Thoracic Cord Compression Research Articles

Thoracic Cord Compression by epidural Multiple Myeloma: A Rare Presentation of Multiple Myeloma

Multiple myeloma is a hematopoietic disorder and multicentric disease, with the most common localization being the spine. A 53-year-old male presented with progressive paraplegia, superficial and deep sensory disturbance below the level of T2. Spinal magnetic resonance image showed an epidural mass compressing the spinal cord at the level of T1 with intact bone structure. The patient underwent surgical posterior spinal decompression. Microscopic examination and immuno-histochemical studies confirmed the diagnosis of multiple myeloma of kappa subtype. The patient was subsequently started on steroids and chemotherapy for myeloma.Extra osseous epidural tumors causing compression myelopathy without evidence of destruction or collapse of vertebral bodies are relatively rare; to our knowledge very few cases exist in the literature.

Metastatic Carcinoma Related Long Segment Thoracic Spinal Epidural Hematoma

Case report. To report a long segment epidural hematoma with thoracic cord compression caused by a metastatic carcinoma. To our knowledge, there have been no previous reports of spontaneous spinal epidural hematoma caused by metastatic carcinoma. A 60-year-old woman with back pain and progressive leg weakness suddenly developed complete paraplegia and anesthesia below T8. A thoracic spine MRI showed an epidural hematoma and metastatic tumor. We describe the clinical course, radiographic imaging, operative findings, and treatment results. Despite immediate surgery, the patient failed to have any significant improvement in her neurologic symptoms. A previously unsuspected primary lung tumor was diagnosed. She died 6 months after spine surgery. Spinal epidural hematoma can occur in association with metastatic tumors in that area.

Intramedullary spinal epidermoid cyst of the upper thoracic region

We report a 40-year-old male who presented with a two year history of thoracic cord compression. MRI of the thoracic spine demonstrated a diffuse, non-gadolinium enhancing intramedullary spinal cord tumour, extending from the C7 to T2 vertebral body levels. The lesion was surgically resected and the pathology revealed an epidermoid cyst. Epidermoid cysts are rare slow-growing lesions apparently resulting from inclusion of ectodermal tissue during the closure of the neural tube. The average age of presentation is about 35 years and the history of the symptoms is usually long. The treatment is surgical, and complete removal is the goal, if possible.

Clinical and radiological features of thoracic cord compression caused by epidural extramedullary hematopoiesis in thalassaemia—A local report

We report a young adult patient with known history of thalassaemia on regular blood transfusion presented with one month history of bilateral lower limbs paraesthesia, weakness and other neurological deficit. MRI scans show thoracic cord compression contributed by extramedullary hematopoiesis. Its clinical and radiological features are discussed.

An unusual presentation of thoracic cord compression by a dorsal arachnoid cyst in a 14-month-old boy. A discussion of the case and review of the literature

Spinal arachnoid cysts are a rare cause of spinal cord compression in children and presenting symptoms may be subtle. We present a neurologically intact 14-month-old boy who presented with pain and postural irritability from a thoracic arachnoid cyst.

Thoracic myelopathy caused by calcified ligamentum flavum

Calcification of the ligamentum flavum is a rare manifestation of the calcium pyrophosphate dihydrate deposition disease (CPPD). In CPPD deposition disease, spinal involvement is rare. Until now, thoracic spine CPPD causing thoracic cord compression has been reported in only sporadic cases. We report a new case of thoracic calcification of the ligamentum flavum. In our case, similar to the other reported cases, an affected middle-aged woman despite the clinical and MRI signs of myelopathy had an unexpected important and rapid improvement of the neurological picture. This condition should be considered in differential diagnosis of thoracic cord compression to offer the patient an early and useful surgical treatment.

Patients with "Lumbar Stenosis" and Unrecognized Distal Thoracic Cord Compression

Patients with "Lumbar Stenosis" and Unrecognized Distal Thoracic Cord Compression

Sarcome à cellules claires des tendons et des aponévroses: À propos de trois cas

Clear-cell sarcoma (CCS) of tendons and aponeuroses is a rare malignant tumor representing about 1% of soft tissue tumors. Preferentially observed in young adults in the second or third decade, the tumor generally develops in the limbs. Only 2% of SCC of tendons and aponeuroses have been reported in children less than 10 years of age. This slowly progressive tumor usually forms a painless mass. The tumor increases in size followed by metastatic dissemination to lymph nodes and the lungs. The prognosis is related to tumor size. At the present time, the recognized limit is greater than 5 cm. Early diagnosis must be achieved to enable effective treatment by carcinological surgical resection. We report the three cases of CCS of tendons and aponeuroses observed at the Strasbourg University hospital over a 35-year period. Each case had a special clinical presentation. The first patient, treated in 1967, presented tumor bone lysis on the plain x-ray, an observation rarely reported in the literature. In the second patient, treated in 2002, the tumor was discovered after trauma. This patient developed skin ulceration associated with paraplegia secondary to metastatic thoracic cord compression. The third case occurred in a 12-year-old girl, treated in 2002.

Ossification of the Ligamentum Flavum as a Result of Fluorosis Causing Myelopathy: Report of Two Cases.

Abstract OBJECTIVE AND IMPORTANCE: Ossification of the ligamentum flavum (OLF) is increasingly being recognized as a cause of myeloradiculopathy. However, the cause of such OLF has been identified only occasionally. The purpose of this case report is to highlight one more cause of OLF causing myelopathy. CLINICAL PRESENTATION: Two middle-aged men residing in an area endemic for fluorosis presented with the insidious onset of myelopathy. Clinical examination revealed evidence of thoracic cord compression in both patients. Plain x-rays revealed markedly increased bone density characteristic of fluorosis. Magnetic resonance imaging revealed OLF in the lower thoracic region causing cord compression (at one level in the first patient and at three consecutive levels in the second patient). Plain x-rays of the forearm revealed ossification of the interosseous membrane, which is characteristic of fluorosis. INTERVENTION: Both patients underwent decompressive laminectomy with removal of the OLF. The laminae and ossified yellow ligaments formed one mass of bone, which was removed with rongeurs and drills. After surgery, the first patient demonstrated improvement in motor power, whereas the second patient did not demonstrate any change in neurological status. CONCLUSION: Fluorosis should be entertained in the differential diagnosis of OLF, especially in patients from endemic areas. The magnetic resonance imaging appearance of the spine in such cases is characteristic. In properly selected cases of fluorotic myelopathy, surgery is indicated. However, the prognosis is guarded, and long-term follow-up of these patients is necessary given the nature of the underlying disease.

'Look beneath the stockings' -- delayed diagnosis of ankle fractures in patients with thoracic cord compression

Two patients with thoracic cord compression and ankle fractures are presented. The diagnosis and treatment of the ankle fractures was delayed in these patients. The lack of pain sensation in the lower limbs and the use of TED stockings that covered the area of abnormality were the reasons for the delayed diagnosis.

Calcium Pyrophosphate Dihydrate Deposition Disease Causing Thoracic Cord Compression: Case Report

Calcium pyrophosphate dihydrate (CPPD) deposition disease is being increasingly recognized. Spinal involvement in CPPD deposition disease is rare. When involved, the cervical and lumbar regions are commonly affected. We report a rare case of CPPD deposition disease that caused thoracic cord compression. A 45-year-old woman presented with clinical features suggestive of thoracic cord compression. Radiographic findings were consistent with calcification of the ligamenta flava in the lower thoracic levels causing cord compression. Calcification of the ligamentum flavum is commonly attributed to CPPD deposition disease. Evaluation for conditions that might be associated with CPPD deposition disease proved to be negative. Laminectomy with removal of the calcified ligamenta flava was performed. Histopathological examination of the excised ligaments revealed evidence of CPPD crystals. Postoperatively, the patient's spasticity decreased and sensations improved, with no significant improvement in motor power. Calcification of the ligamenta flava due to CPPD deposition disease is a rare cause of thoracic cord compression. CPPD deposition disease should be entertained in the differential diagnosis of thoracic cord compression.

充実性腫りゅうを形成し両下肢麻ひを来した胸椎の多発性骨髄腫の一例

充実性腫りゅうを形成し両下肢麻ひを来した胸椎の多発性骨髄腫の一例

Granulomatous compressive thoracic myelopathy as the initial manifestation of Wegener's granulomatosis

Wegener's granulomatosis (WG) is a multisystem disorder characterized by glomerulonephritis and necrotizing granuloma formation and vasculitis in the upper airways and lungs.1,2 Neurologic complications occur in 22% to 54% of patients, including mononeuritis multiplex, symmetric distal sensorimotor neuropathy, cranial neuropathies, external ophthalmoplegia, cerebral infarction, or seizures.2-4 Spinal cord involvement is rare but at least five cases have been reported.5,6 Pathologic examination in one patient revealed dural vasculitis.6 We describe a patient with WG who presented with a gradually progressive spastic paraparesis secondary to thoracic cord compression by meningeal granuloma. Case report. A 58-year-old Brazilian woman presented with a 4-week history of gradually progressive gait difficulty, a sensation of tightness in the midthoracic region, and a 12-hour history of urinary retention and lower extremity paresthesia. She also complained of a dry cough, nasal stuffiness, and epistaxis, which occurred shortly after presentation. Neurologic examination revealed a spastic gait, with weakness (Medical Research Council [MRC] grade 4/5) in both lower extremities; bilateral lower extremity hypertonia; hyperreflexia and extensor plantar responses; reduced rectal tone; and a midthoracic sensory level to pinprick testing. General examination revealed a left knee effusion but no fever, rash, or oropharyngeal or pulmonary abnormalities. Gadolinium-enhanced thoracic MRI revealed a circumferential enhancing soft-tissue mass extending from T2 to T8, with compression of the thecal sac and cord (figure, A). Figure. (A) Sagittal T1-weighted MRI of thoracic cord with gadolinium shows cord compression with circumferential meningeal thickening and enhancement from T2 to T8 vertebral levels. (B) Transverse section of resected dura shows marked thickening by …

Spinal metastases from solid tumors. Analysis of factors affecting survival.

Factors affecting survival were determined for 109 patients with thoracic spine metastases and cord compression. Lung, prostate, and breast were the most common primary sites (78%). All patients had surgical decompression of the spinal cord, and 99% received radiotherapy. Survival was determined based on anatomic site of primary carcinoma, preoperative neurologic deficit, extent of disease, number of vertebral bodies involved, tumor location (site of cord compression), and age. The respective compounding weight of the negative prognostic factors also was analyzed in terms of survival. The overall median survival was 10 months. Patients preoperatively ambulatory survived statistically significantly longer than nonambulatory patients or those with sphincter incontinence (P = 3.469 x 10(-6)). Patients with renal cell carcinoma survived the longest, followed by those with breast, prostate, lung, and colon cancer. Patients with breast cancer survived statistically longer than those with lung cancer (P = 0.039). Patients with one vertebral body involved survived statistically significantly longer than patients with multiple vertebral level involvement (P = 0.027). Extent of disease, age, and tumor location did not significantly influence survival. In patients with vertebral column disease, the presence of two or more poor prognostic indicators (leg strength 0/5-3/5, lung or colon cancer, multiple vertebral body involvement), had a compounding adverse effect on survival. For patients with spinal metastases and cord compression, the factors found to affect survival include preoperative neurological status, anatomic site of primary carcinoma, and number of vertebral bodies involved. Patients with vertebral column disease and two or more of the poor prognostic indicators have a short life expectancy, and, therefore, radical surgery is not recommended because the benefits may not be substantial.

Bilateral synovial cysts of the thoracic spine: A case report

We report a case of bilateral synovial cysts of the thoracic spine. The patient presented with progressive, lower-extremity weakness and hypesthesia, culminating in complete paraplegia. This rare lesion should be considered when confronted with a patient with thoracic cord compression.

多発性骨軟骨腫に合併し，脊髄圧迫症状を呈した胸椎脊柱管内骨軟骨腫の１例

Osteochondromas rarely compress the spinal cord or cauda equina. A case of thoracic cord compression by an osteochondroma combined with multiple osteochondromas is reported. A 21-year-old man was admitted to our hospital with a 3-month history of spastic gait and sensory disturbance. The diagnosis of osteochondroma of the 1-3rd thoracic spine was made based on histological examination, roentgenogram, myelogram and CT scan.Right decompressive hemilaminectomy was performed at the 1-4th thoracic level. Postoperative CT scan and MR images showed no evidence of reccurence or malignancy.

Relationship between bladder trigone and bladder neck induced by traction of an indwelling balloon catheter with a spring balance and parameters of cystometrogram

Sensation of the bladder trigone and bladder neck induced by traction of an indwelling balloon catheter with a spring balance and cystometry was evaluated in 393 males and 106 females. Male patients with an average age of 56.9 +/- 15.9 (mean +/- standard deviation) years old (range 17 to 88 years) were divided into 7 groups as follows: 19 patients without any micturitional disturbance, uregency and chronic prostatitis (11 patients), benign prostate hypertrophy (BPH) (131 patients), cervical or thoracic cord compression disorders (67 patients), lumbar vertebral disorders (114 patients), other peripheral nerve disorders associated with diabetes mellitus, post operative status of rectum cancer and others (27 patients) and brain diseases (24 patients). Female patients with an average age of 55.2 +/- 15.5 years old (range 17 to 88 years) were divided into 6 groups as follows: 24 patients without any neurological problems, urgency (7 patients), cervical or thoracic cord compression disorders (11 patients), lumbar vertebral disorders (37 patients), other peripheral nerve disorders (18 patients) and brain diseases (9 patients). The observed sensation, first desire to void (FDV) and maximum cystometric capacity (MCC) were evaluated statistically in relation to clinical factors (e.g. disease group, generation and patterns of cystometrogram). The correlation between the sensation and FDV or MCC in these patients were assessed by linear regression analysis. Sensation of normal males was 334.2 +/- 159.7 g on the average and correlated well with FDV (r = 0.88, y = 375x - 189.4). Sensation of normal females was 373.3 +/- 199.5 g on the average. However, there was no correlation (r = 0.35) between sensation and FDV in females. In males, the means of sensation obtained in patients with other peripheral nerve disorders (557.3 +/- 314.5 g) was significantly larger than the means of normal subjects (p less than 0.001), and patients with uregency and chronic prostatitis (236.4 +/- 148.3 g, p less than 0.01), BPH (424.1 +/- 215.6 g, p less than 0.001), cervical or thoracic cord compression disorders (349.0 +/- 229.5 g p less than 0.001), lumbar vertebral disorders (349.7 +/- 201.7 g, p less than 0.001) or brain diseases (490.6 +/- 305.0 g, p less than 0.05). Furthermore, the differences in the means of sensation between BPH and lumbar vertebral disorders (p less than 0.05) or brain diseases (p less than 0.05) were statistically significant.(ABSTRACT TRUNCATED AT 400 WORDS)

Thoracic cord compression due to chondrosarcoma in two cousins with hereditary multiple exostoses. Report of two cases.

✓ Two teen-age male cousins with hereditary multiple exostoses developed cord compression secondary to chondrosarcoma. The clinical presentation, diagnostic work-up, surgical treatment, pathological findings, and postoperative course are described in each patient.

Spinal cord compression in Morquio-Brailsford's disease

Eight patients with Morquio-Brailsford's disease have been followed neurologically.All 8 had roentgenographic evidence of hypoplasia or complete absence of the odontoid and of thoracic gibbus formation. Four of the 8 patients had evidence of cervical cord compression secondary to atlantoaxial dislocation or subluxation. Two patients had thoracic cord compression at the level of the gibbus. Prevention of spinal cord compression may be possible by the application of a Milwaukee brace during early childhood. If serial neurological examination reveals spinal cord damage, surgical intervention is indicated.

Thoracic cord compression from multiple hereditary exostoses associated with cerebellar astrocytoma. Case report.

M ULTIPLE hereditary exostoses have been recognized for almost 150 years. In 1925 the hereditary nature of this disorder was shown conclusively by Stocks and Barrington? 3 They found a parent with typical lesions in 60% of 727 patients. In 1943 Jaffe simplified the nomenclature of the disease and alluded to its pathogenesis. Exact genetic classification is still unsettled, but more males than females are affected. Neurological complications and especially spinal cord compression, in relation to the exostoses, are rare. The patient we are reporting exhibits this benign spinal cord compression in apparently coincidental association with a benign cerebellar tumor.