Acute vertebral collapse and cauda equina compression in tertiary syphilis.
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A patient with observed acute collapse of a lumbar vertebral body developed cauda equina compression. He was known to have contracted syphilis some 20 years before and, while he may well have suffered from tabetic spinal neuroarthropathy, histology of the collapsed vertebra showed features which indicate that an intra-osseous gumma could also have been responsible for his vertebral collapse and subsequent neurological deficit. (+info)
Epidural spinal cord compression: a single institution's retrospective experience.
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Epidural spinal cord compression (ESCC) is a common metastatic complication occurring in 5% of patients with cancer. We sought to determine retrospectively the frequency of multiple sites of ESCC at presentation and the risk of recurrence of ESCC. Of the cancer patients seen by the University of California San Diego's Neuro-Oncology Service between August 1986 and January 1997, 108 developed ESCC that was documented both clinically and by MRI of the spine. In 77 patients (71%), a single site of ESCC was seen; 31 patients (29%) had multiple sites of ESCC. All sites of ESCC were irradiated. In 7% of patients with single-site ESCC and in 9% of patients with multiple-site ESCC, the disease recurred. Length of survival was similar for patients with single- or multiple-site ESCC (median, 4.5 months) versus patients with recurrent ESCC (median, 7 months). An MRI of the entire spine in patients with suspected ESCC demonstrated multiple sites of ESCC in nearly one-third of patients. In 8% of patients with ESCC, symptomatic ESCC recurred. (+info)
Tumoral calcinosis in the upper cervical spine causing progressive radiculomyelopathy--case report.
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A 54-year-old woman with chronic renal failure presented with tumoral calcinosis manifesting as progressive radiculomyelopathy. Magnetic resonance imaging revealed a spinal epidural mass in the C-2 to C-4 levels. The clinical and radiological findings suggested malignant tumor. Resection of the lesion was performed with total C-2 laminectomy and C-3 and C-4 laminoplasty. The symptoms totally disappeared after surgery. The histological diagnosis was tumoral calcinosis. Tumoral calcinosis is a rare tumoral calcium pyrophosphate dihydrate crystal deposition disease which presents as periarticular soft tissue calcification. Tumoral calcinosis should be considered in patients with a mass lesion involving the upper cervical spine and associated with metabolic abnormalities. Surgical excision is the treatment of choice, because this is completely curative without known recurrence. (+info)
Laminar hook instrumentation in the cervical spine. An experimental study on the relation of hooks to the spinal cord.
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Several anterior and posterior methods are today available for stabilization of the cervical spine. Factors such as level and degree of instability, method of decompression, bone quality, length of fixation and safety factors influence the choice of method for a particular patient. The use of laminar hooks in the cervical spine has been restricted by fear of cord compression with the potential of tetraplegia. The aim of the present study was to assess the safety and determine the anatomical relation between hooks inserted in the cervical spinal canal and the dura and spinal cord. Thirteen cadavers from seven women and six men with no evidence of cervical spine disorder were included. The mean age was 81.3 years (range 65-101 years). The cervical spine was instrumented with cervical Compact Cotrel Dubousset hooks and rods. The effect of the hook on the dura was studied by myelography in nine cadavers. The deformation of the dural sac was quantified by measurement of the maximal width of the indentation of the contrast column at each level. A CT myelography scan was obtained in three cadavers. The ratio between the distance of maximal hook intrusion into the spinal canal and the canal diameter in the direction of the hook was calculated. The relation between inserted hooks and the spinal cord and dura was documented in a fresh cadaver studied with CT myelography. A hemilaminectomy was performed at all levels in three cadavers with direct visual inspection and photography of the hook sites before and after excision of the dura. A dural deformation of 2 mm or less, as observed by myelography, was found at four out of 77 (5%) hook sites. The deformation was caused by a supralaminar hook at C3, C6 and C7 and by an infralaminar hook at C6. The mean hook intrusion in the spinal canal, as observed on CT, was 27% (range 8-43) of the canal diameter. On visual inspection, 14 out of 18 hooks were in contact with the dura. After removal of the dura, two out of the 18 hooks in the same cadaver were in contact with the spinal cord. However, no deformation of the cord was observed. To our knowledge this is the first study systematically documenting the relation between hooks and the spinal cord in cadavers. In 95% of the hooks no deformation of the dural sac was observed and there was no evidence of spinal cord deformation. From an anatomical point of view, laminar hook instrumentation can be considered a safe procedure. The study shows, however, that hooks inserted in the cervical spine have a close anatomical relationship with the neuraxis, and at stenotic levels the use of other techniques is therefore recommended. (+info)
Minimally invasive endoscopic approach to the cervicothoracic junction for vertebral metastases: report of two cases.
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The anterior cervicothoracic junction is difficult to expose and many techniques have previously been described. Most of them require an extensile exposure, which can lead to significant morbidity. The aim of this study is to present a less invasive approach, allowing the same exposure on the spine as a larger one. The approach begins with the same incision as the Smith-Robinson technique: a blunt dissection of the posterior face of the manubrium is performed with the finger. An endoscope is inserted through 10-mm trocars, one above the manubrium and the second through the second rib space. The upper mediastinal space is exposed; the dissection is performed on the left side, between the esophagus and trachea medially, between the innominate vein and brachio-cephalic artery distally, and between the left common carotid and internal jugular vein laterally. The recurrent nerve must be protected. Two patients with spine metastases underwent this new approach. A strut graft was fixed anteriorly after decompression of the spinal cord. Levels T1-T3 can be well exposed through this approach, allowing complete vertebral body removal at level T1 or T2. After body removal, the posterior longitudinal ligament is well exposed, allowing complete release of the spinal cord. The use of the endoscope is the key to providing a good view of the spine without an extensile exposure. This new approach is technically feasible. The exposure is sufficient for vertebral body resection and reconstruction by strut graft. The procedure is less aggressive and painful than sternotomy. (+info)
Clinical efficacy of telemedicine in emergency radiotherapy for malignant spinal cord compression.
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The authors developed a Telecommunication-HElped Radiotherapy Planning and Information SysTem (THERAPIST), then estimated its clinical benefit in radiotherapy in district hospitals where consultation with the university hospital was required. The system consists of a personal computer with an image scanner and a digital camera, set up in district hospitals and directly connected via ISDN to an image server, and a treatment planning device set up in a university hospital. Image data and consultative reports are sent to the server. Radiation oncologists at the university hospital determine a treatment schedule and verify actual treatment fields. From 1998 to 1999, 12 patients with malignant spinal cord compression (MSCC) were treated by emergency radiotherapy with the help of this system. Image quality, transmission time, and cost benefit also were satisfactory for clinical use. The mean time between the onset of symptoms and the start of radiotherapy was reduced significantly from 7.1 days to 0.8 days (P < .05) by the introduction of the system. Five of 6 nonambulant patients became ambulant after the introduction of THERAPIST compared with 2 of 8 before the introduction of THERAPIST. The treatment outcome was significantly better after the introduction of the system (P < .05), and suggested to be beyond the international standard. The telecommunication-helped radiotherapy and information system was useful in emergency radiotherapy in district hospitals for patients with MSCC for whom consultation with experienced radiation oncologists at a university hospital was required. (+info)
Laminoplasty improves respiratory function in elderly patients with cervical spondylotic myelopathy.
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Respiratory insufficiency after acute cervical trauma is well documented, but the relationship between respiratory function and chronic lesions, such as cervical spondylosis, has received scant attention. This clinical study investigated the effect of cervical spondylosis on respiratory function in 12 patients over 65 years of age who underwent expansive laminoplasty. Functional and neurological status were assessed using the Japanese Orthopaedic Association (JOA) scale and Neurosurgical Cervical Spine Scale (NCSS). To assess the effect of laminoplasty on respiratory function in patients with cervical spondylotic myelopathy, lung volumes including vital capacity, tidal volume (TV), inspiratory reserve volume, expiratory reserve volume, inspiratory capacity, and forced expiratory volume were measured by spirometer before surgery and 6 months after surgery. The arterial blood gas values were also measured before and after surgery. All patients showed functional improvement after surgery, and neurological examination 6 months after surgery revealed a significant improvement in both JOA scale and NCSS scores (p < 0.001). There were no significant differences in most lung volumes, but TV (p = 0.039) at 6 months after surgery showed a significant increase compared to before surgery. PCO2 also showed a significant reduction after surgery (p = 0.047). This limited study revealed that laminoplasty improved respiratory function in patients over 65 years of age with cervical spondylotic myelopathy. Lung volume measurement may be one method to estimate spinal cord function after a surgical procedure. (+info)
Osteological features in pure-bred dogs predisposing to cervical spinal cord compression.
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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. (+info)