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Cox K, Ahmed H, Saha P, Liu WK, Aitken K, Bernard J, Bishop T, Minhas P, Papadopoulos M, Johnston F, Piggott A, Pereira E, Lui D, Afshar M. Six-Month Survivorship Prediction in Spinal Metastatic Patients by Oncologists Shows Reliable Prognostication. Global Spine J 2023:21925682231218712. [PMID: 38009792 DOI: 10.1177/21925682231218712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
STUDY DESIGN A retrospective analysis of oncologist-provided prognoses vs actual survival outcomes of patients referred with Metastatic spinal cord compression (MSCC) to a supra-regional multidisciplinary team (MDT). OBJECTIVES Prognostic scoring systems, such as the revised Tokuhashi, are commonly used to help guide the treatment of MSCC. However, scoring systems do not accommodate for the improved outcomes of contemporary cancer therapy. Oncologist-provided prognoses play an important role in real world rapid decision making. There is a paucity of evidence assessing the accuracy of the oncologist-provided prognosis. We conducted a retrospective study to evaluate this. METHODS Data was captured between January 2015 and December 2018. Patients were split into 2 groups: Group 1 (prognosis estimated <6 months) and Group 2 (prognosis estimated >6 months). Median overall survival (mOS) and hazard ratio for death (HR) was assessed. Receiver operating characteristic (ROC) analysis was performed to assess the accuracy of the oncologist's prognosis. RESULTS 829 patients were included. mOS in Group 1 was 5.8 months (95% CI 4.2-7.4 m), and in Group 2 mOS was not reached. Log rank test gave a Chi2 of 131 (P < .001). Cox regression analysis revealed a HR of .30 (P < .001). Area under the ROC curve was 78%. CONCLUSIONS Oncologist-provided prognosis is accurate in this cohort of unselected, consecutive MSCC patients. It reduced reliance on scoring systems that can become outdated. Given the rapid progress in cancer treatment, the oncologist's prognostic prediction is integral in efficient and effective MSCC management to help rapidly determine surgical candidacy.
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Affiliation(s)
- Kofi Cox
- Department of Medicine, St. George's University of London, London, UK
| | - Hassam Ahmed
- Department of Medicine, St. George's University of London, London, UK
| | - Priyanshu Saha
- Department of Medicine, St. George's University of London, London, UK
| | - Wing Kin Liu
- Department of Oncology, St. George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Jason Bernard
- Department of Complex Neurosurgery, Atkinson Morley Wing, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Timothy Bishop
- Department of Complex Neurosurgery, Atkinson Morley Wing, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Pawan Minhas
- Department of Complex Neurosurgery, Atkinson Morley Wing, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Marios Papadopoulos
- Department of Complex Neurosurgery, Atkinson Morley Wing, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Francis Johnston
- Department of Complex Neurosurgery, Atkinson Morley Wing, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Alicia Piggott
- Department of Complex Neurosurgery, Atkinson Morley Wing, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Erlick Pereira
- Department of Complex Neurosurgery, Atkinson Morley Wing, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Darren Lui
- Department of Complex Neurosurgery, Atkinson Morley Wing, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Mehran Afshar
- Department of Oncology, St. George's University Hospitals NHS Foundation Trust, London, UK
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Giglio AG, de Brito Rangel J, Cardozo CL, Bergmann A, da Silva GT, Thuler LCS. Incidence and risk factors associated with the development of metastatic spinal cord compression due to bone metastasis in women with cervical cancer. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3139-3145. [PMID: 35861891 DOI: 10.1007/s00586-022-07314-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/11/2022] [Accepted: 06/26/2022] [Indexed: 06/08/2023]
Abstract
PURPOSE The aim of this study was to determine the incidence and factors associated with the development of metastatic spinal cord compression (MSCC) after cervical cancer (CC). METHODS This retrospective cohort of 3551 women with CC who underwent treatment at the Brazilian National Cancer Institute were included in the study. Clinical and sociodemographic variables were obtained from the Hospital Cancer Registry and from hospital records. A descriptive study of the population was carried out, using means and standard deviations or frequencies and percentages. The Kaplan-Meier curve was used to identify annual incidence rates. Associations between the independent variables and the outcome (MSCC) were evaluated by a univariate analysis, applying crude and adjusted odds ratios (aOR) assuming 95% confidence intervals. RESULTS The MSCC incidence was of 1.5% (n = 51), associated to advanced staging (aOR = 2.65, 95% CI: 1.45-4.85, p = 0.001) and initial treatment with concomitant chemotherapy and radiotherapy (aOR = 4.40, 95% CI: 1.74-11.13, p = 0.002). CONCLUSIONS Our findings revealed the incidence and factors associated with MSCC, indicating a subset of patients who may be potential targets for the prevention and early treatment of this condition, indicating unprecedented and relevant data for the Brazilian epidemiological scenario due to the high CC incidence rates.
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Affiliation(s)
- Alessandra Grasso Giglio
- Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil
- Brazilian National Cancer Institute (INCA), Instituto Nacional de Câncer, Coordenação de Pesquisa Clínica, Rua André Cavalcanti, 37/Anexo, 3º andar, Centro, Rio de Janeiro, RJ, 20231-050, Brazil
| | - Juliana de Brito Rangel
- Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil
- Brazilian National Cancer Institute (INCA), Instituto Nacional de Câncer, Coordenação de Pesquisa Clínica, Rua André Cavalcanti, 37/Anexo, 3º andar, Centro, Rio de Janeiro, RJ, 20231-050, Brazil
| | - Cristiane Lemos Cardozo
- Brazilian National Cancer Institute (INCA), Instituto Nacional de Câncer, Coordenação de Pesquisa Clínica, Rua André Cavalcanti, 37/Anexo, 3º andar, Centro, Rio de Janeiro, RJ, 20231-050, Brazil
| | - Anke Bergmann
- Brazilian National Cancer Institute (INCA), Instituto Nacional de Câncer, Coordenação de Pesquisa Clínica, Rua André Cavalcanti, 37/Anexo, 3º andar, Centro, Rio de Janeiro, RJ, 20231-050, Brazil
| | - Gustavo Telles da Silva
- Brazilian National Cancer Institute (INCA), Instituto Nacional de Câncer, Coordenação de Pesquisa Clínica, Rua André Cavalcanti, 37/Anexo, 3º andar, Centro, Rio de Janeiro, RJ, 20231-050, Brazil
| | - Luiz Claudio Santos Thuler
- Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil.
- Brazilian National Cancer Institute (INCA), Instituto Nacional de Câncer, Coordenação de Pesquisa Clínica, Rua André Cavalcanti, 37/Anexo, 3º andar, Centro, Rio de Janeiro, RJ, 20231-050, Brazil.
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Adhikari P, Khadka S, Regmi PR, Shrestha A, Panta BR, Bhandari S, Acaroglu E. Primary spinal Non-Hodgkin Lymphoma presenting as impending cauda equina syndrome: A case report. Ann Med Surg (Lond) 2022; 83:104696. [DOI: 10.1016/j.amsu.2022.104696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/05/2022] [Accepted: 09/09/2022] [Indexed: 11/26/2022] Open
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Pokhrel NB, Prasad R, Paudel S, Kafle D, Pokharel RK. Primary spinal epidural non-Hodgkin's diffuse large B-cell lymphoma: A case report. Clin Case Rep 2020; 8:2276-2280. [PMID: 33235776 PMCID: PMC7669400 DOI: 10.1002/ccr3.3122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/26/2020] [Accepted: 06/13/2020] [Indexed: 11/10/2022] Open
Abstract
Rare disease like primary spinal epidural diffuse large B-cell lymphoma should be considered as a differential diagnosis in patients presenting with back pain and rapid neurological deterioration in the lower extremities.
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Affiliation(s)
- Nishan Babu Pokhrel
- Department of Orthopaedics and Trauma SurgeryTribhuvan University Institute of MedicineKathmanduNepal
| | - Rohit Prasad
- Department of Orthopaedics and Trauma SurgeryTribhuvan University Institute of MedicineKathmanduNepal
| | - Sushil Paudel
- Department of Orthopaedics and Trauma SurgeryTribhuvan University Institute of MedicineKathmanduNepal
| | - Dinesh Kafle
- Department of Orthopaedics and Trauma SurgeryTribhuvan University Institute of MedicineKathmanduNepal
| | - Rohit Kumar Pokharel
- Department of Orthopaedics and Trauma SurgeryTribhuvan University Institute of MedicineKathmanduNepal
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Elmesallamy WAA, Taha MM. Surgical management and prognostic factors of spinal metastatic tumors. EGYPTIAN JOURNAL OF NEUROSURGERY 2020. [DOI: 10.1186/s41984-020-00080-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Objective
This study aims to evaluate different prognostic factors after surgical management of metastatic spinal tumors regarding clinical condition, preoperative investigations, histopathological results, and surgical data.
Methods
Seventy patients diagnosed as metastatic spinal tumors with neurological deficits and/or unstable spine operated for spinal decompression with or without instrumental fixation according to Spinal Instability Neoplastic Score (SINS) at our institute during the period from May 2014 to October 2018 with follow-up at least 9 months.
Results
Lymphoma metastases were the commonest spinal metastases of 23% with significant p value = 0.001, males and ages above 50 years old were significantly affected. High vascularity and bone invasion were significant operative findings. Significant good prognostic factors for both survival and Klekampe score improvement were paretic patients, > 15 preoperative Klekampe score, early surgery, ≤ 3 vertebral affection, extradural tumor location, gross total resection, and metastatic tumors from multiple myeloma, thyroid gland, lymphoma, and prostatic gland.
Conclusion
Early surgeries aiming neural decompression and keeping spinal stability according to Spinal Instability Neoplastic Score for patients with spinal metastases are the main hope for better survival and neurological improvement.
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Javed G, Laghari AA, Ahmed SI, Madhani S, Shah AA, Najamuddin F, Khawaja R. Development of Criteria Highly Suggestive of Spinal Tuberculosis. World Neurosurg 2018; 116:e1002-e1006. [PMID: 29860015 DOI: 10.1016/j.wneu.2018.05.149] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/20/2018] [Accepted: 05/22/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND In a developing country there is a need for development of criteria that can be used for the diagnosis of spinal tuberculosis, which is common in that region. METHODS Demographic, clinical, and radiologic features of spinal tuberculosis and spinal epidural tumors have been compared statistically, and inferences have been drawn in terms of P values, sensitivity, specificity, positive predictive values, and negative predictive values. RESULTS A statistically significant relationship was found between spinal tuberculosis and spinal pain, fever, gradually progressive lower limb weakness, contrast-enhancing epidural ± paravertebral lesions, continuous levels affected, spinal deformity, and raised erythrocyte sedimentation rate. CONCLUSIONS These relationships were considered the most probable criteria for the diagnosis of spinal tuberculosis.
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Affiliation(s)
- Gohar Javed
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Altaf Ali Laghari
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan.
| | - Syed Ijlal Ahmed
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Sarosh Madhani
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Ahmed Ali Shah
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Reehana Khawaja
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
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Guzik G. Analysis of factors delaying the surgical treatment of patients with neurological deficits in the course of spinal metastatic disease. BMC Palliat Care 2018. [PMID: 29514666 PMCID: PMC5842651 DOI: 10.1186/s12904-018-0295-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Thoracic spine cancer metastases is frequently the cause of neurological deficits. Despite the availability of diagnostics, delays in treatment are still quite common. The aim of this work is to analyze the reasons for delayed diagnostics and treatment, in patients with neurological deficits in the course of metastatic spine disease. Methods In our study patients medical data was analyzed from 2013 to 2015. The analysis covered the following aspects: symptoms of metastases, time of neurological deficits occurrence, where and when initial diagnostics were performed, time from diagnosis to proper surgical treatment in an oncological centre. In total, 411 patients were consulted and 287 were operated on. Of 112 patients with neurological deficits, 64 underwent surgeries. Women represented the majority of the patients. The most common primary neoplasms were breast cancer and myeloma. Results In 75% of the patients neurological symptoms occurred prior to admission to a hospital. The average time between the onset of neurological symptoms and medical consultation was 4 days. The patients were diagnosed mainly at neurologic, orthopedic and emergency departments. The mean time between undergoing radiological examinations and receiving the examinations results was 2.4 days for CT and 2.8 days for MRI. The average time between a patients’ admission from the department where they were initially diagnosed, to the orthopedic oncology ward was 4.5 days. Conclusions The most common cause of the delayed treatment of patients with neurological deficits, in the course of metastatic spine disease, is a combination of the lack of knowledge among patients and healthcare personnel regarding the necessity of early diagnosis.
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Affiliation(s)
- Grzegorz Guzik
- Orthopedic Oncology Department, Specialist Hospital in Brzozów- Podkarpacki Oncology Center, ul. Dworska 77a, 38-420, Korczyna, Polska, Poland.
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Abstract
Patients with brain tumors and systemic malignancies are subject to diverse neurologic complications that require urgent evaluation and treatment. These neurologic conditions are commonly due to the tumor's direct effects on the nervous system, such as cerebral edema, increased intracranial pressure, seizures, spinal cord compression, and leptomeningeal metastases. In addition, neurologic complications can develop as a result of thrombocytopenia, coagulopathy, hyperviscosity syndromes, infection, immune-related disorders, and adverse effects of treatment. Patients may present with typical disease syndromes. However, it is not uncommon for patients to have more subtle, nonlocalizing manifestations, such as alteration of mental status, that could be attributed to other systemic, nonneurologic complications. Furthermore, neurologic complications are at times the initial manifestations of an undiagnosed malignancy. Therefore a high index of suspicion is essential for rapid assessment and management. Timely intervention may prolong survival and improve quality of life. In this chapter, we will discuss the common neuro-oncologic emergencies, including epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment.
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Affiliation(s)
- J T Jo
- Neuro-Oncology Center, University of Virginia, Charlottesville, VA, USA
| | - D Schiff
- Neuro-Oncology Center, University of Virginia, Charlottesville, VA, USA.
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9
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Image-guidance technology and the surgical resection of spinal column tumors. J Neurooncol 2016; 131:425-435. [DOI: 10.1007/s11060-016-2325-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
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Lee SH, Grant R, Kennedy C, Kilbride L. Positioning and spinal bracing for pain relief in metastatic spinal cord compression in adults. Cochrane Database Syst Rev 2015; 2015:CD007609. [PMID: 26400848 PMCID: PMC7199117 DOI: 10.1002/14651858.cd007609.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND This is an updated version of the original Cochrane review published in Issue 3 (Lee 2012) on patient positioning (mobilisation) and bracing for pain relief and spinal stability in adults with metastatic spinal cord compression.Many patients with metastatic spinal cord compression (MSCC) have spinal instability, but their clinician has determined that due to their advanced disease they are unsuitable for surgical internal fixation. Mobilising may be hazardous in the presence of spinal instability as further vertebral collapse can occur. Current guidance on positioning (whether a patient should be managed with bed rest or allowed to mobilise) and whether spinal bracing is helpful, is contradictory. OBJECTIVES To investigate the correct positioning and examine the effects of spinal bracing to relieve pain or to prevent further vertebral collapse in patients with MSCC. SEARCH METHODS For this update, we searched for relevant studies from February 2012 to 31 March 2015. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE In Process, EMBASE, AMED, CINAHL, TRIP, SIGN, NICE, UK Clinical Research Network, National Guideline Clearinghouse and PEDro database. We also searched the metaRegister of Controlled Trials (mRCT), ClinicalTrials.gov, UK Clinical Trials Gateway (UKCTG), WHO International Clinical Trials Registry Platform (ICTRP) and Australia New Zealand Clinical Trials Registry (ANZCTR).For the original version, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, CANCERLIT, NICE, SIGN, AMED, TRIP, National Guideline Clearinghouse, and PEDro database, in February 2012. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of adults with MSCC of interventions on positioning (mobilisation) and bracing. DATA COLLECTION AND ANALYSIS Two review authors independently assessed each possible study for inclusion and quality. MAIN RESULTS For the original version of the review, we screened 1611 potentially relevant studies. No studies met the inclusion criteria. Many papers identified the importance of mobilisation, but no RCTs of bed rest versus mobilisation have been undertaken. We identified no RCTs of bracing in MSCC.For this update, we identified 347 potential titles. We screened 300 titles and abstracts after removal of duplicates. We did not identify any additional studies for inclusion. AUTHORS' CONCLUSIONS Since publication of the original version of this review, no new studies were found and our conclusions remain unchanged.There is a lack of evidence-based guidance around how to correctly position and when to mobilise patients with MSCC or if spinal bracing is an effective technique for reducing pain or improving quality of life. RCTs are required in this important area.
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Affiliation(s)
- Siew Hwa Lee
- University of LimerickDepartment of Nursing and Midwifery, Faculty of Education and Health SciencesHealth Sciences BuildingRoom HS3‐029LimerickIreland
| | - Robin Grant
- Western General HospitalEdinburgh Centre for Neuro‐Oncology (ECNO)Crewe RoadEdinburghScotlandUKEH4 2XU
| | - Catriona Kennedy
- University of LimerickDepartment of Nursing and Midwifery, Faculty of Education and Health SciencesHealth Sciences BuildingRoom HS3‐029LimerickIreland
| | - Lynn Kilbride
- Glasgow Caledonian UniversityNursing and Community HealthGlasgowUK
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Prognostic factors in patients with metastatic spinal cord compression secondary to lung cancer: a systematic review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015. [DOI: 10.1007/s00586-015-4157-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Adeolu AA, Oyemolade TA, Salami AA, Adigun TA, Malomo AO, Akang EA, Shokunbi MT. Features and Outcome of Surgical Management of Spinal Tumors in a Cohort of Nigerian Patients. World Neurosurg 2015; 84:1090-4. [PMID: 26074431 DOI: 10.1016/j.wneu.2015.05.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 05/23/2015] [Accepted: 05/26/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE There is a dearth of information on operated cases of spinal tumors in patients in sub-Saharan Africa. The objective of this study was to evaluate the histologic pattern, anatomic distribution, and extent and outcome of surgery of Nigerian patients with spinal tumors. METHODS This retrospective study comprised a cohort of Nigerians who underwent surgery for spinal tumors. Data obtained included patient demographics, duration of symptoms, anatomic location, imaging findings, Frankel grading before and after surgery, and type and outcome of surgery. Univariate analysis was performed, and results were compared with results from other parts of the world. RESULTS There were 59 patients (male-to-female ratio 1:1.1) with a bimodal age distribution. The highest (20.34%) incidence was seen in the 20-29 age group. More than half (58.06%) of the patients presented with a duration of symptoms of at least 6 months (duration of symptoms was >12 months in 35.48%). Motor deficit was present in 97.73% of patients at presentation. Functional grading was Frankel A in 38.10% of patients, Frankel C in 26.19%, Frankel B in 16.67%, Frankel D in 16.67%, and Frankel E in 2.38%. The tumors were mostly in the thoracic region (65.45%), and 58% were extradural in location. Gross total tumor excision was performed in 50.88% of the cases, and subtotal resection was performed in 24.56%. Spinal stabilization was performed in 17.86% with spinous process wiring and vertical strut being the most common method of stabilization (80%) among this group. Metastasis was the most common histologic tumor type (23.21%). Meningioma accounted for 12.50% of tumors, and ependymoma, astrocytoma, and hemangioma each accounted for 7.14%. The most common source of metastasis was the prostate (38.46%). Postoperatively, 45% of patients improved neurologically, 52.5% remained the same, and 2.5% deteriorated. There was no perioperative mortality. CONCLUSIONS Metastasis was the most common histologic type of spinal tumor in this study, and the most common location was extradural. The outcome was satisfactory in most cases with neurologic function remaining the same or improving after surgery in most patients.
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Affiliation(s)
- Augustine A Adeolu
- Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria; Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Toyin A Oyemolade
- Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
| | - A A Salami
- Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - T A Adigun
- Department of Anaesthesia, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - A O Malomo
- Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria; Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - E A Akang
- Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - M T Shokunbi
- Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria; Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Incidence, associated factors, and survival in metastatic spinal cord compression secondary to lung cancer. Spine J 2015; 15:1263-9. [PMID: 25687415 DOI: 10.1016/j.spinee.2015.02.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 12/15/2014] [Accepted: 02/06/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Bone metastasis (BM) occurs frequently in patients with lung cancer (LC). The most affected are the bones of the spine, increasing the risk of developing metastatic spinal cord compression (MSCC). Although MSCC is one of the most disabling complications, few studies have reported relevant results related to its frequency and prognosis among patients with LC. PURPOSE The purpose of this study was to determine the incidence and associated factors of the development of MSCC after BM with LC and its prognosis. STUDY DESIGN/SETTING This is a cohort study. PATIENT SAMPLE A cohort of 112 patients with BM because of LC, whose treatment was performed exclusively at the National Cancer Institute, was analyzed. OUTCOME MEASURES Study outcome measures included incidence of MSCC, factors associated with MSCC, and survival analysis. METHODS A cohort study was performed involving patients with BM because of LC diagnosed between 2007 and 2011. Clinical and sociodemographic data were extracted from the physical and electronic medical records because of initial diagnosis (up until December 2013). The association between the independent variables and the outcomes was performed by using crude and adjusted odds ratios (ORs), assuming 95% confidence intervals (CIs). For the exploratory evaluation between the independent variables and the time until the outcomes, Kaplan-Meier survival analysis was conducted. To identify if the differences between the curves were statistically significant, a log-tank test was calculated. A Cox multiple regression model, using the forward stepwise method, was applied, aiming to estimate the factors associated with time to death in the different exposure groups. RESULTS Of the 112 patients with BM, 31 (27.7%) developed MSCC. The univariate analysis showed that patients with three or more involved vertebrae revealed a 6.1 times greater risk of developing MSCC, compared with those with up to two metastatic vertebrae involved (OR: 6.1, 95% CI: 2.5-15.1, p<.001). Among the patients who developed MSCC, the median survival time was 4.4 months (95% CI: 1.5-7.3) and 4.7 months (95% CI: 3.5-5.9) in the patients without MSCC, not being a statistically significant difference (p=.19). After the occurrence of the MSCC, the median survival time was 2.8 months (95% CI: 1.4-4.1). CONCLUSIONS In this study, a high incidence of MSCC was observed in patients with BM. The study suggests that patients with three or more involved vertebrae per metastasis are more likely to develop MSCC. No alteration in the overall survival time was noticed among the patients with or without MSCC.
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Apoptosis in human compressive myelopathy due to metastatic neoplasia. Spine (Phila Pa 1976) 2015; 40:E450-7. [PMID: 25868101 DOI: 10.1097/brs.0000000000000821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Immunohistochemical assessment of apoptotic markers in human cases of compressive myelopathy due to neoplastic compression. OBJECTIVE To characterize the role of apoptosis in neoplastic compressive myelopathy in human postmortem tissue with extramedullary tumor involvement. SUMMARY OF BACKGROUND DATA Neoplasms, whether primary or metastatic, may lead to compression of the spinal cord and development of a compressive myelopathy syndrome. Apoptotic processes of cell death are thought to contribute to cell death in chronic compressive myelopathy because of degenerative spondylosis, but this has not previously been described in neoplastic compression. METHODS Six postmortem cases of human neoplastic compressive myelopathy were assessed for apoptosis using a panel of immunohistochemical markers including Fas, B-cell lymphoma 2 (Bcl-2), caspase-3 and 9, DNA-dependent protein kinase catalytic subunit (DNA-PKcs), poly (ADP-ribose) polymerase (PARP), apoptosis-inducing factor (AIF), and terminal deoxynucleotide transferase dUTP Nick End Labeling (TUNEL). RESULTS Apoptosis was maximal at the site of tumor compression. Glial cells, predominantly oligodendrocytes, were immunopositive for DNA-PKcs, PARP, AIF, and TUNEL. Axons were immunopositive for caspase 3, DNA-PKcs, and AIF. Neurons were immunopositive for DNA-PKcs, PARP, AIF, and TUNEL. CONCLUSION The current study demonstrates that apoptosis plays a role in human neoplastic compressive myelopathy. Necrosis dominates the severe end of the spectrum of compression. The prominent oligodendroglial involvement is suggestive that apoptosis may be important in the ongoing remodeling of white matter due to sustained compression. LEVEL OF EVIDENCE 4.
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Direct decompressive surgery followed by radiotherapy versus radiotherapy alone for metastatic epidural spinal cord compression: a meta-analysis. Spine (Phila Pa 1976) 2014; 39:E587-92. [PMID: 24503688 DOI: 10.1097/brs.0000000000000258] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A systemic review and meta-analysis. OBJECTIVE To compare the ambulatory status and survival for metastatic epidural spinal cord compression (MESCC) in patients treated with direct decompressive surgical resection (DDSR) followed by radiotherapy (RTx) with those in patients treated with RTx alone. SUMMARY OF BACKGROUND DATA Surgical techniques have remarkably evolved from decompressive laminectomy without ventral tumor excision to DDSR, which has displayed favorable outcomes since the 2000s. RTx alone has also evolved and is regarded to have accomplished outcome comparable with that of the surgery. The optimal treatment of MESCC has not been clearly defined yet. METHODS We searched MEDLINE, EMBASE, and the Cochrane library in July 2013. Comparative studies enrolled patients with similar performance, primary cancer, age, and sex at the baseline state were included. Outcome measures included ambulatory status and overall survival rate. We did a fixed-effects meta-analysis of the ambulatory status and survival in patients with MESCC compared with DDSR+RTx and RTx alone. RESULTS Five studies were used to obtain data from 238 and 1137 patients treated with DDSR+RTx and RTx alone, respectively. The DDSR+RTx group displayed substantial improvement in ambulatory status after the treatment that was superior to the improvement in the RTx-alone group (relative risk [RR], 1.43; 95% confidence interval [CI], 1.14-1.78) in a fixed-effects model and significantly lower deterioration after treatment than the RTx group (RR, 0.35; 95% CI, 0.19-0.63). The DDSR+RTx group showed significant improvement in the survival rate at 6 months post-treatment (RR, 1.21; 95% CI, 1.09-1.33). Similar findings were observed at 12 months post-treatment (RR, 1.32; 95% CI, 1.12-1.56). CONCLUSION The meta-analysis indicates that DDSR+RTx may produce better clinical improvement of ambulation status and survival than RTx alone in the treatment of MESCC. Additional prospective studies are warranted to better address this question. LEVEL OF EVIDENCE 1.
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Shiue K, Sahgal A, Chow E, Lutz ST, Chang EL, Mayr NA, Wang JZ, Cavaliere R, Mendel E, Lo SS. Management of metastatic spinal cord compression. Expert Rev Anticancer Ther 2014; 10:697-708. [DOI: 10.1586/era.10.47] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Iacoangeli M, Di Rienzo A, Nocchi N, Alvaro L, Gladi M, Colasanti R, Herber N, Dobran M, Scerrati M. An unusual instrumentation-related s1 radiculopathy in a patient treated for a primary vertebral (l3) lymphoma. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2012; 6:375-80. [PMID: 23226078 PMCID: PMC3511055 DOI: 10.4137/cmo.s10773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Paravertebral titanium rod migration represents an unusual and potentially fatal complication of vertebral stabilization surgical procedures. This condition, which requires a prompt and rapid diagnosis, is often mistaken for other more common diseases, or scotomized. We present a case of a 69 years old female affected by a non-Hodgkin lymphoma with evidence of migration of both rods five years after the posterior stabilization procedure for a pathological L3 fracture. Unusual clinical onset was represented by a left S1 radiculopathy without other symptoms. For several months, the symptoms were attributed to a possible radicular infiltration by the lymphoma. We conclude that paravertebral rod migration could happen not only within the spinal canal, but could also rarely damage blood vessels or parenchymal organs. This is generally a long-term complication, probably due to an insufficient fixation. Strict long-term follow-up monitoring is mandatory since this unusual complication can mimic other more common pathological conditions.
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Affiliation(s)
- Maurizio Iacoangeli
- Department of Neurosurgery, Università Politecnica delle Marche, Umberto I General Hospital, Ancona, Italy
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Kasper EM, Lam FC, Luedi MM, Zinn PO, Pihan GA. Primary epidural lymphocyte-depleted Hodgkin's lymphoma of the thoracic spine - presentation of a rare disease variant. BMC Neurol 2012; 12:64. [PMID: 22862748 PMCID: PMC3482592 DOI: 10.1186/1471-2377-12-64] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 07/19/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lymphocyte-depleted Hodgkin's lymphoma is the rarest form of classical Hodgkin's lymphoma, accounting for < 1% of all cases. Patients often have advanced-stage disease at the time of presentation with an aggressive clinical course. Even more uncommon is primary extranodal disease and rarely it will be presenting with spinal cord compression. CASE PRESENTATION An 88-year-old Caucasian female presented with a history of upper back pain for several months and new onset bilateral leg numbness and weakness. MRI of the spine showed a dorsal epidural lesion with cord compression at T1-T4 with involvement of the paraspinal muscles. The patient received urgent surgical decompression, with final histopathology showing a lymphocyte-depleted Hodgkin's lymphoma. Systemic work-up did not show evidence of nodal disease. Following surgery, she received a course of radiotherapy with good outcome. CONCLUSION To the best of our knowledge, this is the first reported case of primary lymphocyte-depleted Hodgkin lymphoma presenting as epidural spinal cord compression. Our report, in conjunction with a review of the literature, suggests that surgical intervention is clearly indicated in de novo disease followed by radiotherapy.
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Affiliation(s)
- Ekkehard M Kasper
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Lee SH, Cox KM, Grant R, Kennedy C, Kilbride L. Patient positioning (mobilisation) and bracing for pain relief and spinal stability in metastatic spinal cord compression in adults. Cochrane Database Syst Rev 2012:CD007609. [PMID: 22419325 DOI: 10.1002/14651858.cd007609.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Many patients with metastatic spinal cord compression (MSCC) have spinal instability but are determined, by their clinician, to be unsuitable for surgical internal fixation due to their advanced disease. Mobilisation may be hazardous in the presence of spinal instability as further vertebral collapse can occur. Current guidance on positioning (or mobilisation) and spinal bracing is contradictory. OBJECTIVES To investigate the correct positioning (or mobilisation) and examine the effects of spinal bracing to relieve pain or to prevent further vertebral collapse in patients with MSCC. SEARCH METHODS The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, CANCERLIT, NICE, SIGN, AMED, TRIP, National Guideline Clearinghouse and PEDro database were searched; the last search was run in February 2012. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of adults with MSCC of interventions on positioning or mobilisation and bracing. DATA COLLECTION AND ANALYSIS Two review authors independently assessed each possible study for inclusion and quality. MAIN RESULTS One thousand, six hundred and eleven potentially relevant studies were screened. No studies met the inclusion criteria. Many papers identified the importance of mobilisation but no RCTs have been undertaken. No RCTs of bracing in MSCC were identified. AUTHORS' CONCLUSIONS There is lack of evidence based guidance around how to correctly position and when to mobilise patients with MSCC or if spinal bracing is an effective technique for reducing pain or improving quality of life. RCTs are required in this important area.
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Affiliation(s)
- Siew Hwa Lee
- School of Nursing, Midwifery and Social Care, Faculty of Health, Life & Social Sciences, Edinburgh Napier University, Edinburgh,UK
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Aregawi DG, Sherman JH, Schiff D. Neurological complications of solid tumors. HANDBOOK OF CLINICAL NEUROLOGY 2012; 105:683-710. [PMID: 22230528 DOI: 10.1016/b978-0-444-53502-3.00018-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Dawit G Aregawi
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
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Cugati G, Singh M, Pande A, Ramamurthi R, Balasubramanyam M, Sethi SK, Singh AK. Primary spinal epidural lymphomas. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2011; 2:3-11. [PMID: 22013369 PMCID: PMC3190427 DOI: 10.4103/0974-8237.85307] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An epidural location for lymphoma is observed in 0.1-6.5% of all the lymphomas. Primary spinal epidural lymphoma (PSEL) is a subset of lymphomas, where there are no other recognizable sites of lymphomas at the time of diagnosis. The incidence of this subset of lymphomas is much less. It, however, is increasingly diagnosed, due to the increased use of more sensitive imaging modalities. For the electronic search, Pubmed was used to identify journals that enlisted and enumerated PSEL from 1961 to January 2011. The following combination of terms: "primary," "spinal," "epidural," and "lymphoma" were used. The most significant articles and their bibliographies were analyzed by the authors. The symptoms, pathogenesis, diagnostic workup, histopathology, treatment, and outcome have been analyzed in a systematic manner.
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Affiliation(s)
- Goutham Cugati
- Dr. Achanta Lakshmipathi Neurosurgical Centre, Post Graduate Institute of Neurological Surgery, VHS Medical Centre, Taramani, India
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Fattal C, Fabbro M, Gelis A, Bauchet L. Metastatic paraplegia and vital prognosis: perspectives and limitations for rehabilitation care. Part 1. Arch Phys Med Rehabil 2011; 92:125-33. [PMID: 21187215 DOI: 10.1016/j.apmr.2010.09.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 09/14/2010] [Accepted: 09/15/2010] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate the vital prognosis of patients with metastatic epidural spinal cord compression (MESCC) to determine the relevance and duration of physical medicine and rehabilitation (PM&R) admission. DATA SOURCES Publications from 1980 to January 2010 selected from 3 databases. STUDY SELECTION Publications reporting data correlated with survival and prognosis factors, highlighting publications with level A scientific evidence (prospective randomized controlled studies with significant casuistry and relevant judgment criteria). The work focused on patients with MESCC below T1. DATA EXTRACTION Standardized reading grid. DATA SYNTHESIS Thirty-eight studies met the inclusion criteria. Most were retrospective. For survival rate at 1 year, they reported data ranging from 12% to 58%. The 12-month and median survival rates were the data reported most often in the articles. The median survival rate ranged from 2.4 to 30 months, and 12-month survival rates ranged from 12% to 58%. Of publications that chose this parameter, 95% reported 12-month survival rates less than 55.2% (95th percentile) regardless of patients' functional status and associated risk factors (eg, location of primary cancer, metastases spreading, pretreatment ambulatory status). CONCLUSIONS Despite major progress in cancer care, patients with MESCC still have a limited vital prognosis. The relevance and duration of PM&R care must be evaluated against the patient's functional need for rehabilitation while making time for family. The hypothesis of a 1-month stay extended only once appears reasonable for patients to adapt to their new functional status without taking precious time away from their loved ones.
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Affiliation(s)
- Charles Fattal
- Centre Mutualiste Neurologique Propara, Montpellier, France.
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Metastatic paraplegia and functional outcomes: perspectives and limitations for rehabilitation care. Part 2. Arch Phys Med Rehabil 2011; 92:134-45. [PMID: 21187216 DOI: 10.1016/j.apmr.2010.09.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 09/14/2010] [Accepted: 09/15/2010] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To identify functional outcomes that could justify the need for a rehabilitation care program for patients with metastatic epidural spinal cord compression (MESCC) and paraplegia. DATA SOURCES Publications from 1950 to January 2010 selected from 3 databases. STUDY SELECTION Original articles dealing with outcome data for functional status, pain, and bladder dysfunction. DATA EXTRACTION Standardized reading grid. DATA SYNTHESIS The data are dominated by retrospective studies for even functional-related data, and studies from rehabilitation teams are rare. They report a functional evolution similar to a population with traumatic spinal cord injury for the first 3 months. Patients who were ambulatory before treatment retained their ability to walk, and patients who were nonambulatory before treatment could regain gait abilities. Data also showed a positive impact on pain and bladder and/or bowel dysfunction. CONCLUSIONS By restricting physical medicine and rehabilitation therapeutic care to a short time (1-2mo), the progression margin is possible in the short term and implies a voluntary and active therapeutic care approach for patients with paraplegia after MESCC on the basis of a codified and standardized program with clinical indicators, as well as patients' comfort indicators.
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Tancioni F, Navarria P, Lorenzetti MA, Pedrazzoli P, Masci G, Mancosu P, Alloisio M, Morenghi E, Santoro A, Rodriguez y Baena R, Scorsetti M. Multimodal approach to the management of metastatic epidural spinal cord compression (MESCC) due to solid tumors. Int J Radiat Oncol Biol Phys 2010; 78:1467-73. [PMID: 20231072 DOI: 10.1016/j.ijrobp.2009.09.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 09/24/2009] [Accepted: 09/28/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess the impact of a multidisciplinary approach for treatment of patients with metastatic epidural spinal cord compression in terms of feasibility, local control, and survival. METHODS AND MATERIALS Eighty-nine consecutive patients treated between January 2004 and December 2007 were included. The most common primary cancers were lung, breast, and kidney cancers. Ninety-eight surgical procedures were performed. Radiotherapy was performed within the first month postoperatively. Clinical outcome was evaluated by modified visual analog scale for pain, Frankel scale for neurologic deficit, and magnetic resonance imaging or computed tomography scan. Nearly all patients (93%) had back pain before treatment, whereas major or minor preoperative neurologic deficit was present in 62 cases (63%). RESULTS Clinical remission of pain was obtained in the vast majority of patients (91%). Improvement of neurologic deficit was observed in 45 cases (72.5%). Local relapse occurred in 10%. Median survival was 11 months (range, 0-46 months). Overall survival at 1 year was 43.6%. Type of primary tumor significantly affected survival. CONCLUSIONS In patients with metastatic epidural spinal cord compression, the combination of surgery plus radiotherapy is feasible and provides clinical benefit in most patients. The discussion of each single case within a multidisciplinary team has been of pivotal importance in implementing the most appropriate therapeutic approach.
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Affiliation(s)
- Flavio Tancioni
- Department of Neurosurgery, Istituto Clinico Humanitas, Milan, Italy
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Mavrogenis AF, Papadopoulos EC, Starantzis K, Korres DS, Papagelopoulos PJ. Posterior decompression and stabilization, and surgical vertebroplasty with the vertebral body stenting for metastatic vertebral and epidural cauda equina compression. J Surg Oncol 2010; 101:253-8. [DOI: 10.1002/jso.21472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Mavrogenis AF, Pneumaticos S, Sapkas GS, Papagelopoulos PJ. Metastatic epidural spinal cord compression. Orthopedics 2009; 32:431-9; quiz 440-1. [PMID: 19634817 DOI: 10.3928/01477447-20090511-20] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Andreas F Mavrogenis
- First Department of Orthopedics, Attikon General University Hospital, Athens, Greece
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Metastatic paraplegia: care management characteristics within a rehabilitation center. Spinal Cord 2008; 47:115-21. [DOI: 10.1038/sc.2008.75] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hung PC, Fan KT, Lai HC, Shen CH, Luk HN. Postoperative paraplegia as a result of undiagnosed primitive neuroectodermal tumor, not epidural analgesia. J Chin Med Assoc 2007; 70:456-9. [PMID: 17962148 DOI: 10.1016/s1726-4901(08)70039-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Postoperative paraplegia is a rare complication after epidural analgesia and often occurs with spinal hematoma or cord injury. We present the case of a 16-year-old girl who suffered from a tumor mass in the neck and abdomen who underwent gynecologic operation. Preoperatively, liver metastasis was found by computed tomography. Pathologic findings revealed that the abdominal mass was an ovarian dermoid cyst. After the operation, the patient complained of paraplegia while receiving epidural analgesia for postoperative pain control. A peripheral primitive neuroectodermal tumor in the thoracic and lumbar spines with spinal cord compression was later detected using magnetic resonance imaging. Learning from this case, we suggest that when a patient is preoperatively diagnosed with tumor metastasis, back pain and soreness, spinal cord compression from tumor metastasis should be excluded before epidural analgesia is implemented.
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Affiliation(s)
- Pei-Ching Hung
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
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Rajagopal AS, Copson E, Addis B, Shinkfield M, Mead G. Plasmablastic lymphoma: a case of rectal disease with spinal cord compression. Leuk Lymphoma 2007; 47:2670-3. [PMID: 17169819 DOI: 10.1080/10428190600909727] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
MESH Headings
- ADP-ribosyl Cyclase 1/biosynthesis
- Adult
- Antineoplastic Agents/therapeutic use
- Biopsy
- HIV Infections/complications
- HIV Infections/diagnosis
- Humans
- Immunohistochemistry/methods
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Lymphoma, AIDS-Related/complications
- Lymphoma, AIDS-Related/diagnosis
- Lymphoma, AIDS-Related/drug therapy
- Male
- Rectal Neoplasms/complications
- Rectal Neoplasms/diagnosis
- Rectal Neoplasms/drug therapy
- Remission Induction
- Spinal Cord Compression/complications
- Spinal Cord Compression/etiology
- Tomography, X-Ray Computed/methods
- Treatment Outcome
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