Risk Of Spinal Cord Compression Research Articles

Clinical Factors Associated with Increased Risk of Spinal Cord Compression in Multiple Myeloma Patients: Insights from National Inpatient Sample Database (2016-2020)

Clinical Factors Associated with Increased Risk of Spinal Cord Compression in Multiple Myeloma Patients: Insights from National Inpatient Sample Database (2016-2020)

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.

Airway management in patients with suspected or confirmed traumatic spinal cord injury: a narrative review of current evidence.

SummaryAround 1 million people sustain a spinal cord injury each year, which can have significant psychosocial, physical and socio‐economic consequences for patients, their families and society. The aim of this review is to provide clinicians with a summary of recent studies of direct relevance to the airway management of patients with confirmed or suspected traumatic spinal cord injury to promote best clinical practice. All airway interventions are associated with some degree of movement of the cervical spine; in general, these are very small and whether these are clinically significant in terms of impingement of the spinal cord is unclear. Manual in‐line stabilisation does not effectively immobilise the cervical spine and increases the likelihood of difficult and failed tracheal intubation. There is no clear evidence of benefit of awake tracheal intubation techniques in terms of prevention of secondary spinal cord injury. Videolaryngoscopy appears to cause a similar degree of cervical spine displacement as flexible bronchoscope‐guided tracheal intubation and is an appropriate alternative approach. Direct laryngoscopy does cause a slightly greater degree of cervical spinal movement during tracheal intubation than videolaryngoscopy, but this does not appear to increase the risk of spinal cord compression. The risk of spinal cord injury during tracheal intubation appears to be minimal even in the presence of gross cervical spine instability. Depending on the clinical situation, practitioners should choose the tracheal intubation technique with which they are most proficient and that is most likely to minimise cervical spine movement.

PLACE OF SURGERY IN THE DIAGNOSIS AND TREATMENT OF MEDIASTINAL NEUROFIBROMA

TYPE: Abstract TOPIC: Disorders of the Mediastinum PURPOSE: Mediastinal neurofibroma is a benign nerve tumor caused by a disorderly proliferation of Schwann cells intertwined with nerve fibers.These tumors may pose diagnostic difficulties.The discovery is often fortuitous on imagery.Surgical treatment is required for any resectable lesion because of the risk of malignant transformation or the risk of spinal cord compression. METHODS: Retrospective study of 19files of patients operated on for mediastinal neurofibroma from 2000to 2020 in our thoracic surgery department RESULTS: They were 19patients.The average age was 43years.11 patients were symptomatic.Symptomatologie was made of dyscpnea with chest pain, cought, dysphagia, back pain, and coffee spots characteristic of Von Recklinghausen's disease.The discovery was fortuitous for the other patients.All the patients were explored by a thoracic scan specifying the site, the size, the nature of the lesion and its relationship with neighboring structures.The mean lesion size was 58mm.The localization was in the posterior mediastinum in16 cases, straddling the middle and posterior mediastinum in3 cases.Chest MRI was performed in 7patients to look for spinal endocanal extension.The surgical procedure consisted of a lumpectomy by posterolateral thoracotomy in 13 cases, VATS in 3 cases and exclusive video thoracoscopy in 3 cases.The diagnosis was made on the pathological examination of the surgical specimen.One patient presented with a recurrent tumor who was treated with chemotherapy. CONCLUSIONS: The diagnosis of mediastinal neurofibroma is suggested on imaging, and confirmed by pathological examination of the surgical specimen. CLINICAL IMPLICATIONS: Treatment is based on surgical resection of the tumor to prevent malignant transformation which can occur in about 4% of cases, mainly occurring in neurofibromatosis. DISCLOSURE: Nothing to declare. KEYWORD: neurofibroma, surgery

Spinal Epidural Capillary Hemangioma: a Review

The hemangiomas are benign vascular malformations. There are two types of hemangiomas that may affect the central nervous system, the cavernous type and the capillary type. The last is most uncommon and its presentation at spinal epidural space is extremely rare. These lesions usually present with signs and symptoms of myelopathy, radiculopathy or cauda equine syndrome. Magnetic resonance imaging (MRI) is the examination of choice and the treatment must be surgical regardless of the presentation of the patient due to the risk of spinal cord compression.

SAT-323 Thoracic Paraganglioma Presenting with Recurrent Cerebrovascular Events

Background: Thoracic spine paraganglioma precipitating acute stroke is extremely rare. We report a case of a patient with thoracic paraganglioma at high risk for spinal cord compression with recurrent cerebrovascular events. Clinical Case: A 59 year old male was admitted for transient right hemiplegia after recent admission for right lacunar CVA. The patient was noted to have episodes of labile hypertension, sinus tachycardia and paroxysmal diaphoresis. Five days after admission, he developed ataxia with right pronator drift and was treated with intravenous thrombolytics for suspected acute CVA. Incidentally, an 8 cm thoracic paraspinal necrotic mass invading T10 and T11 vertebral bodies with impending cord compression was found on imaging. CT-guided needle biopsy of the mass was performed. Pathology showed an oval and spindle cell neoplasm staining positive for synaptophysin and chromogranin, favoring paraganglioma. Chromogranin A was elevated 472 ng/mL (25 - 140 ng/mL). Plasma free metanephrines were 32 g/mL (n < 57 pg/mL) and plasma free normetanephrines were 7690 pg/mL (n < 148 pg/mL). MIBG scan showed focus of increased uptake at T10 and T11 as well as in the left posterior eighth rib and peri-aortic region. Subsequently, the patient developed acute right leg weakness and dysmetria; MRI brain confirmed acute infarct in the posterior limb of the left internal capsule. Alpha blockade followed by beta blockade was initiated. After approximately 2.5 weeks of alpha blockade, the patient underwent spinal angiogram with tumor embolization followed by successful en bloc tumor resection by neurosurgery and cardiothoracic surgery. Final pathology showed a 7.5 cm paraganglioma which demonstrated some aggressive pathologic features including Ki67 index>20% and 10% focal necrosis. Post-operative plasma free normetanephrines decreased to 568 pg/mL and metanephrines were undetectable. Genetic testing utilizing Ambry Genetics PGLnext panel was negative. Conclusion: A differential diagnosis of paraganglioma should be considered in any patient presenting with recurrent stroke and paraspinal mass. Biopsy should be avoided. Timing of surgical resection to decrease risk of further cerebrovascular compromise is challenging and requires a multidisciplinary approach (1). Locally invasive paragangliomas are rare and are often associated with SDHB mutations; however, a full genetic analysis did not identify any known genetic mutations. Reference: (1) Oak, S., Javid, M., Callender, G., Carling, T., Gibson, C. Management of pheochromocytoma in the setting of acute stroke. AACE Clinical Case Reports 2018 4:3, e245-e248.

Clinical implications morphometric study of the cervical spine on MRI

Degenerative changes, history of trauma or inflammation usually progressed to cervical spinal canal stenosis. This condition leads to cervical spondylosis neuropraxia and cervical spondylotic myelopathy (CSM). SAC (space available for the cord) value is important to understand the symptoms of spinal cord compression in cervical canal stenosis. The aim of our study is to establish cervical spinal canal morphometry in Western Maharashtra population observed by MRI of cervical region.70 subjects aged between 18-70 years. The sagittal vertebral body diameter, the sagittal spinal canal diameter and the sagittal spinal-cord diameter were measured at the C3 - C7 level. The SAC was determined. For each variable a two-way ANOVA was performed, sagittal canal diameter, sagittal spinal cord diameter and SAC were significant with p-value P&lt; 0.0001**. Mean vertebral body diameters observed were 1.49-1.51. Values of SAC observed were C3-1.5 cm, C4- 1.51cm, C5- 1.49cm, C6- 1.5cm, C7- 1.49cm. Average sagittal spinal canal diameter from C3-C7 was 14.1± 1.3 mm. The range of SAC was between 6.4-9.5mm, least at the C5 level. We conclude that subjects in our study do not have an increased risk of spinal cord compression.

Kinematic evaluation of thoracic spinal cord sagittal diameter and the space available for cord using weight-bearing kinematic magnetic resonance imaging.

Retrospective kinematic MRI (kMRI) study. To evaluate the dynamic changes of thoracic anterior and posterior space available for cord (SAC), and thoracic spinal cord in the dural sac in three positions. Expert MRI, Bellflower California; andUniversity of Southern California, in Los Angeles, USA. A total of 118 patients (66 males and 52 females, mean age ( ± SD) of 45.6 ± 10.6 years) who underwent thoracic spine kMRI were evaluated from T4-5 to T11-12 in flexion, neutral, and extension positions. The anterior SAC, posterior SAC, and mid-sagittal thoracic cord diameter were measured at each level from T4-5 to T11-12. Inter- and intraobserver agreements were analyzed. The anterior SAC was significantly narrower in flexion position compared with other positions at T8-9 to T11-12 levels (p < 0.01). The T8-9 level had significantly wider posterior SAC in flexion and extension positions compared with the neutral position (p < 0.005). However, the posterior SAC at T9-10 was narrower in extension than the neutral position (p = 0.002). Thoracic spinal cord diameter significantly increased in flexion position when compared with the neutral position at T8-9, T9-10, and T11-12 levels (p < 0.005). Thoracic spinal cord had dynamic changes with positions. In flexion position, the thoracic cord at T8-9 and below tended to move anteriorly, getting closer to the vertebral body and intervertebral disc. The mid-sagittal diameter of the thoracic cord increased in flexion position at the levels below T8-9. In the presence of lesions in anterior epidural space, the risk of spinal cord compression is higher in flexion position, especially at levels below T8-9.

Prevalence and risk of skeletal complications and use of radiation therapy in elderly women diagnosed with metastatic breast cancer.

ObjectiveReal-world data regarding patient factors associated with the occurrence of spinal cord compression (SCC) or pathological fracture (PF), or need for bone surgery (BS), or use of radiation therapy (RAD) (i.e. skeletal complications and radiation therapy; SCRT) are limited for women with metastatic breast cancer (BCa). Given the substantial clinical and economic burden of these events in advanced BCa, we conducted the present study to understand the prevalence and identify the risk factors associated with these events among elderly women presenting with de novo metastatic BCa.MethodsUsing linked Surveillance, Epidemiology, and End Results and Medicare data, we identified women with incident metastatic BCa diagnosed during 2005–2009. Associations between patient demographics and select clinically relevant factors, and SCRT were examined using the Cox proportional hazards model, accounting for death as a competing risk.ResultsOf 3,731 Medicare beneficiaries with incident metastatic BCa, 1,808 (48.5%) experienced at least one SCRT event during a median follow-up of 13.2 months; a majority (69%) experienced a subsequent SCRT event. The proportions of women who had RAD, PF, BS, and SCC were: 32%, 28%, 8%, and 4%. Older women (80+ years), or those with more comorbid conditions (CCI≥2) had a statistically significant lower risk of SCRT (HR 0.78 [CI: 0.67–0.92, p<0.01]; HR 0.77 [CI: 0.67–0.89, p<0.01], respectively), primarily due to lower frequency of radiotherapy (p<0.01). Compared to Caucasians, African Americans had lower risk of SCRT (HR 0.70 [CI: 0.60–0.82, p<0.01]), as well as all SCRT subtypes defining this group except for SCC, which was the same for both race groups.ConclusionThis study highlights that certain patient characteristics and clinical factors are associated with the risk of spinal cord compression or pathologic fractures, or need for bone surgery or radiation among women with metastatic BCa. In future studies, it will also be important to consider the clinical and economic burden based on these components of skeletal complications and radiation therapy use in order to guide and improve the management of women with advanced BCa.

Difference in canal encroachment by the fusion mass between anterior cervical discectomy and fusion with bone autograft and anterior plating, and stand-alone cage

We conducted a prospective randomized study comparing stand-alone cage and bone autograft and plate implants in anterior cervical discectomy and fusion (www.clinicaltrials.gov, NCT01011569). Our interim analysis showed autologous bone graft with plating was superior to a stand-alone cage for segmental lordosis. During this analysis, we noted a difference in canal encroachment by the fusion mass between the two fusion groups. A narrow cervical spinal canal is an important factor in the development of cervical spondylotic myelopathy, therefore this unexpected potential risk of spinal cord compression necessitated another interim analysis to investigate whether there was a difference in canal encroachment by the fusion mass between the two groups. Patients had a minimum 1year of follow-up. The Neck Disability Index, neck and arm pain Visual Analog Scales and lateral radiographs, including bone fusion patterns, were evaluated. Twenty-seven (16 males, 11 females, mean age 54.8years) and 31 (24 males, seven females, mean age 54.5years) patients were in the cage and plate group, respectively. Both groups improved after surgery. Fusion began at 2.6months and 1.3months and finished at 6.7months and 4.0months in 24 (88.9%) and 28 (90.3%) patients in the cage and plate group, respectively. Encroachment into the spinal canal by the fusion mass was significantly different between the fusion types, occuring in 21 (77.8%) patients in the cage group versus six (19.4%) in the plate group (p=0.003). There was a high incidence of spinal canal encroachment by the fusion mass in the stand-alone cage group, possibly limiting use in narrow spinal canals.

Fear of impending fractures: when to refer? A case-based review

Impending fractures and spinal cord compression are frequent complications of bone metastasis with debilitating consequences. The issue of impending fracture of the femurs and risk of spinal cord compression was raised in an 83-year-old woman with multiple myeloma. Some type of prophylactic treatment would appear suitable, usually surgical, for this condition. While criteria for prophylactic treatment exist in the orthopedic literature, most patients present to rheumatologists, oncologists, or internists. This article reviews the various scoring systems available to evaluate the risk of these very serious complications. We also discuss the current limitations of such tools and the need for a research agenda to address this common problem.

Perioperative medullary complications in spinal and extra-spinal surgery in mucopolysaccharidosis: a case series of three patients.

The mucopolysaccharidoses (MPS) are genetic lysosomal storage diseases. Peripheral bone dysplasia and spinal involvement are the predominant orthopedic damage. The risk of spinal cord compression due to stenosis of the craniocervical junction is well known in these patients, whereas the thoracolumbar kyphosis is often well tolerated over a long period of time. Thus, signs of spinal cord compression at this level occur later and more insidiously. The authors describe three cases of patients with thoracolumbar kyphosis who suffered from postoperative spinal cord compression in the absence of direct surgical trauma. Analysis of these cases and review of the literature helped identify causal factors resulting in spinal cord ischemia. The risk of perioperative spinal cord complications related to a thoracolumbar kyphosis must be discussed with patients with MPS and their families prior to any surgery, including extra-spinal procedures.

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

Multicenter US Clinical Evaluation of Minimally Invasive Targeted RF Ablation of Metastatic Spinal Tumors Using a Novel Bipolar Navigational Device

Approximately 85% of patients with advance cancer will develop bony metastasis as their disease progress. Nearly three-fourth of these will involve the axial skeleton, thus increasing the risk of bone pain, pathologic vertebral fractures, and compression of neural elements. Increased morbidity and mortality have been associated with patients who are bed-ridden due to pain or neurologic deficit. Therapeutic goals are pain control, spinal stabilization, reducing risk of spinal cord compression, and tumor control.

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...

International Patterns of Practice in Palliative Radiotherapy for Painful Bone Metastases: Evidence-Based Practice?

Multiple randomized controlled trials have demonstrated the equivalence of multifraction and single-fraction (SF) radiotherapy for the palliation of painful bone metastases (BM). However, according to previous surveys, SF schedules remain underused. The objectives of this study were to determine the current patterns of practice internationally and to investigate the factors influencing this practice. The members of three global radiation oncology professional organizations (American Society for Radiology Oncology [ASTRO], Canadian Association of Radiation Oncology [CARO], Royal Australian and New Zealand College of Radiologists) completed an Internet-based survey. The respondents described what radiotherapy dose fractionation they would recommend for 5 hypothetical cases describing patients with single or multiple painful BMs from breast, lung, or prostate cancer. Radiation oncologists rated the importance of patient, tumor, institution, and treatment factors, and descriptive statistics were compiled. The chi-square test was used for categorical variables and the Student t test for continuous variables. Logistic regression analysis identified predictors of the use of SF radiotherapy. A total of 962 respondents, three-quarters ASTRO members, described 101 different dose schedules in common use (range, 3 Gy/1 fraction to 60 Gy/20 fractions). The median dose overall was 30 Gy/10 fractions. SF schedules were used the least often by ASTRO members practicing in the United States and most often by CARO members. Case, membership affiliation, country of training, location of practice, and practice type were independently predictive of the use of SF. The principal factors considered when prescribing were prognosis, risk of spinal cord compression, and performance status. Despite abundant evidence, most radiation oncologists continue to prescribe multifraction schedules for patients who fit the eligibility criteria of previous randomized controlled trials. Our results have confirmed a delay in the incorporation of evidence into practice for palliative radiotherapy for painful bone metastases.

Localisation dorsale d’une histiocytose langerhansienne responsable d’une compression médullaire

Introduction Langerhans cell histiocytosis of the thoracic spine is a rare condition in adults. It is a serious condition with an increased risk of spinal cord compression. Exegesis A 55-year-old man complained of lumbar and back pain. He developed a spastic paraparesis. Magnetic resonance imaging of the spine showed a spinal cord compression due to bone and epidural tumoral lesions of the eleventh and twelfth thoracic vertebras, located in the posterior elements of the spine. A surgical biopsy showed an infiltrate of eosinophilic cells, positive for CD1a in immunohistochemistry studies. Final diagnosis was therefore langerhans cell histiocytosis of the thoracic spine complicated by spinal cord compression. The patient received glucocorticoid therapy combined with vinblastine followed by local radiotherapy and etoposide. However, the neurological deficit persisted and the patient finally died. Conclusion Langerhans cell histiocytosis is a rare cause of spinal cord compression.

Hydatidose vertébro-médullaire cervicale étendue au rétropharynx : à propos d’une observation

Hydatid disease involves the bones in 0.5 to 2 % of cases, with 44 % of these cases at the level of the spine. The cervical spine is a rare location, with a risk of spinal cord compression and recurrences. The authors report a case of a young male admitted for progressive quadriplegia secondary to cervical spine hydatidosis, extending towards the retropharynx that was evaluated by CT and MRI.

Osteological features in pure‐bred dogs predisposing to cervical spinal cord compression

Relative to body size, midsagittal and interpedicular diameters of the cranial and caudal aspects of cervical vertebral foramina (C3-C7) were found to be significantly (P < 0.05) larger in small breeds than in large breeds and Dachshunds, and also larger in Dachshunds (P < 0.05) than in large breeds. This condition increases the risk for spinal cord compression resulting from relative stenosis of the cervical vertebral foramina, especially in large dogs, and this is also exacerbated by the typical shape of the vertebral foramina (i.e. dorsoventrally flattened cranially and bilaterally narrowed caudally). Within large dogs those breeds highly predisposed to cervical spinal cord compression were Great Danes (the breed with the smallest midsagittal vertebral foramen diameters from cranial C6 to cranial T1) and Doberman Pinschers, because of the most strikingly cranially dorsoventrally narrowed cone-shaped vertebral foramina at C6 and C7. The existence of a small midsagittal diameter in the cranial cervical spine was a high risk factor predisposing to spinal cord compression in small breeds and Dachshunds. Remarkable consistency was noted between the spinal level of the maximum enlargement of the spinal cord which previously was reported to be at C6, and the site of maximum enlargement of the vertebral canal currently stated in Dachshunds and small breeds. In large breeds the maximum enlargement of the vertebral canal tended to be located more caudally at the caudal limit of C7. The average age at which large dogs were most susceptible to noxious factors causing abnormal growth of the pedicles was determined to be 16 wk.

Current management of cervical spine instability.

Instability of the cervical spine is a frequently occurring problem in a number of rheumatologic conditions. The importance of recognizing cervical instability lies in its close association with severe, sometimes irreversible, neurologic compromise that can lead to paralysis or even death. Operative stabilization of cervical instability prior to the onset of irreversible neurologic changes has been advocated. The problem, however, has been that no reliable method has accurately predicted which patients with cervical instability are at risk for spinal cord compression. It has been determined in recent studies that specific measurements of radiographic instability are strongly associated with worsening neurologic compromise. These measurements assess the space available for the spinal cord, and recommendations can be made for surgical stabilization in patients with cervical instability, prior to the onset of neurologic changes.