Treatment Of Spinal Cord Compression Research Articles

Pre-emptive or reactive? PROMPT spinal screening in metastatic castration-resistant prostate cancer.

Approximately 1–15% of patients with metastatic castration-resistant prostate cancer eventually develop spinal cord compression (SCC) during their disease. 1 Tazi H Manunta A Rodriguez A Patard JJ Lobel B Guillé F Spinal cord compression in metastatic prostate cancer. Eur Urol. 2003; 44: 527-532 Summary Full Text Full Text PDF PubMed Scopus (39) Google Scholar , 2 Sutcliffe P Connock M Shyangdan D Court R Kandala NB Clarke A 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. Health Technol Assess. 2013; 17: 1-274 Crossref Scopus (85) Google Scholar Guidelines recommend urgent investigation in case of clinical suspicion to diagnose and treat SCC with surgical decompression or radiotherapy, or both. 3 Vellayappan BA Kumar N Chang EL Sahgal A Sloan AE Lo SS Novel multidisciplinary approaches in the management of metastatic epidural spinal cord compression. Future Oncol. 2018; 14: 1665-1668 Crossref PubMed Scopus (5) Google Scholar However, a third of patients with asymptomatic metastatic castration-resistant prostate cancer have radiological signs of SCC by MRI, 4 Venkitaraman R Sohaib SA Barbachano Y et al. Detection of occult spinal cord compression with magnetic resonance imaging of the spine. Clin Oncol (R Coll Radiol). 2007; 19: 528-531 Summary Full Text Full Text PDF PubMed Scopus (33) Google Scholar which raises the question of whether screening followed by treatment of asymptomatic SCC might prevent the development of clinical symptoms of pain and debilitating neurological deficits. Observation versus screening spinal MRI and pre-emptive treatment for spinal cord compression in patients with castration-resistant prostate cancer and spinal metastases in the UK (PROMPTS): an open-label, randomised, controlled, phase 3 trialDespite the substantial incidence of rSCC detected in the intervention group, the rate of cSCC in both groups was low at a median of 22 months of follow-up. Routine use of screening MRI and pre-emptive treatment to prevent cSCC is not warranted in patients with asymptomatic castration-resistant prostate cancer with spinal metastasis. Full-Text PDF Open Access

Surgical treatment of spinal cord compression due to Hirayama disease: illustrative case.

BACKGROUNDHirayama disease (HD), also known as juvenile spinal muscular atrophy, is a rare condition in which flexion of the cervical neck causes compression and ischemic changes to the anterior horns of the spinal cord. Here the authors presented the first reported case of HD in North America that was successfully treated via surgical intervention.OBSERVATIONSThe patient was a 15-year boy with insidious onset upper limb weakness and atrophy. His findings were a classic presentation of HD although his complex history and relative rarity of the disease caused him to remain undiagnosed for months. After conservative management via cervical collar failed, the patient was successfully treated via C5-C7 anterior cervical discectomy and fusion. The patient’s symptoms stabilized by the 3-month follow-up.LESSONSThe diagnosis of HD is easy to miss because of the lack of reporting and widespread knowledge of this condition in North America. Thus, when presented with a case of insidious onset limb weakness in a juvenile patient, HD should be placed on the differential list and verified with cervical flexion magnetic resonance imaging. Additionally, surgical intervention should be considered a safe and effective option for HD when conservative methods have failed.

ФАКТОРЫ, ОПРЕДЕЛЯЮЩИЕ СТЕПЕНЬ НЕВРОЛОГИЧЕСКОГО ДЕФИЦИТА ПРИ КОМПРЕССИОННОМ И НЕКОМПРЕССИОННОМ ПОРАЖЕНИИ УСОБАКСКАРДИОПАТОЛОГИЯМИ

The number of neurological patients in veterinary prac-tice is constantly growing. This is due to increasing number of injuries in animals (fractures, spondylolisthesis), mani-festations of such pathologies as osteochondrosis, tumors of the spinal cord and spinal column (the life expectancy of pets in large cities increases due to, among other things, the use of ready-made diets in their feeding), and also by close inbreeding which increases the proportion of genetic anomalies of the spinal column. Concomitant cardiac dis-eases in neurologically impaired dogs are common in an-esthetic practice of surgical treatment of spinal cord com-pression. Neurological pathology is referred to as urgent, i.e. associated with the need for early diagnosis and treat-ment. In veterinary medicine, as opposed to humane medi-cine, it is often not possible to determine the level / locali-zation of the lesion on the basis of neurological symptoms and syndromes. Accurate and correct diagnosis using a sequential algorithm for examining a cardiologic animal with neurological disorders, using additional diagnostic methods such as myelography, MRI, morphological exami-nation, etc. allow conducting successful surgical treatment and avoiding complications from the cardiovascular system after anesthesia. In the immediate postoperative period, the adaptive mechanisms in the animal body may be insuf-ficient and take on a decompensation character which may cause complications from the cardiovascular system and the death of the patient. The research goal was to statisti-cally analyze the causes of neurological disorders in dogs with concomitant heart diseases, identify the most frequent neurological disorders, and determine the breed and age predisposition of dogs to these diseases under planned anesthesia.

Neurological outcomes after surgery for spinal metastases in symptomatic patients: Does the type of decompression play a role? A comparison between different strategies in a 10-year experience

IntroductionThe impact of neurological deficits plays a role of inestimable importance in patients with a neoplastic disease. The role of surgery for the management of symptomatic spinal cord compression (SSCC) cannot be overemphasized, as surgery represents often the first and paramount step in patients presenting with motor deficits. The traditional paradigm of simple bilateral laminectomy for the treatment of spinal cord compression has been reviewed. The need to achieve a proper circumferential decompression of the spinal sac has been progressively highlighted in combination with the development of the more comprehensive and multidisciplinary concept of separation surgery. ObjectiveThe aim of this paper is to analyze different strategies of decompression, while evaluating whether circumferential/anterior decompression is able to guarantee a better control and restoration of neurological functions in patients with motor impairment, if compared to traditional posterior decompression. Materials and methodsThis is a retrospective observational study investigating symptomatic patients that underwent surgical treatment for spinal metastases at author’s Institutions from January 2010 to June 2019. Data recorded concerned patient demographics, tumor histology, peri-operative and follow-up neurological status (ASIA), ambulation ability, stability (SINS), grade (ESCC) and source of epidural compression and type of decompression (anterior/anterior-lateral (AD); posterior/posterior-lateral (PD/PDL); circumferential (CD)). ResultsA total number of 84 patients was included. AD/CD patients showed higher chance of neurological improvement and reduced rates of worsening compared to PD/PLD group (94.1%/100% vs 60.4%; 11.8% vs 45.8% respectively). Univariate logistic regression identified immediate post-operative improvement to be a significative protective factor for worsening at last follow-up. Stratifying patients for site of compression and considering anterior and circumferential groups, immediate post-operative neurological improvement, was mostly associated with AD and CD (p 0.011 and 0.025 respectively). Walking at last follow up was influenced by post-operative maintenance of ambulation (p 0.001). ConclusionThe necessity to remove the epidural metastatic compression from its source should be considered of paramount importance. Since the majority of spinal cord compression involves firstly the ventral part of the sac, CD/AD are associated with better neurological outcomes and should be achieved in case of circumferential or anterior/anterolateral compression.

Cervical myelopathy due to neurovascular compression syndrome caused by persistent first intersegmental artery: a case report

BackgroundPersistent first intersegmental artery (PFIA) is a rare anatomical variation of vertebral arteries and is an asymptomatic finding in most cases. Here we report a rare case of cervical myelopathy caused by spinal cord compression by the PFIA.Case presentationThe patient was a 52-year-old man who complained of numbness and burning sensation around the neck and left shoulder area, partial weakness in the left deltoid muscle, right side thermal hypoalgesia, and disturbance of deep sensation since the past 1 year, and the symptoms had gradually worsened. Magnetic resonance imaging (MRI) and computed tomography (CT) showed spinal cord compression by the left PFIA at the C1/C2 level. Because conservative treatment was ineffective, microvascular decompression (MVD) of the PFIA was performed. The left PFIA was laterally transposed using polytetrafluoroethylene (PTFE) bands and anchored to the dura mater using three PTFE bands. To achieve adequate transposition, the small blood vessels bridging the spinal cord and PFIA and the dorsal root nerve had to be sacrificed. Postoperative T2-weighted MRI showed a small hyperintense region in the lateral funiculus of the spinal cord, but no new neurological deficits were identified. In the early postoperative stage, the patient’s deep sensory impairment and motor dysfunction were improved. His numbness and burning sensation almost disappeared, but slight thermal hypoalgesia remained in the lower limb.ConclusionMVD is an effective treatment for spinal cord compression caused by the PFIA, but further studies are necessary to help address technical difficulties and avoid complications.

Surgical Treatment of Spinal Cord Compression Caused by Metastatic Small Cell Lung Cancer: Ten Years of Experience in a Single Center.

PurposeMetastatic spinal cord compression (SCC) secondary to small cell lung cancer (SCLC) is a disastrous oncological emergency, but it is poorly understood due to the small numbers of patients and their short survival times. Whether patients suffered from SCC caused by metastatic SCLC benefit from spinal surgery remains unknown. The aim of this study was to evaluate the role of surgical treatment and prognostic factors in patients with SCC caused by metastatic SCLC.MethodsFrom 2009 to 2019, 30 consecutive patients surgically treated for metastatic SCC from SCLC were enrolled in this retrospective analysis. Kaplan–Meier method and Cox regression analysis were used to estimate overall survival (OS) and identify prognostic factors. Quality of life (QoL) was assessed by the three-level EuroQol-five-Dimensions (EQ-5D-3L) instrument and compared using Student’s t test.ResultsThe median OS time was 9 months in our series. Relief of pain, preservation of neurological function, and improvement of performance status were achieved after surgical intervention. The mean EQ-5D-3L utility score showed a significant improvement after surgery (0.3394 preoperatively vs 0.5884 postoperatively). According to Cox regression analysis, postoperative ECOG-PS and immunotherapy were identified to be independent prognostic factors for patients with SCC caused by metastatic SCLC.ConclusionDespite the short life expectancy, prompt surgical decompression is extremely necessary for patients with SCC caused by SCLC, for surgery played a critical role in improving patients’ QoL. Better performance status after surgery and receiving immunotherapy were associated with a longer OS.

Prognostic implication of gait function following treatment for spinal cord compression in men diagnosed with prostate cancer

Background: Malignant spinal cord compression (MSCC) is a severe complication of metastatic prostate cancer (PCa) and may compromise neurological functions, including gait function. This study aimed to evaluate the association between survival and gait function prior to, immediately after and 6 weeks following radiotherapy for MSCC in PCa patients.Patient sample: All PCa patients admitted with MSCC at Rigshospitalet, Denmark from January 1, 2010 to December 31, 2011 were included. Patients were followed until death to analyze gait function as a prognostic factor.Methods: Of the 76 included patients, four patients underwent surgical decompression followed by radiotherapy and 72 patients received only radiotherapy. Gait was evaluated prior to radiotherapy, immediately after radiotherapy and at 6 weeks follow-up.Results: Before radiotherapy, 88% had normal gait function and 12% had complete loss of gait function. Corresponding percentages after radiotherapy were 72% and 28%, respectively. Median overall survival following MSCC was 4.9 months (95% CI = 3.6–6.2) with a 3-, 6-, and 12-months survival probability of 64%, 42%, and 21%, respectively. Multivariate analyses demonstrated that patients without gait function after radiotherapy had a 2.6–2.8-fold increased risk of dying compared to men with gait function. Patients with more than two vertebrae involved had a 2.3–3.4-fold increased risk of dying when compared to patients with 1–2 vertebral metastases.Conclusions: PCa patients with MSCC have a poor prognosis. Most likely reflecting differences in tumor burden, preserved gait function following radiotherapy is associated with better prognosis. Further prospective studies are required to confirm this association.

A critical assessment of the quality of radiation therapy in Israel: time to initiation of treatment of spinal cord compression as an index of efficiency.

Radiotherapy departments function under workload pressure. We examined the process from referral to treatment initiation for spinal cord compression (SCC), one of the most daunting clinical scenarios in oncology. We identified 235 patients with SCC, treated between 2013-2015. Two physicians classified cases as "emergent" or "urgent" (treatment within 24 or 72h, respectively). The distribution of referrals over the week was uniform for inpatients. In contrast, there was a referral peak (62.27%) during the first two workdays for emergency ambulatory patients (p = 0.011). There were few weekend referrals in all groups (3.0%). There was a statistically shorter interval between referral and treatment for emergent versus urgent cases (0.94days vs. 4.17days; p < 0.0001, Bonferroni correction p < 0.0005). Time elapsed between referral and treatment of SCC may constitute a quality index in neuro-oncology. Modern departments of radiotherapy should determine the degree to which they can successfully implement such treatment. Patients with cancer and their physicians should be taught to recognize signs of SCC to expedite intervention.

Outcome of Surgical Treatment for Spinal Cord Compression in Patients With Hematological Malignancy.

We investigated the outcome of surgical treatment of patients with radiosensitive hematological malignancies presenting with spinal cord compression. Retrospective review of 50 patients who had treatment between 1993 and 2012. The neurological outcome was favorable in 35 patients, stable in 12, whereas 3 patients deteriorated. Decompression within 48 hours from referral was associated with a superior neurological recovery (P = .001). Complications were noted in 11 patients, and 6 of these underwent secondary surgery. Early (30-day) mortality was 8%. Radiotherapy was associated with increased incidence of complications (χ2 = 0.009). Patients who had low blood hemoglobin preoperatively as well as those who remained totally bedridden postoperatively had an inferior overall survival rate (P < .001). Patients with cord compression from hematological malignancy benefit from early surgical decompression. There is an inherent high risk for complications, which increases further if radiotherapy is given. Patients failing to ambulate after surgery have a poor prognosis.

Recent Techniques in Management of Lumbosacral Region Tumours: A Prospective Comparative Study

Background: The lumbosacral plexus consists of the ventral rami from the L2 to S3 nerve roots, with some additions from the L1 and S4 nerve roots as well. The standard treatment for spinal cord compression is urgent surgically decompressive laminectomy over the affected level with resection as much as possible of the exposed tumor to relieve the cord compression. We aim to correlate the impact of preoperative clinical picture, duration of symptoms, and the pathological nature of the lumbo-sacral spine tumors on the outcome of comparative study different modalities of management. Patients and Methods: During the period between 2015 and 2017, thirty cases were studied and surgically managed in Al-Azhar University Hospital, Damietta. Cases were selected for surgery if they were diagnosed as having a symptomatizing lumbosacral lesion. Results: Thirty patients were included in the current study; the commonest lesion in this study was ependymoma eight patients (27%), astrocytoma six patients (20%), and meningioma five patients (17%). Nerve sheath tumor comprised five cases (17%) with the hemangioblastomas three cases (10%), epidermoid one case (3%), and ependymoma of the filum terminale two cases (6%). The mean age of the included patients was 38.96 ± 15.42. The mean duration of lesions was 13.66 ± 10.93. They were 15 male patients (50%), and 15 female patients (50%), with male: female ratio 1:1. The mean duration of symptoms ranged for 1:60 months. The most common presenting manifestations were sensory followed by motor and sphinctric disturbance. Complications occurred in 8 patients (23%), and the most common was postoperative CSF leak. 19 out of 30 cases were surgically totally resected (63%), while 11 cases (37%) were grossly totally resected. Conclusions: Ependymoma and meningioma have more favorable outcome compared to other spinal tumors. Accurate and rapid diagnosis prior to surgery also associated with good outcome.

Surgical treatment of spinal cord compression in client owned dogs with different grades of neurological dysfunction

Surgical treatment of spinal cord compression in client owned dogs with different grades of neurological dysfunction

EL14 - Oncology Emergency, Its Dynamics of Diagnosis and Treatment From Viewpoint of General Internal Medicine

Oncology emergency refers to critical conditions among complications of cancer itself and adverse events by anti-cancer treatments. In my opinion, it can be divided into two categories including emergency in a narrow sense, which needs hasty correspondence within at least several hours, and urgency, which demands speedy one within not hours but one day. Even though they are the identical condition, certain oncologic emergencies can be assigned to different categories such as emergency, urgency and others in terms of their time course and severity. Furthermore, cancer diagnosis can be triggered by diagnosis of oncology emergency, and therefore considered to be an important theme for all of health care providers. In some sense, patients' history and physical examination are more essential than laboratory and imaging tests in order to adequately divide into three categories mentioned above and take care of patients with oncology emergency.As a general internist as well as a medical oncologist, I would like to share its importance with all of you through dynamics from diagnosis to treatment of spinal cord compression and hypercalcemia as representative of oncologic emergency.

Prise en charge par radiothérapie des métastases osseuses et de leurs complications : les standards

Sixty percent of cancer patients have or develop bone metastases during the development of their cancer. Bone metastases are the most common cause of cancer-related pain. External radiation therapy is the standard treatment of uncomplicated bone metastases, for the treatment of pain, the prevention of fracture, and for tumor control. Fractionation schedules (one session of 8Gy or several sessions, typically 30Gy in 10 fractions) vary in terms of efficacy with however more retreatments after a single session. The treatment of spinal cord compression is classically based on radiotherapy associated or not with surgery with indications assessed in emergency by a multidisciplinary team. The use of prognostic scores and prospective studies including patients corresponding to the daily practice and the work of groups like the GEMO aim to harmonize and optimize the management of bone metastases.

Clinical outcomes of treatment for spinal cord compression due to primary non-Hodgkin lymphoma

Background contextPrimary non-Hodgkin lymphoma of the spine (PNHLS) with spinal cord compression is an extremely rare disease in clinical practice. The optimal treatment options for this disease have been controversial and pose a challenge for the clinicians. PurposeTo provide some useful insight into the treatments, outcomes, and prognostic factors of PNHLS. Study designRetrospective analysis. Patient sampleThe authors collected 40 patients’ data with primary non-Hodgkin lymphoma at the mobile spine, and these patients presented with spinal cord compression as a first symptom between 1998 and 2010. Outcome measuresThe posttreatment neurologic status, general status, local recurrence, and survival were noted according to the telephone calls, letters, or follow-up visits in the outpatient department. MethodsMultidisciplinary treatments, including surgical intervention, chemotherapy, and radiotherapy, were performed in this series. Follow-ups regarding treatment outcomes, local recurrence, and survival rates were carried out and analyzed. The prognostic factors including age, neurologic status, general status, vertebrae involvement, and treatment outcomes were determined. ResultsThe median age of the patients was 52 years (range, 13–79 years). After treatments, 30 patients (75%) reached a complete remission (CR). The 5-year overall survival (OS) of all patients was 72.9%. Patients who were younger than 60 years, with single vertebra involvement, or had CR after treatment had higher 5-year OS (p<.05). In multivariate analysis, CR after treatment and involvement of a single vertebra were identified as favorable prognostic factors for OS. ConclusionsPatients with PNHLS with neurologic compression had distinct clinical features. Regarding treatment, the authors emphasized the importance of multidisciplinary management and the optimal operating juncture. Patients with excellent response to the treatment and single vertebra involvement had better survival.

The Use of Spine Stereotactic Body Radiation Therapy for the Treatment of Spinal Cord Compression

The Use of Spine Stereotactic Body Radiation Therapy for the Treatment of Spinal Cord Compression

Treatment of spinal cord compression: are we overusing radiotherapy alone compared to surgery and radiotherapy?

This article describes how patients with metastatic spinal cord compression (MSCC) were treated from 2005 to 2011 at a single institution. A comparison is made with an international and standardized scoring system which would have predicted which patients would have a better outcome with neurosurgery in addition to radiotherapy in accordance with current best practice standards. A retrospective audit of all MSCC patients presenting from 2005 to 2011 was undertaken. An assessment of outcome was made by using ambulatory assessment tool and by comparing overall survival with published standards. In all, 39 patients were identified, of whom 37 received radiotherapy alone and two (5%) received surgery and postoperative radiotherapy. The international standardized scoring system predicted 28 (72%) of the 39 patients might have had a better outcome with neurosurgery in addition to radiotherapy. MSCC patients generally had reasonable outcomes, but selected patients could potentially do better with decompressive surgery. There is a subset of MSCC patients who have poor predicted ambulatory rates after radiotherapy alone and who may benefit from decompressive surgery. It is recommended that MSCC patients be categorized according to the international scoring system to identify appropriate candidates for surgical intervention and postoperative radiotherapy or radiotherapy alone.

Early diagnosis and treatment is crucial for neurological recovery after surgery for metastatic spinal cord compression in prostate cancer

Background. Spinal cord compression is an oncological and surgical emergency. Delays in referral and diagnosis may influence functional outcome. It is therefore important to identify patients who will regain or maintain the ability to walk after surgery. The aim of the present study was to examine current practice for referral and diagnosis of prostate cancer patients with spinal cord compression and to identify prognostic factors for neurological outcome after surgery. Patients and methods. The study includes 68 consecutive patients with prostate cancer who underwent surgery due to neurological compromise. Intervals from onset of neurological symptoms to referral, diagnosis, and treatment were analyzed in relation to functional outcome. The prognostic significance of preoperative clinical parameters on gait function one month after surgery was evaluated. Results. Patients who were referred from local hospitals had longer delay to surgery than those who directly presented to the cancer center (p = 0.004). The rate of diagnosis with MRI increased through the week and peaked on Friday, with few patients being diagnosed during weekends. The ability to walk before surgery, hormone-naive prostate cancer, and/or shorter time from loss of ambulation were associated with more favorable neurological outcome. In patients with hormone-refractory disease who were unable to walk before surgery regaining ambulation was associated with: duration of paresis < 48 hours (p = 0.005), good preoperative performance status (p = 0.04), preoperative PSA serum level < 200 ng/ml (p = 0.03), and surgery with posterior decompression and stabilization (p = 0.03). Conclusion. Early diagnosis and rapid treatment of spinal cord compression in prostate cancer patients is crucial for neurological recovery. Raising awareness of the condition among patients at risk and among physicians is of outmost importance as well as improving local and regional guidelines for treatment.

Effect of Hypertransfusion on Extramedullary Hematopoietic Compression Mass in Thalassemia Major: A Case Report

Hereby we report a patient with thalassemia major having extradural cord compression at T3-T9 levels due to a mass of extramedullary hematopoiesis (EMH) tissue, whose treatment was successful with hypertransfusion therapy alone. The patient was a 23-year-old man who had not received regular blood transfusion since two years before admission. He suffered from paraparesis with a history of progressive lower limb weakness for 2 months. MRI of the spinal cord demonstrated thoracic extramedullary hematopoietic mass causing spinal cord compression. The patient demonstrated a significant response to hypertransfusion and improvement in the neurologic status started a few days after treatment. Almost complete resolution of the mass was seen in spinal MRI one week after hypertransfusion. Hypertransfusion seems to be a useful method for treatment of spinal cord compression due to a hematopoietic mass. It may be used as the first line therapy.

Intraoperative Radiotherapy Combined with Posterior Surgery for Spinal Metastases

Patients with cancer often suffered from spinal metastasis, and spinal cord compression from spinal metastasis represents a substantial clinical problem. External beam radiotherapy (EBRT) or conventional surgical decompression of the spinal cord often results in unsatisfactory neurological recovery and local recurrence. To improve neurological recovery and local control in such cases, we introduced intraoperative radiotherapy (IORT) combined with posterior surgery in 1992. We report the results for neurological recovery and local control in patients who received IORT combined with posterior surgery. Between November 1992 and March 2009, 158 cases (133 patients) were treated using IORT combined with posterior surgery for spinal paresis due to spinal metastases of breast, renal, thyroid, colorectal, and lung cancer. 99 cases were nonambulatory and 59 cases ambulatory before surgery. After posterior decompression, a single large dose of electron beam irradiation was delivered to the exposed metastatic lesion. Percentage dose in the spinal cord was approximately 10 - 25% with a lead shield, however, scattering of electron beams spread from behind the shielded central spinal cord region to reach the posterior region of the vertebra body located directly anterior to the spinal cord. Median dose of IORT was 20 Gy (range, 10 - 35 Gy), and median energy was 16 MeV (range, 11 - 22 MeV). 61 cases were treated with EBRT before the surgery; the delivered median dose was 40 Gy (range, 7.5 - 60 Gy). 41 cases were treated with EBRT after the surgery; the delivered median dose was 35 Gy (range, 8 - 50.5 Gy). Neurologic improvement of at least one level according to Frankel's classification was attained in 106 cases (67%) with a median follow-up period of 12.8 months. Spinal paralysis completely disappeared after surgery in 34 cases (22%). Of all 158 cases, 136 cases (86%) were ambulatory after surgery. Of the 99 cases nonambulatory before surgery, 78 cases (80%) became ambulatory after surgery. Postoperatively, 14 cases (9%) experienced local recurrence and neurologic exacerbation of at least one level according to Frankel's classification. The median time to local recurrence was 10.6 months (range, 3.0 - 40.6 months) after the surgery. For all 158 cases, median survival time was 18.5 months (range, 0.5 - 111.8 months) after the surgery. One patient experienced radiation myelopathy, and another patient experienced radiation neuropathy of cauda equina during the follow-up period. IORT combined with posterior surgery is a useful technique for the treatment of spinal cord compression caused by spinal metastasis, offering significant neurologic recovery and a low rate of local recurrence.

Is intrathecal enzyme replacement therapy a viable option for the treatment of spinal cord compression in a patient with Maroteaux-Lamy Syndrome?

Is intrathecal enzyme replacement therapy a viable option for the treatment of spinal cord compression in a patient with Maroteaux-Lamy Syndrome?