Development Of Spinal Cord Compression Research Articles

РЕКОНСТРУКТИВНЫЕ И СТАБИЛИЗИРУЮЩИЕ ВМЕШАТЕЛЬСТВА В КОМПЛЕКСНОЙ ТЕРАПИИ ПАЦИЕНТОВ С СОЛИТАРНЫМИ МЕТАСТАЗАМИ ПОЗВОНОЧНИКА

Abstract. Introduction: The problem of diagnosis and treatment of patients with oncological pathology of the spine is relevant due to treatment complexity and the increasing number of patients’ morbidity. Secondary neoplastic processes are common in spine because of its anatomy, physiological features, complex biomechanics and enhanced vascularization. The main clinical manifestations of metastatic lesions of the spine are pain and neurological deficit. The development of spinal cord compression and pain syndrome leads to a sharp deterioration in the quality of life in patients with metastatic lesions of the spine. Despite the progress made in modern surgery of patients with oncological diseases with metastasis to the spine, mortality rates after surgery reaches 6.3% and complications appear in 23% of cases. Aim: Improving the results of treatment of patients with solitary spinal metastases and spinal cord compression. Methods and materials: Between 2010 and 2018, patients with spinal neoformations (N=240) received surgical treatment at Traumatology Unit of North-Western State Medical University named after I.I. Mechnikov. All patients were put into the categories according to their sex, age, histologic type and location of tumors. We assessed patients’ pain severity (BAIII), neurologic status (Frankel scale) and life span (by Kaplan-Meier method). Results: The study presents the analysis of the results of complex therapy of 183 patients with solitary metastases of the spine, who underwent the surgical stage of treatment. For these patients the epidemiological structure and the main clinical and radiological characteristics of solitary metastatic lesions of the spine were determined, a comparative assessment of the effectiveness of various options for surgical interventions in the complex treatment was carried out. To do so, all patients of the primary cohort were divided into 2 groups depending on the volume of surgery. The first group included 54 patients who underwent a radical resection of the affected vertebra in a single block with prosthetics of the anterior support column and posterior instrumental fixation. The second group included 129 patients after palliative decompressive and stabilizing operations from the posterior approach. Conclusion: There were no statistically significant differences between the two studied methods of surgical treatment in terms of the dynamics of the level of pain syndrome, regression of neurological deficit and life expectancy. When choosing the tactics of surgical treatment of patients with solitary spinal metastases, the main method is decompressive and stabilizing interventions, which helps to reduce the risk of surgical complications, improve the quality of life of the patient and continue the complex treatment of the underlying disease.

Characterization of metastatic spinal cord compression from prostate cancer.

248 Background: Spinal cord compression (SCC) is one of the most debilitating conditions in metastatic prostate cancer patients (pts). A comprehensive analysis of pts could shed lights on predisposing factors and help with devising new ways for early detection and prompt treatment. Methods: 52 pts with magnetic resonance imaging-confirmed metastatic SCC from prostate cancer were identified at MD Anderson Cancer Center. Characteristics including age, anatomical site, Gleason score, overall survival(OS), time to diagnosis of SCC, underlying gene mutations, numbers of bone metastasis, number of lines of treatment and clinical outcome were analyzed. Results: 96.15% of SCC occurred in thoracic spine in comparison to 74% as reported previously. At the time of diagnosis of SCC, median age is 70 years, median OS is 1537 days, median time to development of SCC is 1222.5 days, median lines of systemic treatment is 4, median PSA value is 66.4, 100% of pts have a Gleason score above 7, 94% of pts have >4 bone metastasis, roughly 20% of pts had visceral metastases. 55% of 9 evaluable pts harbored P53 gene mutation. About 80% of pts received radiation treatment; 17% of pts received surgery; 49% of pts had fair clinical outcome after treatment (Table). Conclusions: The observed predominance of SCC in thoracic spine (96.15%) suggests an underlying mechanism governing development of SCC in preferential sites. Further research to define this mechanism will help with prevention, detection and treatment of SCC. Additionally, characterized potential predictive factors (Gleason score≥7, >4 bone mets, presence of P53 mutation) could be used to develop an algorithm to improve the management of SCC.[Table: see text]

A systematic review of evidence on malignant spinal metastases: natural history and technologies for identifying patients at high risk of vertebral fracture and spinal cord compression

A systematic review of evidence on malignant spinal metastases: natural history and technologies for identifying patients at high risk of vertebral fracture and spinal cord compression

PS14 A Systematic Review of Evidence on Malignant Spinal Metastases: Technologies for Identifying Patients at High Risk of Vertebral Fracture and Spinal Cord Compression

BackgroundSpinal metastases are common and can lead to significant morbidity and reduction in quality of life towards the end of life due to spinal cord compression (SCC). Between 5% and...

Incidence and prognostic factors of Japanese breast cancer patients with bone metastasis

BackgroundFew previous studies have analyzed the incidence of bone metastases in a defined population of Japanese breast cancer patients and their prognosis after chemotherapy. MethodsThis is a retrospective cohort study. We investigated 695 patients who underwent surgery for breast cancer. The strategy of adjuvant therapy was as follows. Patients with both estrogen receptors (ERs) and progesterone receptors (PgRs) had endocrine therapy as initial adjuvant therapy (n = 239). Patients with neither ERs nor PgRs had chemotherapy. When metastasis to other organs, including bone, was identified, patients received chemotherapy. The survival rates after surgery and after the onset of bone metastasis, as well as the incidence of bone metastasis, were calculated. We also evaluated the prognostic and predictive factors. ResultsBone metastases developed in 148 of 695 patients. All 148 received chemotherapy, and 121 of them developed spinal metastases. The 5-year survival rate after bone metastases was 26.1%. Prognostic factors for bone metastases were visceral metastases and PgR status. Cord compression was observed in 17 of the 148 patients, with the thoracic spine being the most common. The 1-year survival rate for patients with bone metastases who received chemotherapy was 66.3%, whereas that of patients with paralysis after spinal metastases was 17.6%. Within 6months of the development of spinal cord compression, 70.6% of the patients died. ConclusionsWe reported the incidence and prognostic factors for a defined population of Japanese breast cancer patients with bone and spinal metastases. Our results suggest that the expected survival time for patients with paralysis who received adequate endocrine therapy or chemotherapy is generally poor. However, to detect a predictive factor of long survival after paralysis and establish the indications for surgery, a comparative study among large groups of patients with paralysis and with different backgrounds is necessary.

Chronic inflammatory demyelinating polyradiculoneuropathy: two cases with cervical spinal cord compression

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a peripheral nerve disorder probably due to an immunological disturb. It evolves either in a steadily progressive or in a relapsing and fluctuating course. Weakness is mainly in the lower limbs proximally and distally. The electromyography is demyelinating. The cerebral spinal fluid protein is most of times elevated. Sometimes enlarged nerves are found. There are few cases described with spinal cord compression due to hypertrophic spinal nerve roots. Two patients (females, 66 and 67 years old) with diagnosis of a long standing CIDP are described. In the first one, the evolution was characterized by remission and relapsing course. The second patient had a chronic and progressive course. These patients presented after a long evolution a cervical spinal cord compression syndrome due to hypertrophic cervical roots. Neurologists must be aware of the possibility of development of spinal cord compression by enlarged spinal roots in patients with a long standing CIDP.

Spinal cord compression by secondary epi- and intradural metastases in childhood.

Over a 9-year period, 35 out of 614 children with malignant tumours who were treated at the Centre Léon Bérard developed spinal metastases. Of these, 18 with known malignancies before the development of spinal cord compression are reviewed. The most common tumours causing spinal metastases were Ewing's sarcoma, neuroblastoma and renal tumours. Cord compression occurred 5-88 months after the diagnosis of systemic cancer. The median interval from first symptoms to the diagnosis of compression was 17 days. There were 16 patients with neurological deficit, including 5 with paraplegia. Specific imaging procedures were performed in 16 patients. Treatment included operation in 8 patients, followed by chemotherapy (6 patients) and/or radiotherapy (4 patients); 9 of the 10 non-operated patients received radiotherapy. Only 6 patients had a significant neurological improvement. All patients but 1 died within a median time of 2 months. Early diagnosis might prevent permanent disability in these children with a short survival expectancy.

Paraplegia after a Routine Lumbar Laminectomy: Report of a Rare Complication and Successful Management

Arachnoid cysts of the spinal canal are relatively common lesions that may be either intra- or extradural. These cysts are usually asymptomatic but may produce symptoms by compressing the spinal cord or nerve roots. We report a case in which an intradural thoracic arachnoid cyst became symptomatic after a routine decompressive lumbar laminectomy for spinal stenosis. Myelography revealed no abnormality, although magnetic resonance imaging and computed tomography after myelography demonstrated a mass within the posterior aspect of the thoracic spinal canal associated with anterior displacement and compression of the spinal cord. A change in the flow dynamics of the cerebrospinal fluid probably allowed the development of spinal cord compression due to one of the following: expansion of the cyst, decreased cerebrospinal fluid buffer between the cord and the cyst, or epidural venous engorgement. A concomitant and more cephalad lesion such as an arachnoid cyst should be considered when myelopathic complications arise after lumbar surgery. Magnetic resonance imaging and computed tomography after myelography are useful to demonstrate the additional pathological processes.

Treatment outcome of spinal cord compression by nasopharyngeal carcinoma

Spinal cord compression occurred in 1.6% of a cohort of 626 patients with nasopharyngeal carcinoma during a median follow-up period of 22 months. The degree of motor deficit before treatment was the most important predictor of subsequent motor recovery. One patient had complete reversal of motor deficit and returned to an ambulatory state by chemotherapy alone. The development of spinal cord compression was associated with a short life expectancy in nasopharyngeal carcinoma.