Management Of Spinal Cord Compression Research Articles

The Efficacy of a Multidisciplinary Approach and Diagnostic-Therapeutic Algorithm for Vertebral Metastases with Spinal Cord Compression.

Background and Objectives: Metastatic spinal cord compression represents a substantial risk to patients, given its potential for spinal cord and/or nerve root compression, which can result in severe morbidity. This study aims to evaluate the effectiveness of a diagnostic-therapeutic algorithm developed at our hospital to mitigate the devastating consequences of spinal cord compression in patients with vertebral metastases. Materials and Methods: The algorithm, implemented in our practice in January 2022, is based on collective clinical experience and involves collaboration between emergency room physicians, oncologists, spine surgeons, neuroradiologists, radiation oncologists, and oncologists. To minimize potential confounding effects from the COVID-19 pandemic, data from the years 2019 and 2021 (pre-protocol) were collected and compared with data from the years 2022 and 2023 (post-protocol), excluding the year 2020. Results: From January 2022 to December 2023, 488 oncological patients were assessed, with 45 presenting with urgency due to suspected spinal cord compression. Out of these, 44 patients underwent surgical procedures, with 25 performed in emergency settings and 19 cases in elective settings. Comparatively, in 2019 and 2021, 419 oncological patients were evaluated, with 28 presenting with urgency for suspected spinal cord compression. Of these, 17 underwent surgical procedures, with 10 performed in emergency scenarios and 7 in elective scenarios. Comparing the pre-protocol period (years 2019 and 2021) to the post-protocol period (years 2022 and 2023), intrahospital consultations (commonly patients neurologically compromised) for spine metastasis decreased (105 vs. 82), while outpatient consultations increased remarkably (59 vs. 124). Discussion: Accurate interpretation of symptoms within the context of metastatic involvement is crucial for patients with a history of malignancy, whether presenting in the emergency room or oncology department. Even in the absence of a cancer history, careful interpretation of pain characteristics and clinical signs is crucial for diagnosing vertebral metastasis with incipient or current spinal cord compression. Early surgical or radiation intervention is emphasized as it provides the best chance to prevent deficits or improve neurological status. Preliminary findings suggest a notable increase in both the number of patients diagnosed with suspected spinal cord compression and the proportion undergoing surgical intervention following the implementation of the multidisciplinary protocol. The reduced number of intrahospital consultations (commonly patients neurologically compromised) and the increased number of visits of outpatients with vertebral metastases indicate a heightened awareness of the issue, leading to earlier identification and intervention before neurological worsening necessitating hospitalization. Conclusions: A comprehensive treatment planning approach is essential, and our multidisciplinary algorithm is a valuable tool for optimizing patient outcomes. The protocol shows potential in improving timely management of spinal cord compression in oncological patients. Further analysis of the factors driving these changes is warranted. Limitations: This study has limitations, including potential biases from the retrospective nature of data collection and the exclusion of 2020 data due to COVID-19 impact. To enhance the robustness of our results, long-term studies are required. Moreover, the single-center study design may limit the validity of the findings. Further multicenter studies would be beneficial for validating our results and exploring underlying factors in detail.

Nursing care for patients with bone metastases undergoing radiotherapy: a scoping review

Objective: to map studies on nursing care for patients with bone metastases undergoing radiotherapy. Methods: scoping review conducted in nine databases, according to the guidelines of the Joanna Briggs Institute. Scientific articles available for full open access, in any language, regardless of the method used, were included. Results: 13 studies were analyzed, with a predominance of literature reviews. The themes were: health education to patients and companions about events related to the skeleton; pain assessment and management; prevention of pathological fractures; management of spinal cord compression; assessment of hypercalcemia; ensuring safety in the administration of oral bisphosphonates; quality of life assessment; and monitoring of progress, adverse events, and therapeutic outcomes. Conclusion: nurses provide important ongoing support to patients, monitor progress, side effects, and therapeutic outcomes, and prevent and manage skeletal-related events. Contributions to practice: the study highlighted the main nursing care to patients with bone metastases in radiotherapy treatment, being relevant to give theoretical subsidy to professionals directing their assistance, especially in the oncology area.

The etiologies and management of spinal cord compression in childhood cancers: Are we aware of the emergency of cord compression?

The spinal cord compression causes irreversible long-term permanent neurological sequelae. This study aims to increase awareness of childhood cancers that cause cord compression by comparing histopathological diagnosis, treatments, and survival rates to the literature. Seventy-three patients (38 male, 35 female) with spinal cord compression, among 1085 patients diagnosed with solid tumors at Gazi University Department of Pediatric Oncology between 1991 and 2021 were retrospectively evaluated. The mean time between the onset of complaints and diagnosis was 27.5± 24.9 (2-150) days. The first three most common tumors that caused cord compression; were central nervous system tumors in 22 (30%), neuroblastoma in 17 (23%), and malignant germ cell tumors in 8 (10%) cases. Of the patients, 46 (63%) had compression due to extradural masses, and 27 (37%) patients had an intradural compression. The most common symptoms were pain in 60 (82%), weakness in 57 (78%), and pins and needles in 28 (38%) patients, respectively. The clinical physical neurological examination findings were motor deficit in 62 (84%), and deep tendon reflex changes in 54 patients (73.9%). Compression findings were detected in 58 (79.5%) patients at diagnosis, and in 15 (20.5%) of them during follow-up. The most common level of compression was seen in the thoracolumbar region in 19 (26%) cases. In 65 (89%) patients with cord compression, corticosteroids were given as anti-edema treatment. Surgical excision was performed in 39 (53%) patients. Spinal radiotherapy was given to 35 patients (48%) with radiosensitive tumors. Chemotherapy protocols were started in 52 (71.2%) cases according to their diagnoses. Complete neurological recovery was achieved in 33 (45%) patients. The 5-year overall survival rates for solid tumors with extradural compression and intradural compression were 62% and 22%, respectively (p=0.002). Neurological sequela-free recovery is possible with early diagnosis and urgent treatment. Spinal compression must be detected by detailed systemic and neurological examination and imaging methods. Patients should be rapidly transferred to pediatric oncology units after starting anti-edema treatment.

Spine Stereotactic Body Radiation Therapy for Management of Spinal Cord Compression

Spine Stereotactic Body Radiation Therapy for Management of Spinal Cord Compression

Management of spinal cord compression in Togo

The aim of this study was to describe the epidemiologic, clinical, diagnostic and therapeutic aspects of spinal cord compression at the Lomé-Campus teaching hospital. We retrospectively analyzed the files of all patients hospitalized for spinal cord compression at Lome-Campus teaching hospital from January 1, 1998, through December 31, 2007. 39 files were selected, mostly of men (77%). The mean age was 53 years (range: 22 to 79). Median time from the start of symptoms to hospital admission was 14.9 ± 24.5 weeks. The spinal cord compression was confirmed by myeloscan in 35 cases (90%), myelography in 2 (5%) and magnetic resonance imaging in 2 cases (5%). The thoracic spine was the most common site of involvement. The principal cause was malignant neoplasm (17 cases: 44%), followed by cervical spondylotic myelopathy (9 cases: 23%) and Pott's disease (7 cases: 18%). Only one patient underwent surgery. Spinal cord compression appears to be a rare condition in Togo. It is a true medical emergency and immediate intervention is required. Its management remains precarious and its prognosis poor.

Practical Tips for Imaging and Management of Spinal Cord Compression

Practical Tips for Imaging and Management of Spinal Cord Compression

Practical Tips for Imaging and Management of Spinal Cord Compression

Contemporary Diagnostic Radiology: April 15, 2011 - Volume 34 - Issue 8 - p 6 doi: 10.1097/01.CDR.0000397813.30224.97

Practical Tips for Imaging and Management of Spinal Cord Compression

According to the National Spinal Cord Association, 250,000 to 400,000 people in the United States live with acute spinal cord injuries or spinal cord dysfunction and an estimated 7800 new cases occur each year. Motor vehicle accidents account for 44% of these cases. The etiology of spinal cord compression is diverse. Common offenders are listed in Table 1. Efficient and accurate radiologic diagnosis of spinal cord compression should lead to prompt decompression to alleviate symptoms and to potentially reverse the progressive and devastating course of myelopathy, incontinence, and paresis.Table 1: Causes of Spinal Cord Compression From Most to Least CommonEfficient and accurate diagnosis of spinal cord compression should lead to prompt decompression to alleviate symptoms and reverse a progressive and devastating course. This review aims to update diagnostic radiologists with an understanding of spinal cord compression based on modern imaging and the current literature. Therefore, the focus will be on diagnostic imaging of spinal cord compression emphasizing an appreciation of the available imaging modalities and their applications. By using the best methodology, radiologists can provide valuable information to aid clinicians in timely management of these seriously ill patients.

Practical Tips for Imaging and Management of Spinal Cord Compression

Practical Tips for Imaging and Management of Spinal Cord Compression

Management of Spinal Cord Compression #238

Management of Spinal Cord Compression #238

Imaging the spine for tumour and trauma – A national audit of practice in Irish hospitals

Background and purposeThe provision of appropriate spinal imaging in cases of acute injury as a consequence of trauma or tumour is becoming ever more challenging. This study assessed the use of multimodal radiological investigations in the management of spinal cord compression as a result of trauma and metastatic cancer in all major Irish hospitals. MethodsWe conducted a questionnaire of thirty four hospitals in an effort to assess the provision of these services to patients with possible spinal cord compromise.In all public hospitals the Emergency Department and/or the Orthopaedic Registrars were contacted and asked a series of questions relating to spinal clearance, spinal clearance protocols, CT and MRI scanning facilities and on site orthopaedic services. ResultsAll centres participated in the study. 67.64% of centres routinely used a protocol in spinal clearance. In 87% of hospitals the Emergency department were responsible for clearing the spine. 85.3% of hospitals had CT availability during normal working hours (9–5) dropping to 47% availability after hours. MRI was available in 50% of hospitals, with surprisingly just two centres providing out of hours MRI imaging services. ConclusionThe provision of radiological services in the management of suspected spinal injuries in Irish hospitals is inadequate in comparison to international best practice. This is most marked in relation to CT and MRI.

95 Audit of the management of spinal cord compression (pre-NICE guideline implementation)

95 Audit of the management of spinal cord compression (pre-NICE guideline implementation)

Management of Spinal Cord Compression Caused by Extramedullary Hematopoiesis in Beta-thalassemia

Thalassemia is a chronic hemolytic anemia, endemic around the Mediterranean basin. Extramedullary hematopoiesis (EMH) is a normal compensatory reaction that can involve many organs or tissues, including the epidural space, leading to a spinal cord compression syndrome. In almost all cases, the clinical and MR patterns are those of a lower dorsal spinal cord progressive compression secondary to an epidural expanding process. The management still remains controversial, including mainly blood transfusions, decompressive surgery and radiotherapy. We present a case of EMH in a thalassemic adolescent boy presenting with a T12 level of compression, treated successfully with blood transfusion, surgical decompression and radiotherapy.

Intralesional Injection of Absolute Alcohol Into Symptomatic Vertebral Hemangiomas

The management of vertebral hemangiomas remains controversial. This report describes the successful management of spinal cord compression caused by an intraosseous and extraosseous vertebral hemangioma with the percutaneous injection of absolute alcohol. A 71-year-old woman presented with lower extremity weakness and sensory disturbance. Magnetic resonance imaging and computed tomography (CT) confirmed the presence of a vertebral hemangioma involving the Th11 vertebral body. A CT-guided percutaneous transpedicular injection of absolute alcohol into the affected vertebral body resulted in symptomatic and imaging improvement. CT-guided percutaneous transpedicular injection of absolute alcohol into symptomatic vertebral hemangiomas is a simple, safe, and effective technique for relieving compression and devascularizing the hemangioma.

Cervical arthroplasty in the management of spondylotic myelopathy: 18-month results

Cervical spinal cord compression managed via an anterior approach with an arthrodesis may be associated with a decreased range of motion and accelerated adjacent-segment degeneration. Artificial cervical disc replacement may address these problems. The author presents a series of 11 patients (seven men and four women, ages 31-55 years) with anterior cervical decompression and placement of a total of 15 artificial disc prostheses. Clinical and radiological follow-up review was performed at 24 hours, 6 weeks, 3 months, 6 months, and then yearly (mean follow-up period 18.4 months, range 10-32 months). There were no major complications. There was an improvement in the Nurick grade by 0.91 grades (p < 0.001) and in the Oswestry Neck Disability Index by 41.5 percentage points (p < 0.001). In one case fusion was attained at 17 months postoperatively and one patient had a transient worsening of preoperative symptoms postoperatively, with focal kyphosis. The spinal cord was decompressed on postoperative imaging in all cases. Cervical arthroplasty after anterior cervical decompression at one or more levels represents an exciting tool in the management of spinal cord compression caused by spondylotic disease or acute disc prolapse. Results obtained in this study add further weight to the potential role of cervical arthroplasty for cervical myelopathy and longer follow up is provided on a previously reported series. It is suggested that care must be taken in using this unconstrained prosthesis if there is a preexisting spinal deformity. Longer follow up will reveal any delayed problems with artificial disc implantation, but in the short to medium term, this technique offers an excellent outcome.

Surgical Management of Spinal Cord Compression from Plexi form Neurofibromas

Surgical Management of Spinal Cord Compression from Plexi form Neurofibromas

Surgical Management of Spinal Cord Compression from Plexiform Neurofibromas in Patients with Neurofibromatosis 1

Surgical Management of Spinal Cord Compression from Plexiform Neurofibromas in Patients with Neurofibromatosis 1

Surgical Management of Spinal Cord Compression from Plexiform Neurofibromas in Patients with Neurofibromatosis 1

Surgical Management of Spinal Cord Compression from Plexiform Neurofibromas in Patients with Neurofibromatosis 1

Surgical management of spinal cord compression from plexiform neurofibromas in patients with neurofibromatosis 1.

Plexiform neurofibromas with sizable intraspinal extensions and resultant spinal cord compromise pose challenging management problems, because these lesions may involve multiple nerves and engulf adjacent vascular and visceral structures. In this report, we review our experience with the surgical treatment of these lesions. Patients were identified by a detailed review of hospital medical records and the database of our multidisciplinary neurofibromatosis clinic. Ten patients had large plexiform neurofibromas that extended intraspinally, producing a combination of myelopathy and radiculopathy. Two patients exhibited single-level intraspinal growth, and eight showed multilevel involvement. Four patients showed bilateral plexiform neurofibromatous growth intraspinally, with "hourglass" compression of the spinal cord. Operative approaches and outcomes were reviewed in detail. Gross total resection of the symptomatic intraspinal tumor component was achieved for nine patients. The management of the extraspinal component was individualized, depending on the pattern and extent of involvement of the surrounding structures. Nine patients experienced complete recovery of neurological function postoperatively; the remaining patient demonstrated significant functional improvement. With a median follow-up period of 4 years, only one patient has developed recurrent intraspinal compression, in this case from tumor involvement by the same plexiform lesion at a lower spinal level. Two patients treated early in the series using standard laminectomy approaches developed significant kyphotic deformities, necessitating subsequent fusion. Based on these initial results, osteoplastic laminotomy techniques were used in the last five cases, allowing anatomic reconstruction of the involved levels; none of these latter patients has developed significant kyphosis, with a median follow-up period of 3 years. Radical resection of intraspinal tumor components in patients with neurofibromatosis 1 and large plexiform neurofibromas can help to preserve excellent neurological function. Technical factors in the management of these lesions are presented.

Surgical Management of Spinal Cord Compression from Plexiform Neurofibromas in Patients with Neurofibromatosis 1

Surgical Management of Spinal Cord Compression from Plexiform Neurofibromas in Patients with Neurofibromatosis 1