Symptoms Of Spinal Cord Compression Research Articles

Malignant melanotic schwannoma of the cervical spinal cord: a case report

Spinal cord malignant melanotic schwannoma (MMNST) is a rare central nervous system tumor that originates from the spinal cord or spinal myelin sheath cells and can produce melanin. This type of tumor is usually highly aggressive and malignant, with a poor prognosis. The clinical manifestations of spinal cord MMNST are mainly pain, paresthesia, muscle weakness, muscle atrophy, etc., and symptoms of spinal cord compression, such as intestinal and bladder dysfunction, paraplegia, etc. Early detection of tumor lesions can facilitate tumor removal, improve patients’ quality of life, and prolong patients’ survival. In this case report, a 27-year-old young woman was diagnosed with MMNST of the cervical spinal cord due to weakness of her limbs in our hospital, and underwent surgical resection. The patient’s limbs returned to normal after surgery. It is worth mentioning that the patient visited our hospital 7 months ago for “right upper limb pain for 3 days” and was diagnosed with a cervical spine space-occupying lesion at the same position this time, but the pathology report was “hemosiderosis”. This case report aims to raise awareness of the problem of spinal cord MMNST and contribute to greater knowledge of this rare tumor.

Does Elective Admission vs. Emergency Department Presentation Affect Surgical Outcomes in Metastatic Spine Surgery?

Approximately 20% of patients with metastatic spine disease develop symptomatic spinal cord compression, and these patients can present urgently to the emergency department (ED) or, in a more organized fashion, to a clinic. In a cohort of patients undergoing metastatic spine surgery, we sought to (1) determine the rate of ED presentation, (2) identify preoperative and perioperative risk factors associated with ED presentation, and (3) evaluate whether ED vs. clinic presentation impacts long-term outcomes. A single-institution, multi-surgeon, retrospective cohort study was undertaken of patients undergoing metastatic spinal tumor surgery between 02/2010 and 01/2021. The primary exposure variable was presentation setting, dichotomized to the ED vs. clinic. The primary outcomes were postoperative functional status, measured with the Karnofsky Performance Scale (KPS) and McCormick Scale (MMS), local recurrence (LR), and overall survival (OS). Secondary outcomes included complications and readmissions. A total of 311 patients underwent metastatic spine surgery (51.7% ED vs. 48.3% clinic). Those presenting to the ED had higher rates of smoking (21.7% vs. 16.0%, p = 0.02), were more likely to have 2+ comorbidities (47.2% vs. 32.7%, p = 0.011), and were more likely to have public insurance (43.5% vs. 32.0%, p = 0.043). Preoperative KPS was lower in ED patients (p < 0.001), while the Bilsky score was higher (p = 0.049). ED patients had higher rates of oligometastatic disease (p = 0.049), higher total decompressed levels (p = 0.041), and higher rates of costotransversectomy (p = 0.031) compared to clinic patients. Length of stay was significantly longer for ED patients (7.7 ± 6.1 vs. 6.1 ± 5.8 days, p = 0.020), and they were less likely to be discharged home (52.2% vs. 69.3%, p = 0.025). ED presentation was significantly associated with shorter overall survival (HR =1.53 95% CI = 1.13-2.08, p = 0.006). Of patients undergoing metastatic spine disease, approximately half presented through the ED vs. clinic. ED patients had higher rates of smoking, public insurance, and higher Bilsky score. ED patients also underwent more extensive surgery, had longer LOS, were less likely discharged home, and most importantly, had a shorter overall survival. These results suggest that initial presentation for patients undergoing surgery for metastatic spine disease significantly impacts outcomes, and signs/symptoms of metastatic spine disease should be recognized as soon as possible to prevent ED presentation.

Systematic Review and Meta-Analysis on Optimal Timing of Surgery for Acute Symptomatic Metastatic Spinal Cord Compression.

Introduction: Symptomatic acute metastatic spinal epidural cord compression (MSCC) is an emergency that requires multimodal attention. However, there is no clear consensus on the appropriate timing for surgery. Therefore, to address this issue, we conducted a systematic review and meta-analysis of the literature to evaluate the outcomes of different surgery timings. Methods: We searched multiple databases for studies involving adult patients suffering from symptomatic MSCC who underwent decompression with or without fixation. We analyzed the data by stratifying them based on timing as emergent (≤24 h vs. >24 h) and urgent (≤48 h vs. >48 h). The analysis also considered adverse postoperative medical and surgical events. The rates of improved outcomes and adverse events were pooled through a random-effects meta-analysis. Results: We analyzed seven studies involving 538 patients and discovered that 83.0% (95% CI 59.0-98.2%) of those who underwent urgent decompression showed an improvement of ≥1 point in strength scores. Adverse events were reported in 21% (95% CI 1.8-51.4%) of cases. Patients who underwent emergent surgery had a 41.3% (95% CI 20.4-63.3%) improvement rate but a complication rate of 25.5% (95% CI 15.9-36.3%). Patients who underwent surgery after 48 h showed 36.8% (95% CI 12.2-65.4%) and 28.6% (95% CI 19.5-38.8%) complication rates, respectively. Conclusion: Our study highlights that a 48 h window may be the safest and most beneficial for patients presenting with acute MSCC and a life expectancy of over three months.

Cervical Kyphosis

Abstract Kyphosis of the cervical spine can have many causes. The most common causes include degeneration of the cervical spine, infection, trauma, inflammatory diseases, tumors, and iatrogenic causes. Cervical kyphosis can be associated with myelopathy and radiculopathy, so it is important to look for signs and symptoms of spinal cord and nerve root compression as well. As the kyphosis worsens, patients can experience problems with horizontal gaze, swallowing, and even breathing. The first line of treatment for cervical kyphosis is rest and lifestyle modifications. Cervical kyphosis can cause muscular strain best treated with rest and avoidance of re-injuring the muscles and tendons. Nonsurgical treatments for cervical kyphosis also includes physical therapy and pain management procedures, and is attempted if there are no findings of sensory loss, motor weakness, bowel or bladder dysfunction, or spinal cord impingement signs. Many factors play a role in the decision-making process for surgical intervention, which include level of pain, degree of physical impairment, and the amount of cervical kyphosis present. The optimal surgical approach is not always clear but can include an anterior, posterior, or combined anterior and posterior approach.

Radiographic and clinical features of thoracic intradural extramedullary epidermoid tumor: Illustrative case

Spinal epidermoid tumors are uncommon benign neoplastic lesions arising from heterotopic epidermal rest-cells. These lesions rarely occur in the thoracic region (&lt;0.8%) and can present with symptoms of spinal cord and nerve root compression.

The clinical efficacy of posterior cervical open-door expansive laminoplasty combined with Key-hole technique for the treatment of mixed cervical spondylosis

Objective: To investigate the clinical efficacy of posterior cervical open-door expansive laminoplasty combined with Key-hole technique in treating mixed cervical spondylosis. Methods: A retrospective cohort study. A retrospective analysis was made of 128 cases of mixed cervical spondylosis with symptoms of spinal cord and nerve root compression and complete follow-up data admitted to the Department of Spinal Surgery, Affiliated Hospital of Jining Medical University from January 2016 to June 2022. Of the patients, there were 90 males and 38 females with a mean age of (58.5±9.8) years. Before February 2018, 72 cases were treated with posterior cervical open-door expansive laminoplasty (single-door group), and after February 2018, 56 cases were treated with posterior cervical open-door expansive laminoplasty combined with Key-hole technique (combined group). There was no significant difference between the two groups in age, Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) score of pain and Cobb angle of imaging before operation. The operation time, intraoperative blood loss, postoperative JOA score, VAS score and Cobb angle of imaging were compared between the two groups. Results: Both groups of patients successfully completed the operation. Operation time [M(Q1, Q3)]: 89.0 (68.5, 104.5) min in the single-door group and 90.0 (72.8, 108.8) min in the combined group, there was no statistical difference between the two groups (P=0.640). The intraoperative blood loss in the single-door group was 100 (100, 200) ml, and it was 100(100, 200) ml in the combined group, there was no significant difference between the two groups (P=0.680). Postoperative JOA scores increased significantly, while VAS scores decreased significantly in both groups. At the last follow-up, the JOA and VAS scores of the combined group were better than those of the single-door group (both P<0.05). Conclusion: The posterior cervical open-door expansive laminoplasty combined with Key-hole technique for the treatment of mixed cervical spondylosis can effectively remove the compression on the cervical spine without causing cervical instability.

A case study and review of the literature regardingextradural spinalarachnoid cyst

Arachnoid cysts are spaces containing cerebrospinal fluid partitioned into an arachnoid-formed sheath and are a rare cause of symptomatic spinal cord compression. This case study examined a patient with spastic paraparesis who underwent surgery to remove the cystic lesion and push back the marrow. Post-op control spinal MRI showed total excision of the cyst, and the patient has progressed well and has fully recovered from his deficit. Nabors divides extradural arachnoid cysts into three types: type 1, type 2, and type 3. Type 1 is essentially thoracic, extending over several vertebrae with a peak of greater frequency around the eighth dorsal vertebra. Symptoms are generally slowly progressive, but rapid revelation or decompensation are possible. Treatment options include marsupialization, wide resection, and total excision. For symptomatic cases, total excision is the reference treatment. For painful cases, complete excision, tied off the intradural communication pedicle, and reshaping the dura is the primary surgical goal.

Dorsal intraspinal B-cell Non-Hodgkin lymphoma in two patients

Non-Hodgkin Lymphoma is rarely diagnosed as spinal cord compression syndrome. Caused by an epidural mass, this complication is often encountered in the late stage of the disease. We report two cases presenting symptoms of low thoracic spinal cord compression due to an epidural tumor on the MRI. Possible complications that may occur and how to prevent adverse events during surgery are essential. This case is of special interest for being a low-incidence pathology in a rare location. The case is of high interest because of the importance of resecting the lesion to prevent sequels and the complexity of its management and highlights the importance of considering the diagnosis of this event.

Three-dimensional simulation/printing-assisted surgery for symptomatic metastatic epidural spinal cord compression of posterior column: efficacy assessment based on 2-year follow-up.

Surgical intervention is necessary for resolving the symptoms of the spinal cord and nerve compression caused by symptomatic metastatic epidural spinal cord compression. However, surgeons are constantly seeking ways to improve surgical efficiency and safety. This study aims to evaluate the efficacy of 3D simulation/printing-assisted surgery for symptomatic metastatic epidural spinal cord compression of the posterior column. We retrospectively analyzed the clinical data of patients who underwent surgical treatment for symptomatic metastatic epidural spinal cord compression of the posterior column in our hospital from January 2015 to January 2020. The simulated group underwent a 3D digital simulation of the lesion area using imaging data before surgery. Twelve patients in the simulated group also received 3D printing, while the direct surgery group did not receive any 3D simulation or printing. All patients were followed up for at least 2 years. We collected clinical data, including operation time, intraoperative blood loss, pedicle screw adjustment rate, intraoperative fluoroscopy times, the incidence of dural injury and cerebrospinal fluid leakage, VAS score, postoperative neurological function improvement, and tumor recurrence. Statistical analysis was performed using SPSS23.0, and P < 0.05 was considered statistically significant. A total of 46 patients were included in this study, with 20 in the simulated group and 26 in the non-simulated group. The simulated group had better operation time, intraoperative blood loss, screw adjustment rate, fluoroscopy times, and incidence of dural injury/cerebrospinal fluid leakage compared to the non-simulated group. The VAS scores of the two groups improved significantly after the operation and at the last follow-up compared to before the operation. However, there was no statistically significant difference between the two groups. There was also no statistically significant difference in neurological function improvement between the two groups. In the simulated group, 25% of patients relapsed, while in the non-simulated group, 34.61% of patients relapsed. However, there was no statistical difference between the two groups. Preoperative 3D simulation/printing-assisted surgery is a practical and feasible approach for treating symptomatic metastatic epidural spinal cord compression of the posterior column.

Delayed inhibition of collagen deposition by targeting bone morphogenetic protein 1 promotes recovery after spinal cord injury.

Fibrotic scars appear after spinal cord injury (SCI) and are mainly composed of fibroblasts and excess extracellular matrix (ECM), including different types of collagen. The temporal and spatial distribution and role of excess collagens and ECM after SCI are not yet fully understood. Here, we identified that the procollagen type I C-terminal propeptide (PICP), a marker of collagen type I deposition, and bone morphogenetic protein 1 (BMP1), a secreted procollagen c-proteinase (PCP) for type I collagen maturation, were significantly elevatedin cerebrospinal fluid of patients with SCI compared with healthy controls, and were associated with spinal cord compression and neurological symptoms. We revealed the deposition of type I collagen in the area damaged by SCI in mice and confirmed that BMP1 was the only expressed PCP and induced collagen deposition. Furthermore, transforming growth factor-β (TGF-β), tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) can activate the expression of BMP1. However, inhibition of BMP1 at the acute phase eliminated fibrotic scars in the damaged area and inhibited activation and enrichment of astrocytes, which made the damage difficult to repair and increased hematoma. Unexpectedly, knockdown of Bmp1 by adeno-associated virus or the inhibition of BMP1 biological function by specific inhibitors and monoclonal antibodies at different time points after injury led to distinct therapeutic effects. Only delayed inhibition of BMP1 improved axonal regeneration and myelin repair at the subacute stage post-injury, and led to the recovery of motor function, suggesting that scarring had a dual effect. Early inhibition of the scarring was not conducive to limiting inflammation, while excessive scar formation inhibited the growth of axons. After SCI, the collagen deposition indicators increased in both human cerebrospinal fluid and mouse spinal cord. Therefore, suppression of BMP1 during the subacute phase improves nerve function after SCI and is a potential target for scar reduction.

Implant Materials for Anterior Column Reconstruction of Cervical Spine Tumor.

The spine is the most common site of bone metastases. Many cancer patients will ultimately develop spinal metastatic disease with symptomatic epidural spinal cord compression. At present, the main treatment for cervical spine tumors is surgical resection combined with postoperative radiotherapy. Implant materials for cervical spine anterior column reconstruction need to meet amounts of different properties, such as biocompatibility, bioactivity and the ability to maintain long-term mechanical strength. The selection of different materials determines the surgical efficacy and prognosis of patients to a certain extent. This article provides an overview of a variety of implant materials used for anterior column reconstruction after cervical spine tumor resection, introduces and analyzes their properties, advantages, disadvantages, derivatives, and applications in clinical practice, and looks forward to the future development of implant materials.

Planning for the Effect of the SC.24 Trial on Spine Stereotactic Body Radiation Therapy Utilization at a Tertiary Cancer Center

The goal of this study was to assess the potential real-world effect of the recently reported SC.24 trial on spine stereotactic body radiation therapy (SBRT) utilization. We estimated the proportion of patients treated with conventional radiation therapy (CRT) who would have been eligible for spine SBRT per trial inclusion criteria and analyzed the potential estimated increased costs to our institution. This was a retrospective review of patients who received spine CRT at our institution between August and October 2020. Data abstracted included demographics, SC.24 eligibility criteria, provider-reported pain response, and survival. A cost analysis and time survey was performed using institutional and provincial data. Of 73 patients reviewed, 24 patients (33%) were eligible. The most common exclusion factors included irradiation of ≥3 consecutive spinal segments (n=32, 44%), Eastern Cooperative Oncology Group performance status >2 (n=17, 23%), and symptomatic spinal cord compression (n=13, 18%). Of eligible patients, the mean age was 68.92 years, median spinal instability in neoplasia score was 8 (interquartile range, 7-9), and median Eastern Cooperative Oncology Group performance status was 2 (interquartile range, 1-2). The most common primary cancer types among eligible patients were lung (n=10) and breast (n=4). The median survival of eligible patients was 10 months (95% confidence interval, 4 months to not reached) with 58% surviving longer than 3 months. Of patients who had subjective pain documented after CRT, 54% had at least some response. The cost of spine SBRT was estimated at CA$4764.80 compared with $3589.10 for CRT, and tasks for spine SBRT took roughly 3 times as long as those for CRT. One-third of patients who received palliative spine CRT met eligibility criteria for SC.24. This possible expanded indication for spine SBRT can have a substantial effect on resource utilization. These data may be useful in guiding resource planning at institutions looking to commence a spine SBRT program.

Targeting patient recovery priorities in degenerative cervical myelopathy: design and rationale for the RECEDE-Myelopathy trial—study protocol

IntroductionDegenerative cervical myelopathy (DCM) is a common and disabling condition of symptomatic cervical spinal cord compression secondary to degenerative changes in spinal structures leading to a mechanical stress injury of...

Diagnosing and Prognosing Bone Metastasis in Prostate Cancer: Clinical Utility of Blood Biomarkers.

Bone metastasis (BM) may occur in any type of cancer. The diagnosis of patients with BM has increased due to improved imaging technologies and advances in cancer drug therapy that have prolonged the survival time of cancer patients. BM may be asymptomatic in the early stages; however, as the disease progresses, it causes pain, fracture, neurological symptoms associated with spinal cord compression, hypercalcemia, and other specific symptoms that significantly impair the patient's quality of life (QOL). Imaging modalities have disadvantages, such as high cost, radiation exposure, and bone pain associated with holding posture for imaging test; further, they are time-consuming. Hence, patients with BM require convenient and useful biomarkers. However, no blood biomarkers generally useful for diagnosis and therapeutic monitoring of BM are established. Prostate cancer (PC) and breast cancer, in particular, are among the most prone to BM because BM occurs in approximately 70% of patients with advanced disease. Herein, we reviewed various potential bone turnover markers and liquid biopsy for diagnosis and prognosis prediction in patients with BM of PC based on PubMed literature search. The usefulness of conventional bone turnover markers of BM in PC is limited, and cut-off values vary. In the future, the creation of algorithms using these conventional markers and multiple tests, such as liquid biopsy and imaging tests, will help to develop highly accurate techniques for the diagnosis of BM.

Symptomatic spinal cord compression in spinal epidural metastasis of a testicular germ cell tumor: a case report with review of the literature

Metastatic germ cell tumors particularly in the bone are rare entities. They occur in young men and classified in the group of poor prognosis. Bone metastases are responsible for a significant functional handicap and a deep alteration in the quality of life of young patients. Metastatic germ cell tumors are rare entities with a high cure rate due to their extreme chemosensitivity. To our knowledge, epidural metastasis of this tumor has not yet been reported in the English medical literature. Tumors of the breast, lung and prostate are the most notorious for metastasizing in the epidural-spinal space. We report a clinical case of spinal cord compression secondary to metastasis in the spinal epidural space of a testicular germ cell tumor in a 23-year-old. Patient whose evolution was marked by a decrease in tumor markers and a clear clinical improvement with disappearance of lower back pain and horsetail syndrome after starting the treatment with decompressive radiotherapy and chemotherapy based on bleomycin cisplatin and etoposide. Through this, we want to emphasize that an epidural metastasis of this tumor is possible, and that it must be part of the diagnoses to be evoked in the face of metastatic spinal cord compression, which potentially allows to avoid a significant functional handicap and a profound alteration in the quality life of young patients.

Efficacy and Safety of Cervical and High-Thoracic Dorsal Root Ganglion Stimulation Therapy for Complex Regional Pain Syndrome of the Upper Extremities

ObjectivesThe purpose of this study was to evaluate analgesic and safety considerations for high thoracic and cervical dorsal root ganglion (DRG) neuromodulation for complex regional pain syndrome (CRPS). We hypothesized that DRG neuromodulation would provide sustained analgesia with complications like that of low thoracic or lumbar electrode implantation. Materials and MethodsA single-center, retrospective study was conducted of patients with CRPS I or II of the upper extremities, refractory to previous therapies, who were treated with DRG neuromodulation in the upper thoracic and cervical spine. The primary outcome was successful DRG therapy, defined as ≥ 50% pain relief on a Numeric Rating Scale (NRS) 0 to 10 pain scale at six months after implantation. A secondary outcome was a reduction in daily opioid use after DRG therapy. ResultsAfter a DRG stimulation trial, 17 of 20 patients (85%) had ≥ 50% improvement in NRS pain and underwent a permanent pulse generator implant, with 100% endorsing ≥ 50% pain relief at six months. Mean NRS pain scores before DRG neuromodulation were 9.3 ± 1.1, with a mean reduction of 5.5 (95% CI, 4.5–6.6; p < 0.001) at six months. Ten patients were taking opioids at baseline; the median (interquartile range) dose was 45 mg (23 to 120) morphine equivalents (MME), which was reduced to 20 MME (15 to 40) at six months. The median reduction in daily MME use was −25 (95% CI, −100 to 20; p = 0.099). Six of 20 patients (30%) experienced a complication: three had lead migration; two experienced paresthesias; and one had a reduction in shoulder mobility. One patient had symptoms of a reversible spinal cord compression immediately after implant, requiring emergent electrode removal. ConclusionsDRG neuromodulation for patients with CRPS of the upper extremities produced clinically important analgesia and reduced opioid use for ≥ six months but was associated with one serious complication.

Planning for the Impact of SC.24 on Spine Stereotactic Body Radiotherapy (SBRT) Utilization at a Tertiary Cancer Center

<h3>Purpose/Objective(s)</h3> CCTG SC.24 was a recently reported randomized phase 2/3 trial that demonstrated superior complete response rates for pain following spine stereotactic body radiotherapy (SBRT; 24 Gy in 2 daily fractions) compared to conventional radiotherapy (CRT; 20 Gy in 5 fractions). These findings support a practice-changing paradigm shift whereby a subset of eligible patients with painful spine metastases may be offered upfront spine SBRT over CRT. At many institutions, this would mark an increase in spine SBRT cases. Therefore, we sought to assess the potential real-world impact of this study on spine SBRT utilization by estimating the proportion of patients treated with CRT who would have been eligible for spine SBRT per SC.24 inclusion criteria. <h3>Materials/Methods</h3> All patients who received palliative spine radiation at our institution between August to October 2020 were reviewed retrospectively. Data extracted included eligibility criteria of the SC.24 study, provider-reported pain response, and overall survival. Descriptive statistics and survival analyses were performed. <h3>Results</h3> Of the 73 patients reviewed, 24 (33%) patients met eligibility criteria for SC.24. The most common exclusion factors included irradiation of more than 3 consecutive spinal segments (n=32, 44%), ECOG greater than 2 (n=17, 23%), symptomatic spinal cord compression (n=13, 18%), and frank mechanical instability (n=12, 16%) as measured using the Spinal Instability in Neoplasia Score (SINS). SINS was indeterminable in 7 cases (10%) of epidural-only disease, which also renders a patient ineligible; otherwise, the median SINS was 9 (IQR: 7–10). Four (5%) patients had prior surgery and 8 (11%) patients had prior overlapping radiation to the area, also rendering them ineligible. Of eligible patients, the mean age was 68.92 years (SD 13.84), median SINS was 8 (IQR: 7–9) and median ECOG was 2 (IQR: 1–2). The most common primary cancer types among eligible patients were lung (n=10) and breast (n=4). The median dose delivered to eligible patients was 20 Gy in 5 fractions (IQR: 8–20 Gy). Fifteen (63%) eligible patients had additional radiation to a site other than the spine at the same time. The median survival of eligible patients was 10 months (95% CI: 4 months–not reached) with 58% surviving longer than 3 months. 75% of patients had pain response documented and of these, 54% had at least some response after CRT. <h3>Conclusion</h3> Around 1/3 of patients who received palliative CRT to the spine met eligibility criteria for SC.24. This possible expanded indication for spine SBRT can have a substantial impact on resource utilization. In addition to increased MR simulation utilization, there can also be higher demand on contouring, planning and quality assurance resources. These data may be useful in guiding resource and workforce planning at institutions looking to commence or expand a spine SBRT program.

Characterization of Clinical Symptoms of Cervical Spondylotic Myelopathy Based on DKI Imaging Parameter Ratios.

In recent years, people's living conditions have significantly improved, and their lifestyles have been diversified. However, the incidence of various diseases has also increased with it, including cervical spondylotic myelopathy (CSM). Spinal cord cervical spondylosis is one of the spinal cord compression disorders that can be severely disabling and accounts for 10% to 15% of all cervical spondylosis. In this paper, DKI image processing technology is used to study the symptoms of cervical spondylosis, which is helpful to help them explore the symptoms and causes. The onset of cervical spondylosis has a longer period of time, and the period of conservative treatment will inevitably require a longer period of time. The clinical symptoms of cervical spinal cord compression are mainly pain, and after the cervical spinal cord nerve is compressed, ischemia and hypoxia will occur, the nerve sensitivity will increase, and the patient will have reflex neck muscle pain symptoms. This causes degeneration of the patient's intervertebral disc tissue, degeneration of facet joints, ossification of the posterior longitudinal ligament, and formation of spurs on the posterior edge of the vertebral body. The condition will become more complicated, so it is very important to identify the characteristics of the clinical symptoms of cervical spondylotic myelopathy to help patients with cervical spondylosis recover. This paper identifies the clinical symptoms of cervical spondylosis based on the parameter ratio method of Diffusional Kurtosis Imaging (DKI). The current state of diffusion kurtosis imaging and the treatment of cervical spondylosis and the treatment operation are introduced, and the image enhancement technology in medical imaging is used to analyze the disc herniation of each segment in the overflexion, neutral and hyperextension positions. After comparing the FA, MK, and MD values in the spinal cord between the normal group and the patient group, the results showed that the FA, MD and MK values in the patient group were lower than those in the normal group, and the findings showed that the MD and MK values were positively correlated with the JOA score, reflecting that as the clinical symptoms of spinal cervical spondylosis worsened. The size and number of cervical intervertebral disc bulge on the hyperextension image is obvious and the number increases (especially the C4/5, C5/6, and C6/7 intervertebral discs with greater mobility), and the highest is 0.82 and 27%, respectively.

Métastases osseuses rachidiennes : quand opérer ? Pourquoi ? Comment ?

Spinal metastases are not rare and require specialized management in order to avoid neurological complications that may lead to serious deterioration of patient’s general health status. Full spine imaging is ordered to analyze spinal compression zones and vertebral lytic lesions. In case of symptomatic spinal cord compression, a liberation procedure is performed in emergency, to avoid neurological sequelae. Instable lesions can be stabilized, by cementing, pedicle fixation or corpectomy, according to the magnitude of vertebral destruction and general health status of the patient. Surgical management is decided in collaboration with treating oncologist, radiologist and radiotherapist.1877-1203/© 2022 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Intradural extramedullary capillary hemangioma with intramedullary component: A case series.

Rationale:Capillary hemangioma in the spinal cord is an exceedingly rare entity that is liable to be misdiagnosed. To summarize the clinical presentation, radiological characteristics, and pathological features of capillary hemangioma in the spinal cord and to share our experience for the diagnosis and treatment of intradural extramedullary capillary hemangioma.Patient concerns:Three patients underwent surgical treatment at our hospital between January 2020 and August 2020. All patients were male[median age at presentation: 57 years (range: 56–60)]. Two patients were experiencing pain and numbness in the lower back, and 1 patient was experiencing numbness and weakness in the left lower limb. The duration of symptoms ranged from 1 to 5 months.Diagnosis:All patients were diagnosed with spinal cord capillary hemangioma after treatment. All lesions were in an intradural extramedullary location and involved spinal cord components. Two patients had lesions in thoracic segments (T8, Th9-10), and 1 patient had a lesion in lumbar segment (L1).Interventions:All patients underwent microscopic laminectomy and complete resection of the extramedullary and intramedullary components of the spinal cord capillary hemangiomas.Outcomes:Postoperatively, all patients experienced transient numbness and pain in the lower limbs, which gradually decreased over time. None of the patients experienced bleeding, severe numbness or pain, or recurrence of symptoms at 3-month follow-up.Conclusion:Intradural extramedullary capillary hemangioma has unique morphological characteristics. Gross-total resection of the extramedullary and intramedullary components of spinal cord capillary hemangioma is recommended for patients with symptoms of spinal cord compression. Careful preoperative imaging and intraoperative decision-making may help avoid residual lesions or reoperation.