidural Spinal Arteriovenous Malformation: Case Report and Literature Review

AbstractSpontaneous spinal epidural hematoma (SEH) represents an extremely rare cause of spinal cord compression. Symptomatic pure extradural spinal AVMs (E-sAVM), in the absence of cavernous hemangiomas, are very rare and have rarely been reported. The clinical presentation of SEH caused by E-sAVM is often nonspecific and may lead to delayed diagnosis and treatment. We report the case of a 16-year-old adolescent girl who presented with paraparesis that rapidly evolved in paraplegia. Emergent magnetic resonance imaging (MRI) of the whole spine showed a posterior SEH, extending from C7 to T2, highly suspicious for the presence of an underlying AVM. The patient underwent emergent C7–T2 laminoplasty. An E-sAVM was intraoperatively found and subsequently excised. The patient was discharged with no neurological defects. E-sAVMs are extremely rare pathologies; they represent an extremely rare cause of spinal cord compression. If immediately diagnosed and treated, most patients recover with good prognosis.

Surgical Intervention for Primary B-cell Lymphoma of the Spine: A Systematic Review and Meta-analysis of Clinical Presentation, Treatment, Postoperative Outcomes, and Histologic Markers.

Systematic review and meta-analysis. To perform a systematic review of the clinical symptoms, radiographic findings, and outcomes after spinal decompression in B-cell lymphoma. B-cell lymphoma is a potential cause of spinal cord compression that presents ambiguously with nonspecific symptoms and variable imaging findings. Surgical decompression is a mainstay for both diagnosis and management, especially in patients with acute neurological deficits; however, the efficacy of surgical intervention compared with nonoperative management is still unclear. The databases of Medline, PubMed, and the Cochrane Database of Systemic Reviews were queried for all articles reporting spinal B-cell lymphoma. Data on presenting symptoms, treatments, survival outcomes, and histologic markers were extracted. Using the R software "survival" package, we generated bivariate and multivariate Cox survival regression models and Kaplan-Meier curves. In total, 65 studies were included with 72 patients diagnosed with spinal B-cell lymphoma. The mean age was 56.22 (interquartile range: 45.00-70.25) with 68% of patients being males and 4.2% of patients being immunocompromised. Back pain was the most common symptom (74%), whereas B symptoms and cauda equina symptoms were present in 6% and 29%, respectively. The average duration of symptoms before presentation was 3.81 months (interquartile range: 0.45-3.25). The most common location was the thoracic spine (53%), with most lesions being hyperintense (28%) on T2 magnetic resonance imaging. Surgical resection was performed in 83% of patients. Symptoms improved in 91% of patients after surgery and in 80% of patients treated nonoperatively. For all 72 patients, the overall survival at 1 and 5 years was 85% (95% CI: 0.749-0.953; n = 72) and 66% (95% CI: 0.512-0.847; n = 72), respectively. Although surgery is usually offered in patients with acute spinal cord compression from B-cell lymphoma, chemotherapy and radiation alone offer a hopeful alternative to achieve symptomatic relief, particularly in patients who are unable to undergo surgery.

Pediatric intraspinal arachnoid cyst: successful endoscopic fenestration. Illustrative case.

Intradural spinal arachnoid cysts (SACs) are a rare cause of spinal cord compression. Treatment is centered on decompression of the spinal cord via laminectomy or laminoplasty followed by resection or fenestration of the cyst. Although laminectomy or laminoplasty access may be needed to achieve the desired result, either procedure can be associated with more extensive surgical dissections and long-term spinal stability concerns, including postsurgical kyphosis. The authors present a case of a cervical intradural SAC in a 4-month-old girl presenting with symptomatic compression. The patient was treated by laminotomy and endoscopic fenestration of the SAC with resolution of symptoms and no disease progression 10 months postoperatively, when the patient was 14 months old. Microsurgical endoscopic fenestration of an intradural SAC can provide a less invasive means of treatment while avoiding the risks associated with more invasive approaches.

SURG-12. SURGICAL INTERVENTION FOR PRIMARY B-CELL LYMPHOMA OF THE SPINE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF CLINICAL PRESENTATION, HISTOLOGICAL MARKERS, TREATMENTS, AND SURVIVAL OUTCOMES

Abstract B-cell lymphoma is a potential cause of spinal cord compression that presents with nonspecific symptoms and inconsistent imaging findings. Surgical decompression is a mainstay for both diagnosis and management especially in patients with acute neurologic deficits; however, the long-term efficacy of intervention is still unclear. We perform a systematic review of the clinical symptoms, radiographic findings, and outcome after spinal decompression in B-cell lymphoma. The databases of Medline, PubMed, and the Cochrane Database of Systemic Reviews were queried for all articles reporting spinal B-cell lymphoma. Data on presenting symptoms, histological markers, treatment and survival outcomes were extracted. Bivariate and Multivariate Cox survival regression models and Kaplan-Meier curves were generated using R software survival package. In total, 57 studies were included with 72 patients diagnosed with spinal B-cell lymphoma. Mean age was 56.22 (IQR: 45.00-70.25) with 68% of patients being male and 4.2% of patients being immunocompromised. Back pain was the most common symptom (74%) with B symptoms and cauda equina symptoms present in only 6% and 29% respectively. Mean length of symptoms before presentation was 3.81 months (IQR: 0.45-3.25). The most common location was the thoracic spine (53%), with a majority of the lesions being hyperintense (28%) on T2 MRI. Surgical resection was performed in 83% of patients. Symptoms improved in 88% of patients after surgery and 80% of patients treated nonoperatively. OS at one- and five-years was 85% (95% CI: 0.749-0.953; n=72) and 66% (95% CI: 0.512-0.847; n=72), respectively. Age &amp;gt; 70 was associated with poorer OS in bivariate (HR 4.07 [95% CI: 1.328-12.46], p &amp;lt; 0.01; n=72) and multivariate analysis (HR 3.829 [95% CI: 1.158-12.662], p &amp;lt; 0.03; n=72). Primary spinal B-cell lymphoma can have a variety of presentations. Both surgery and nonoperative management may have similar improvement in symptoms. Age &amp;gt; 70 appears to confer poorer OS.

Chiari decompression for syringomyelia in the setting of IgG4-related hypertrophic pachymeningitis: A case-based update

Hypertrophic pachymeningitis can lead to clinical brainstem and cervical spinal cord compression leading to neurologic deficits. IgG4-related hypertrophic pachymeningitis (IgG4-RHP) is one recently recognized etiology of previously idiopathic cases. A 34-year-old right-handed female presented with slowly progressive neurologic symptoms and worsening radiographic syringomyelia. She successfully underwent Chiari decompression and excision of her pachymeningitis with improvement in her radiographic findings. Extensive clinical workup has led to a diagnosis of IgG4-RHP and treatment with steroids. IgG4-RHP is a rare cause of spinal cord compression and on our review of the literature this is the first description of significant syringomyelia associated with this condition. This remains a challenging entity to treat and neurology and rheumatology referrals should be placed early to investigate IgG4-RHP as an etiology for idiopathic cases. Treatment of this disease is likely to evolve with further research.

Spinal Cord Compression in Togo: Etiologies and Management

Spinal cord compression etiology depends on geographic region. In sub-Saharan Africa, the etiologies are mostly infectious, and management is characterized by diagnostic delay and limited treatment modalities. In Togo, treatment was nonoperative until 2008. However, management has improved with the development of imaging and availability of specialists. We sought to report etiology and outcome of spinal cord compression since establishment of a neurosurgery unit in Togo. A retrospective descriptive study was performed of patients admitted for spinal cord compression in the neurosurgery unit of a referral hospital in Togo between 2008 and 2018. Follow-up was conducted at 3, 6, and 12 months after discharge. Spinal cord compression represented 4.2% of hospitalizations. Median patient age was 41 years; 5 patients were children. Men accounted for 64.6% of patients. Patients presented late to the hospital; 40.7% reported symptoms lasting >1 year. Claudication was the presenting symptom in 75.2%. At presentation, 20.3% of patients had complete neurological lesions. The main etiology of compression was degenerative disease. Surgery was performed in 81.4% of patients; only 16.3% were operated on within 72 hours of admission. Chemotherapy was administered in 5 cases. At 1 year after surgery, 33.7% of patients had total neurological recovery, and 50% had partial recovery. Factors influencing neurological recovery were age, initial neurological status, and type of treatment. This study found increased degenerative causes of spinal cord compression in Africa. The pathology is characterized in our context by late consultation and operative delay affecting recovery, morbidity, and mortality.

Idiopathic hypertrophic pachymeningitis as a rare cause of spinal cord compression

Idiopathic hypertrophic pachymeningitis (IHP) is a rare inflammatory disease characterized by inflammation and hypertrophy of the dura mater. Spinal form of IHP is extremely rare. We report an idiopathic hypertrophic spinal pachymeningitis case, a 67-year-old female who presented with neck and upper back pain with progressive paraparesis and sensory level. Her magnetic resonance imaging cervico-dorsal spine showed abnormal epidural hypointensity on T2-weighted images from C5 to T4 with significant cord compression and intramedullary cord signal changes at T2 and T3 levels. The lesional biopsy was done suggestive of chronic inflammatory changes. She was treated with steroids and was able to walk unaided.

Focal spinal hyperesthesia as a prognostic factor in paraplegic dogs without deep pain perception

ABSTRACT: Intervertebral disc extrusion (IVDE) is the most common cause of spinal cord compression in dogs, whose prognosis is variable and depends on several factors, with deep pain perception (DPP) being the main parameter used. Investigations of new prognostic factors are studied to assist in the estimation of functional recovery. Thus, this study aimed to evaluate whether spinal hyperesthesia (SH) at the compression site can be used as a prognostic factor for the functional recovery of dogs with acute IVDE (Hansen type I), without DPP being subjected to thoracolumbar hemilaminectomy. Decompression surgery was performed on the same day or the day after admission. The duration of the loss of DPP until surgery performance ranged from 1 to 60 days, with a median of 4.5 days for the group of dogs with SH and 5.5 days for those without SH. Among the 68 dogs included in this retrospective study, 73.5% (50/68) showed SH, and 26.5% (18/68) were not identified. Recovery was satisfactory in 60% (30/50) of dogs with SH and in 27.7% (5/18) of dogs without SH, demonstrating that paraplegic dogs without DPP but with SH were 3.9 times more likely to recover when compared to dogs in the same condition, but with no SH. No studies have evaluated SH by palpation of the spine as a prognostic factor, which reinforces the relevance of the present study. The results of this study imply that SH in paraplegic dogs affected by thoracolumbar IVDE, without the presence of DPP, can be used as a possible prognostic indicator of functional recovery.

Spinal epidural hematoma in an infant patient: a differential diagnostic of spinal cord compression syndrome

A spontaneous spinal epidural hematoma is a collection of blood in the epidural space of the spine occurring in the absence of trauma or other pathological blood conditions, this epidural blood clot has the risk to compress the spinal cord and impact negatively on the neurological outcome of the patients. With a low incidence on pediatrics this condition has not been studied deep, with difficulties on the clinical approach in infants and children due to the limitation in the pediatric neurological exam with the risk to be misdiagnosed. We describe a rare case of spinal cord compression on a young 14 month old patient with a spontaneous cervicothoracic epidural hematoma that presented with a ascending paralysis. Magnetic resonance imaging of the spine demonstrated an extensive epidural hematoma between C4 to T5 with spinal cord compression. An emergency laminectomy was performed with evacuation of the epidural blood clot with a total improve of the neurologic symptoms and without any residual hematoma following 3 months of the surgery. The spontaneous spinal epidural heamtoma is rare cause of spinal cord compression on infants and children with high risk of neurological impact without prompt diagnosis with MRI and emergent surgical evacuation.

Spinal Cord Compression Due to Hypertrophic Dorsal Pachymeningitis in a Patient with ANCA + Vasculitis

Hypertrophic pachymeningitis is an infrequent cause of spinal cord compression, secondary to an intracanal and extramedullary inflammatory infiltrate in patients with Wegener’s disease, and it produces canal stenosis and spinal cord compression. We present the case of a patient with this rare entity, providing explanatory images, who was treated with corticosteroids with partial remission of the lesions.

Multiple extradural arachnoid cysts causing cord compression

Abstract Spinal arachnoid cysts (SACs) are an uncommon cause of spinal cord compression. A nine-year-old female child presented with pain, stiffness, and weakness in both lower limbs. The girl could walk with support. She had clinical features suggestive of Marfan’s syndrome. On examination, she had spastic paraparesis. Neuroimaging revealed multiple extradural arachnoid cysts (EACs) causing cord compression, extending from the cervical to sacral level. Computerized tomography (CT) myelogram did not demonstrate a communication of the EAC with the spinal subarachnoid space at any level or within adjacent cysts. The patient underwent a dorsal laminoplasty (D6 to D8) with excision of the underlying EAC, which was causing maximum compression. Postoperatively, the patient showed significant improvement in her gait. She could walk independently at the time of discharge. The EACs are rare and the present case is the only case to have extensive spinal cord involvement from cervical to sacral levels and only the second in literature in which multiple EACs caused symptomatic cord compression. The relevant literature is reviewed.

Neurological symptoms in Scheuermann’s disease: review of rare clinical observations

Neurological symptoms in Scheuermann’s disease are very rare, only a few dozen cases have been described. The main causes of spinal cord compression with the development of neurological symptoms in spinal deformities due to Scheuermann’s disease are compression by the anterior wall of the spinal canal, together with the dorsal leaflet of the dura mater, intervertebral hernia, and extradural bone cyst. The review provides a description of 38 clinical observations found in the literature. Compressing factors can also be spinal epidural lipomatosis and a displaced fragment of the annular apophysis. Scheuermann’s disease can be combined with syringomyelia. The magnitude of the kyphotic deformity does not correlate with the severity of neurological symptoms. Preoperative examination of a patient with Scheuermann’s disease should include methods that allow visualizing the condition of the spinal canal and its contents.

Neurological symptoms in Scheuermann’s disease: review of rare clinical observations

Neurological symptoms in Scheuermann’s disease are very rare, only a few dozen cases have been described. The main causes of spinal cord compression with the development of neurological symptoms in spinal deformities due to Scheuermann’s disease are compression by the anterior wall of the spinal canal, together with the dorsal leaflet of the dura mater, intervertebral hernia, and extradural bone cyst. The review provides a description of 38 clinical observations found in the literature. Compressing factors can also be spinal epidural lipomatosis and a displaced fragment of the annular apophysis. Scheuermann’s disease can be combined with syringomyelia. The magnitude of the kyphotic deformity does not correlate with the severity of neurological symptoms. Preoperative examination of a patient with Scheuermann’s disease should include methods that allow visualizing the condition of the spinal canal and its contents.

Neurological symptoms in Scheuermann’s disease: review of rare clinical observations

Neurological symptoms in Scheuermann’s disease are very rare, only a few dozen cases have been described. The main causes of spinal cord compression with the development of neurological symptoms in spinal deformities due to Scheuermann’s disease are compression by the anterior wall of the spinal canal, together with the dorsal leaflet of the dura mater, intervertebral hernia, and extradural bone cyst. The review provides a description of 38 clinical observations found in the literature. Compressing factors can also be spinal epidural lipomatosis and a displaced fragment of the annular apophysis. Scheuermann’s disease can be combined with syringomyelia. The magnitude of the kyphotic deformity does not correlate with the severity of neurological symptoms. Preoperative examination of a patient with Scheuermann’s disease should include methods that allow visualizing the condition of the spinal canal and its contents.

Midline solitary osteochondroma of C2 vertebra with myelopathy in a child: A case report with review of literature

Spinal osteochondromas with neurological deficits are rare. Only 0.5% to 1% of spinal osteochondromas present with neurological dysfunction. We hereby present a case of osteochondroma of the C2 lamina with neurological deficit and unique presentation.A 10-year-old female presented with a history of severe weakness of all four limbs after a fall. Weakness had spontaneously improved over initial three days and she presented to us with mild weakness of the right upper limb about two weeks after the fall. On examination, neck movements were full and painless with spastic quadriparesis and a motor power of grade 4/5 in all four limbs with extensor plantars.On radiology, CT scan of the cervical spine showed an osseous outgrowth from the C2 lamina in the midline projecting into the spinal canal, directed superiorly toward the dens. An MRI showed spinal-cord compression with cord deformation and signal changes.She underwent en bloc excision of the tumor mass, which was severely impinging on the spinal cord. Histopathology confirmed a diagnosis of osteochondroma. At four-year follow-up, there was complete recovery with no signs of recurrence.Spinal osteochondroma is a rare but potential cause of spinal-cord compression in a child with varied presentation.