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Koyama K, Takahashi H, Inoue M, Okawa A, Nakajima A, Sonobe M, Akatsu Y, Saito J, Taniguchi S, Yamada M, Yamamoto K, Aoki Y, Furuya T, Koda M, Yamazaki M, Ohtori S, Nakagawa K. Intradural metastasis to the cauda equina found as the initial presentation of breast cancer: a case report. J Med Case Rep 2019; 13:220. [PMID: 31324210 PMCID: PMC6642473 DOI: 10.1186/s13256-019-2155-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 06/10/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Intradural extramedullary spinal metastasis is a relatively rare condition. Furthermore, there are few reports with the initial presentation being a neurological symptom from an intradural metastasis. We report a case of a patient with metastasis to the cauda equina from breast cancer found due to neurological symptoms as the initial presentation. CASE PRESENTATION A 76-year-old Japanese woman who was previously healthy presented to our hospital with bilateral severe buttock and lower extremity pain without any history of injury. A solitary intradural cauda equina mass was found by magnetic resonance imaging at the L2/3 level, and we suspected a schwannoma initially. The patient hoped to undergo surgery due to the severe pain. However, the chest computed tomographic scan obtained to assess the patient's general status showed the suspected breast cancer of the left side and a lung metastasis. Hence, we considered the possibility of cauda equina tumor metastatic from the breast cancer. We performed an L1-3 laminectomy and tumor extirpation. The pathology revealed adenocarcinoma. After surgery, she had relief from pain, and her status remained satisfactory until she died 9 months after surgery. CONCLUSIONS It is difficult to clarify whether the cauda equina tumor is benign or malignant based only on Magnetic resonance imaging findings. Clinicians should consider the possibility of metastasis when planning the surgery for intradural cauda equina tumor extirpation.
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Affiliation(s)
- Keita Koyama
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741 Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741 Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuoku, Chiba City, Chiba 260-8677 Japan
- Department of Orthopaedic Surgery, Chiba Eastern Medical Center, 3-6-2, Okayamadai, Togane City, Chiba 283-8686 Japan
| | - Akihiko Okawa
- Department of Orthopaedic Surgery, National Hospital Organization Chiba Medical Center, 4-1-2, Tsubakimori, Chuoku, Chiba City, Chiba 260-8606 Japan
| | - Arata Nakajima
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741 Japan
| | - Masato Sonobe
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741 Japan
| | - Yorikazu Akatsu
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741 Japan
| | - Junya Saito
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741 Japan
| | - Shinji Taniguchi
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741 Japan
| | - Manabu Yamada
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741 Japan
| | - Keiichiro Yamamoto
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741 Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Chiba Eastern Medical Center, 3-6-2, Okayamadai, Togane City, Chiba 283-8686 Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuoku, Chiba City, Chiba 260-8677 Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1, Tennodai, Tsukuba City, Ibaragi 305-8575 Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1, Tennodai, Tsukuba City, Ibaragi 305-8575 Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuoku, Chiba City, Chiba 260-8677 Japan
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741 Japan
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McKay G, Torrie PA, Bertram W, Landham P, Morris S, Hutchinson J, Watura R, Harding I. Myelography in the Assessment of Degenerative Lumbar Scoliosis and Its Influence on Surgical Management. KOREAN JOURNAL OF SPINE 2018; 14:133-138. [PMID: 29301172 PMCID: PMC5769939 DOI: 10.14245/kjs.2017.14.4.133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/25/2017] [Accepted: 11/06/2017] [Indexed: 11/24/2022]
Abstract
Objective Myelography has been shown to highlight foraminal and lateral recess stenosis more readily than computed tomography (CT) or magnetic resonance imaging (MRI). It also has the advantage of providing dynamic assessment of stenosis in the loaded spine. The advent of weight-bearing MRI may go some way towards improving assessment of the loaded spine and is less invasive, however availability remains limited. This study evaluates the potential role of myelography and its impact upon surgical decision making. Methods Of 270 patients undergoing myelography during 2006–2009, a period representing peak utilisation of this imaging modality in our unit, we identified 21 patients with degenerative scoliosis who fulfilled our inclusion criteria. An operative plan was formulated by our senior author based initially on interpretation of an MRI scan. Subsequent myelogram and CT myelogram investigations were scrutinised, with any additional abnormalities noted and whether these impacted upon the operative plan. Results From our 21 patients, 18 (85.7%) had myelographic findings not identified on MRI. Of note, in 4 patients, supine CT myelography yielded additional information when compared to supine MRI in the same patients. The management of 7 patients (33%) changed as a result of myelographic investigation. There were no complications of myelography of the total 270 analysed. Conclusion MRI scan alone understates the degree of central and lateral recess stenosis. In addition to the additional stenosis displayed by dynamic myelography in the loaded spine, we have also shown that static myelography and CT myelography are also invaluable tools with regards to surgical planning in these patients.
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Affiliation(s)
- George McKay
- Department of Spinal Surgery, Southmead Hospital, Bristol, United Kingdom
| | | | - Wendy Bertram
- Department of Spinal Surgery, Southmead Hospital, Bristol, United Kingdom
| | - Priyan Landham
- Department of Spinal Surgery, Southmead Hospital, Bristol, United Kingdom
| | - Stephen Morris
- Department of Spinal Surgery, Southmead Hospital, Bristol, United Kingdom
| | - John Hutchinson
- Department of Spinal Surgery, Southmead Hospital, Bristol, United Kingdom
| | - Roland Watura
- Department of Spinal Surgery, Southmead Hospital, Bristol, United Kingdom
| | - Ian Harding
- Department of Spinal Surgery, Southmead Hospital, Bristol, United Kingdom
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Intraoperative Myelography in Transpsoas Lateral Lumbar Interbody Fusion for Degenerative Lumbar Spinal Stenosis: A Preliminary Prospective Study. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3742182. [PMID: 29230406 PMCID: PMC5688347 DOI: 10.1155/2017/3742182] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 08/24/2017] [Accepted: 09/10/2017] [Indexed: 11/17/2022]
Abstract
Aim To investigate the feasibility and effectiveness of intraoperative myelography in determining adequacy of indirect spinal canal decompression during transpsoas lateral lumbar interbody fusion (LLIF). Methods Seven patients diagnosed with degenerative lumbar spinal stenosis (DLSS) were prospectively included to this study. All patients underwent LLIF and subsequently received intraoperative myelography to determine the effect of indirect spinal canal decompression, which was visualized in both anterior-posterior and lateral images. Those patients with insufficient indirect canal decompression were further resolved by microendoscopic canal decompression (MECD). Radiological parameters, including stenosis ratio and dural sac area of operated levels, were measured and compared before and after operation. Besides, all patients were followed up for at least one year using visual analogue scale (VAS) for back and leg, Japanese Orthopaedic Association score (JOA), and Oswestry disability index (ODI). Results Seven patients with 8 operated levels underwent LLIF safely and demonstrated significant symptom relief postoperatively. Five operated levels showed adequate indirect canal decompression intraoperatively, while the remaining three levels did not achieve the adequacy, and their residual stenosis was resolved following MECD. Radiological parameters were improved statistically when compared with preoperation (P < 0.05). Furthermore, neurological symptoms of all patients were also improved significantly (P < 0.05), shown by improved VAS (back and leg), JOA, and ODI at both two-week and one-year follow-up. Conclusions Intraoperative myelography during LLIF is able to assess adequacy of indirect canal decompression for DLSS, thus promising favorable clinical outcomes.
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