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Liang X, Wang X, Chen Y, He D, Li L, Chen G, Li J, Li J, Liu S, Xu Z. Predictive value of intraoperative contrast-enhanced ultrasound in functional recovery of non-traumatic cervical spinal cord injury. Eur Radiol 2024; 34:2297-2309. [PMID: 37707550 DOI: 10.1007/s00330-023-10221-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 07/05/2023] [Accepted: 07/15/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVES To evaluate the ability of intraoperative CEUS to predict neurological recovery in patients with degenerative cervical myelopathy (DCM). METHODS Twenty-six patients with DCM who underwent laminoplasty and intraoperative ultrasound (IOUS) were included in this prospective study. The modified Japanese Orthopaedic Association (mJOA) scores and MRI were assessed before surgery and 12 months postoperatively. The anteroposterior diameter (APD), maximum spinal cord compression (MSCC), and area of signal changes in the cord at the compressed and normal levels were measured and compared using MRI and IOUS. Conventional blood flow and CEUS indices (time to peak, ascending slope, peak intensity (PI), and area under the curve (AUC)) at different levels during IOUS were calculated and analysed. Correlations between all indicators and the neurological recovery rate were evaluated. RESULTS All patients underwent IOUS and intraoperative CEUS, and the total recovery rate was 50.7 ± 33.3%. APD and MSCC improved significantly (p < 0.01). The recovery rate of the hyperechoic lesion group was significantly worse than that of the isoechoic group (p = 0.016). 22 patients were analysed by contrast analysis software. PI was higher in the compressed zone than in the normal zone (24.58 ± 3.19 versus 22.43 ± 2.39, p = 0.019). ΔPI compress-normal and ΔAUC compress-normal of the hyperechoic lesion group were significantly higher than those of the isoechoic group (median 2.19 versus 0.55, p = 0.017; 135.7 versus 21.54, p = 0.014, respectively), and both indices were moderately negatively correlated with the recovery rate (r = - 0.463, p = 0.030; r = - 0.466, p = 0.029). CONCLUSIONS Signal changes and microvascular perfusion evaluated using CEUS during surgery are valuable predictors of cervical myelopathy prognosis. CLINICAL RELEVANCE STATEMENT In the spinal cord compression area of degenerative cervical myelopathy, especially in the hyperechoic lesions, intraoperative CEUS showed more significant contrast agent perfusion than in the normal area, and the degree was negatively correlated with the neurological prognosis. KEY POINTS • Recovery rates in patients with hyperechoic findings were lower than those of patients without lesions detected during intraoperative ultrasound. • The peak intensity of CEUS was higher in compressed zones than in the normal parts of the spinal cord. • Quantitative CEUS comparisons of the peak intensity and area under the curve at the compressed and normal levels of the spinal cord revealed differences that were inversely correlated to the recovery rate.
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Affiliation(s)
- Xuankun Liang
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Xianxiang Wang
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Yanfang Chen
- Outpatient Office, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Danni He
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Lujing Li
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Guoliang Chen
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Jiachun Li
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Jie Li
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Shaoyu Liu
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China.
| | - Zuofeng Xu
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China.
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Cao X, Jiang W, Zhang B, Zhao X, Yu H, Lei M, Cao Y, Su X, Liu Y. A New Treatment Strategy for Spinal Metastasis: The "Systemic Conditions, Effectiveness of Systemic Treatment, Neurology, and Oncology" Decision Framework System. Neurosurgery 2024; 94:584-596. [PMID: 37800928 DOI: 10.1227/neu.0000000000002709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/02/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Treating metastatic spinal tumors poses a significant challenge because there are currently no universally applied guidelines for managing spinal metastases. This study aims to propose a new decision framework for the 12-point epidural spinal cord compression grading system to treat patients with metastatic spinal tumors and investigate its clinical effectiveness in a multicenter analysis. METHODS This study analyzed 940 patients with metastatic spinal tumors between December 2017 and March 2023. The study provided the clinical evidence for the systemic conditions, effectiveness of systemic treatment, neurology, and oncology (SENO) decision framework among spine metastases. The SENO decision framework was launched in January 2021 in our hospitals, classifying patients into 2 groups: The non-SENO group (n = 489) consisted of patients treated between December 2017 and January 2021, while the SENO group (n = 451) comprised patients treated from January 2021 to March 2023. RESULTS Patients in the SENO group were more likely to receive minimally invasive surgery (67.85% vs 58.69%) and less chance of receiving spinal cord circular decompression surgery (14.41% vs 24.74%) than patients in the non-SENO group ( P < .001). Furthermore, patients in the SENO group experienced fewer perioperative complications (9.09% vs 15.34%, P = .004), incurred lower hospitalization costs ( P < .001), had shorter length of hospitalization ( P < .001), and received systematic treatments for tumors earlier ( P < .001). As a result, patients in the SENO group (329.00 [95% CI: 292.06-365.94] days) demonstrated significantly improved survival outcomes compared with those in the non-SENO group (279.00 [95% CI: 256.91-301.09], days) ( P < .001). At 3 months postdischarge, patients in the SENO group reported greater improvements in their quality of life, encompassing physical, social, emotional, and functional well-being, when compared with patients in the non-SENO group. CONCLUSION The SENO decision framework is a promising approach for treating patients with metastatic spinal tumors.
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Affiliation(s)
- Xuyong Cao
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing , China
- Department of Orthopedic Surgery, The Fifth Medical Center of PLA General Hospital, Beijing , China
| | - Weihao Jiang
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing , China
- Department of Orthopedic Surgery, The Fifth Medical Center of PLA General Hospital, Beijing , China
| | - Bin Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing , China
| | - Xiongwei Zhao
- Department of Orthopedic Surgery, The Fifth Medical Center of PLA General Hospital, Beijing , China
- Department of Orthopedic Surgery, The Fifth School of Clinical Medicine, Anhui Medical University, Anhui , China
| | - Haikuan Yu
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing , China
- Chinese PLA Medical School, Beijing , China
| | - Mingxing Lei
- Department of Orthopedic Surgery, Hainan Hospital of PLA General Hospital, Hainan , China
- Department of Orthopedic Surgery, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, PLA General Hospital, Beijing , China
- Chinese PLA Medical School, Beijing , China
| | - Yuncen Cao
- Department of Orthopedic Surgery, The Fifth Medical Center of PLA General Hospital, Beijing , China
| | - Xiuyun Su
- Intelligent Medical Innovation Institute, Southern University of Science and Technology Hospital, Shenzhen , China
| | - Yaosheng Liu
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing , China
- Department of Orthopedic Surgery, The Fifth Medical Center of PLA General Hospital, Beijing , China
- Department of Orthopedic Surgery, The Fifth School of Clinical Medicine, Anhui Medical University, Anhui , China
- Department of Orthopedic Surgery, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, PLA General Hospital, Beijing , China
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Lee DW, Kang S, Kim N. Recurrent Acute Disseminated Encephalomyelitis Presenting as Conus Medullaris Syndrome: A Case Report. Medicina (Kaunas) 2024; 60:188. [PMID: 38276067 PMCID: PMC10820680 DOI: 10.3390/medicina60010188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024]
Abstract
Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder that typically follows an infection or recent vaccination. Symptoms such as encephalopathy and focal neurological deficits appear weeks after the initial illness, leading to swift and progressive neurological decline. While ADEM in the brain has been well documented, reports of ADEM, specifically in the spinal cord, are relatively limited. A 58-year-old male presented with rapidly progressive bilateral lower extremity tingling, numbness, and mild gait disturbance approximately two days prior to visiting the emergency room. Spinal magnetic resonance imaging revealed a diffuse, longitudinal, high-signal lesion with mild enlargement of the conus and proximal cauda equina. The lesions were predominantly localized in the distal conus and cauda equina, and serial electrodiagnostic studies showed that the lesions progressed toward the proximal conus in tandem with symptom evolution and lacked clear lateralization. The patient was subsequently treated with high-dose steroids for seven days (intravenous methylprednisolone, 1 mg/kg). The patient's lower extremity weakness gradually improved and he was able to walk independently under supervision three weeks after symptom onset. In this case of spinal ADEM in a middle-aged adult, high-dose steroid treatment led to outstanding neurological recovery from both the initial occurrence and subsequent attacks.
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Affiliation(s)
| | | | - Nackhwan Kim
- Department of Physical Medicine and Rehabilitaiton, Korea University Guro Hospital, Seoul 08308, Republic of Korea; (D.-W.L.); (S.K.)
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Lebret A, Lévy S, Pfender N, Farshad M, Altorfer FCS, Callot V, Curt A, Freund P, Seif M. Investigation of perfusion impairment in degenerative cervical myelopathy beyond the site of cord compression. Sci Rep 2023; 13:22660. [PMID: 38114733 PMCID: PMC10730822 DOI: 10.1038/s41598-023-49896-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023] Open
Abstract
The aim of this study was to determine tissue-specific blood perfusion impairment of the cervical cord above the compression site in patients with degenerative cervical myelopathy (DCM) using intravoxel incoherent motion (IVIM) imaging. A quantitative MRI protocol, including structural and IVIM imaging, was conducted in healthy controls and patients. In patients, T2-weighted scans were acquired to quantify intramedullary signal changes, the maximal canal compromise, and the maximal cord compression. T2*-weighted MRI and IVIM were applied in all participants in the cervical cord (covering C1-C3 levels) to determine white matter (WM) and grey matter (GM) cross-sectional areas (as a marker of atrophy), and tissue-specific perfusion indices, respectively. IVIM imaging resulted in microvascular volume fraction ([Formula: see text]), blood velocity ([Formula: see text]), and blood flow ([Formula: see text]) indices. DCM patients additionally underwent a standard neurological clinical assessment. Regression analysis assessed associations between perfusion parameters, clinical outcome measures, and remote spinal cord atrophy. Twenty-nine DCM patients and 30 healthy controls were enrolled in the study. At the level of stenosis, 11 patients showed focal radiological evidence of cervical myelopathy. Above the stenosis level, cord atrophy was observed in the WM (- 9.3%; p = 0.005) and GM (- 6.3%; p = 0.008) in patients compared to healthy controls. Blood velocity (BV) and blood flow (BF) indices were decreased in the ventral horns of the GM (BV: - 20.1%, p = 0.0009; BF: - 28.2%, p = 0.0008), in the ventral funiculi (BV: - 18.2%, p = 0.01; BF: - 21.5%, p = 0.04) and lateral funiculi (BV: - 8.5%, p = 0.03; BF: - 16.5%, p = 0.03) of the WM, across C1-C3 levels. A decrease in microvascular volume fraction was associated with GM atrophy (R = 0.46, p = 0.02). This study demonstrates tissue-specific cervical perfusion impairment rostral to the compression site in DCM patients. IVIM indices are sensitive to remote perfusion changes in the cervical cord in DCM and may serve as neuroimaging biomarkers of hemodynamic impairment in future studies. The association between perfusion impairment and cervical cord atrophy indicates that changes in hemodynamics caused by compression may contribute to the neurodegenerative processes in DCM.
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Affiliation(s)
- Anna Lebret
- Spinal Cord Injury Center, Balgrist University Hospital, Zürich, Switzerland
| | - Simon Lévy
- CNRS, CRMBM, Aix-Marseille University, Marseille, France
- APHM, CEMEREM, Hôpital Universitaire Timone, Marseille, France
- MR Research Collaborations, Siemens Healthcare Pty Ltd, Melbourne, Australia
| | - Nikolai Pfender
- Spinal Cord Injury Center, Balgrist University Hospital, Zürich, Switzerland
| | - Mazda Farshad
- Department of Orthopedic Surgery, Balgrist University Hospital, Zürich, Switzerland
| | | | - Virginie Callot
- CNRS, CRMBM, Aix-Marseille University, Marseille, France
- APHM, CEMEREM, Hôpital Universitaire Timone, Marseille, France
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zürich, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Center, Balgrist University Hospital, Zürich, Switzerland
- Department of Brain Repair and Rehabilitation, Wellcome Trust Center for Neuroimaging, Institute of Neurology, University College London, London, UK
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Maryam Seif
- Spinal Cord Injury Center, Balgrist University Hospital, Zürich, Switzerland.
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
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Filimonova E, Vasilenko I, Kubetsky Y, Prokhorov O, Abdaev M, Rzaev J. Brainstem and subcortical regions volume loss in patients with degenerative cervical myelopathy and its association with spinal cord compression severity. Clin Neurol Neurosurg 2023; 233:107943. [PMID: 37634395 DOI: 10.1016/j.clineuro.2023.107943] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND In recent years, structural and functional reorganization of the brain and changes in brainstem structural connectivity have been shown in patients with degenerative cervical myelopathy (DCM). We hypothesized that volume loss in the basal ganglia, thalami, and brainstem structures exists and is associated with spinal cord compression severity in patients with DCM. METHODS Forty-seven patients with DCM and 25 patients with cervical radiculopathy were evaluated using cervical spinal cord and brain magnetic resonance imaging (MRI). Brainstem structures, basal ganglia, and thalami volumes were evaluated with FreeSurfer and compared between groups with correction for individual intracranial volume, as well as patient age and sex. Additionally, spinal cord MRI data were analysed with the Spinal Cord Toolbox, and cross-sectional area (CSA) and fractional anisotropy (FA) values were calculated. Correlations between MR-morphometry data and spinal cord structural changes, as well as disease duration, were also evaluated in patients with DCM. RESULTS A statistically significant reduction in the volume of the whole brainstem was revealed in the DCM group compared to the radiculopathy group (p < 0.01, FDR-corrected). Additionally, reductions in medulla oblongata, pons and midbrain volumes were found in patients with DCM (p < 0.01, p < 0.01 and p < 0.05, respectively, FDR-corrected). Additionally, a trend in the loss of volume of the left putamen was found (p = 0.087, FDR-corrected). Furthermore, medulla oblongata volume was correlated with spinal cord compression severity (R = 0.54, adjusted p < 0.001) and white matter damage (R = 0.46, adjusted p < 0.05) in patients with DCM. Negative correlations between the duration of the disease and the severity of spinal cord compression (R = -0.42, adjusted p < 0.05) and white matter damage (R = -0.49, adjusted p < 0.05) were also revealed, as well as a trend toward a negative association between the duration of the disease and the volume of the medulla oblongata (R = -0.35; adjusted p < 0.1). CONCLUSIONS We revealed a reduction in the volume of brainstem structures in patients with DCM compared to patients with radiculopathy. Moreover, we found that these changes are associated with cord compression severity.
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Affiliation(s)
- Elena Filimonova
- Federal Center of Neurosurgery Novosibirsk, Nemirovich-Danchenko Str. 132/1, Novosibirsk 630087, Russia; Novosibirsk State Medical University, Krasny Prospect St. 52, Novosibirsk 630091, Russia.
| | - Ivan Vasilenko
- Federal Center of Neurosurgery Novosibirsk, Nemirovich-Danchenko Str. 132/1, Novosibirsk 630087, Russia
| | - Yulij Kubetsky
- Federal Center of Neurosurgery Novosibirsk, Nemirovich-Danchenko Str. 132/1, Novosibirsk 630087, Russia
| | - Oleg Prokhorov
- Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Pirogov Str. 1, Novosibirsk 630090, Russia
| | - Mars Abdaev
- Federal Center of Neurosurgery Novosibirsk, Nemirovich-Danchenko Str. 132/1, Novosibirsk 630087, Russia
| | - Jamil Rzaev
- Federal Center of Neurosurgery Novosibirsk, Nemirovich-Danchenko Str. 132/1, Novosibirsk 630087, Russia; Novosibirsk State Medical University, Krasny Prospect St. 52, Novosibirsk 630091, Russia; Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Pirogov Str. 1, Novosibirsk 630090, Russia
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Fourman MS, Siraj L, Duvall J, Ramsey DC, De La Garza Ramos R, Hadzipasic M, Connolly I, Williamson T, Shankar GM, Schoenfeld A, Yassari R, Massaad E, Shin JH. Can We Use Artificial Intelligence Cluster Analysis to Identify Patients with Metastatic Breast Cancer to the Spine at Highest Risk of Postoperative Adverse Events? World Neurosurg 2023; 174:e26-e34. [PMID: 36805503 DOI: 10.1016/j.wneu.2023.02.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVE Group patients who required open surgery for metastatic breast cancer to the spine by functional level and metastatic disease characteristics to identify factors that predispose to poor outcomes. METHODS A retrospective analysis included patients managed at 2 tertiary referral centers from 2008 to 2020. The primary outcome was a 90-day adverse event. A 2-step unsupervised cluster analysis stratified patients into cohorts using function at presentation, preoperative spine radiation, structural instability, epidural spinal cord compression (ESCC), neural deficits, and tumor location/hormone status. Comparisons were performed using χ2 test and one-way analysis of variance. RESULTS Five patient "clusters" were identified. High function (HIGH) had thoracic metastases and an Eastern Cooperative Oncology Group (ECOG) score of 1.0 ± 0.8. Low function/irradiated (LOW + RADS) had preoperative radiation and the lowest Karnofsky scores (56.0 ± 10.6). Estrogen receptor or progesterone receptor (ER/PR) positive patients had >90% estrogen/progesterone positivity and moderate Karnofsky scores (74.0 ± 11.5). Lumbar/noncompressive (NON-COMP) had the fewest patients with ESCC grade 2 or 3 epidural disease (42.1%, P < 0.001). Low function/neurologic deficits (LOW + NEURO) had ESCC grade 2 or 3 disease and neurologic deficits. Adverse event rates were 25.0% in the HIGH group, 73.3% in LOW + RADS, 24.0% in ER/PR, 31.6% in NON-COMP, and 60.0% in LOW + NEURO (P = 0.003). CONCLUSIONS Function at presentation, tumor hormone signature, radiation history, and epidural compression delineated postoperative trajectory. We believe our results can aid in expectation management and the identification of at-risk patients who may merit closer surveillance following surgical intervention.
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Affiliation(s)
- Mitchell S Fourman
- Departments of Orthopaedic Surgery and Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Layla Siraj
- Departments of Orthopaedic Surgery and Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Julia Duvall
- Departments of Orthopaedic Surgery and Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Duncan C Ramsey
- Departments of Orthopaedic Surgery and Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Muhamed Hadzipasic
- Departments of Orthopaedic Surgery and Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ian Connolly
- Departments of Orthopaedic Surgery and Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Theresa Williamson
- Departments of Orthopaedic Surgery and Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ganesh M Shankar
- Departments of Orthopaedic Surgery and Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Reza Yassari
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Elie Massaad
- Departments of Orthopaedic Surgery and Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John H Shin
- Departments of Orthopaedic Surgery and Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Moradi F, Bagheri SR, Saeidiborojeni H, Eden SV, Naderi M, Hamid S, Amirian S, Amiri A, Alimohammadi E. Predictors of poor clinical outcome in patients with cervical spondylotic myelopathy undergoing cervical laminectomy and fusion. Musculoskelet Surg 2023; 107:77-83. [PMID: 34569018 DOI: 10.1007/s12306-021-00731-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cervical spondylotic myelopathy (CSM) is a common degenerative disease that arises from spinal cord compression and injury. Laminectomy with posterior spinal fusion (LPSF) is one of the most common approaches used to treat patients with CSM. The present study aimed to evaluate predictors of poor clinical outcome in patients with CSM undergoing LPSF. METHODS We retrospectively evaluated 157 patients with CSM who underwent LPSF at our center between April 2014 and June 2019. The neurological outcome was assessed using the modified Japanese Orthopaedic Association (mJOA) scale before the surgery and at the last follow-up visit. Based on the clinical outcomes, all patients were divided into two groups [the good group (recovery rates ≥ 75%) and the poor group (recovery rates < 75%)]. The following suggested variables as potential predictors for the poor clinical outcome were compared between the two groups:age, gender, body mass index (BMI), smoking, diabetes, number of laminectomy levels, presence of signal changes in Magnetic Resonance Imaging (MRI), duration of symptoms, preoperative JOA scale, preoperative Pavlov ratio, preoperative cervical curvature, and preoperative cervical range of motion (ROM). RESULTS There were 86 males (54.8%) and 71 females (45.2%) with the mean follow-up time of 24.96 ± 1.67 months. Overall, 114 patients (72.6%) had a good clinical outcome. However, 43 subjects (27.4%) failed to achieve a good outcome. According to the binary logistic regression analysis, age (odds ratio [OR], 2.14; 95% confidence interval [95% CI], 1.87-2.63; P = 0.014) and preoperative JOA scale (OR, 3.73; 95% CI 2.96-4.87; p < 0.001) were independent predictors of poor clinical outcome. CONCLUSIONS The results of the present study showed that age and preoperative JOA scale were predictors of poor clinical outcome in patients with CSM undergoing LPSF. These findings will be of great value in preoperative counseling and management of postoperative expectations.
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Affiliation(s)
- Farid Moradi
- Department of Neurosurgery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyed Reza Bagheri
- Department of Neurosurgery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Sonia V Eden
- Wayne State University School of Medicine, Detroit, USA
| | - Mobin Naderi
- Clinical Research Development Center, Imam Reza Hospital Kermanshah University of Medical Sciences, Imam Reza Hospital, Kermanshah, Iran
| | - Shafi Hamid
- Wayne State University School of Medicine, Detroit, USA
| | - Sepideh Amirian
- Department of Neurosurgery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Akram Amiri
- Department of Neurosurgery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ehsan Alimohammadi
- Department of Neurosurgery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Li GS, Chen GH, Wang KH, Wang XX, Hu XS, Wei B, Hu Y. Neurovascular Unit Compensation from Adjacent Level May Contribute to Spontaneous Functional Recovery in Experimental Cervical Spondylotic Myelopathy. Int J Mol Sci 2023; 24:ijms24043408. [PMID: 36834841 PMCID: PMC9962900 DOI: 10.3390/ijms24043408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/23/2022] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
The progression and remission of cervical spondylotic myelopathy (CSM) are quite unpredictable due to the ambiguous pathomechanisms. Spontaneous functional recovery (SFR) has been commonly implicated in the natural course of incomplete acute spinal cord injury (SCI), while the evidence and underlying pathomechanisms of neurovascular unit (NVU) compensation involved in SFR remains poorly understood in CSM. In this study, we investigate whether compensatory change of NVU, in particular in the adjacent level of the compressive epicenter, is involved in the natural course of SFR, using an established experimental CSM model. Chronic compression was created by an expandable water-absorbing polyurethane polymer at C5 level. Neurological function was dynamically assessed by BBB scoring and somatosensory evoked potential (SEP) up to 2 months. (Ultra)pathological features of NVUs were presented by histopathological and TEM examination. Quantitative analysis of regional vascular profile area/number (RVPA/RVPN) and neuroglial cells numbers were based on the specific EBA immunoreactivity and neuroglial biomarkers, respectively. Functional integrity of blood spinal cord barrier (BSCB) was detected by Evan blue extravasation test. Although destruction of the NVU, including disruption of the BSCB, neuronal degeneration and axon demyelination, as well as dramatic neuroglia reaction, were found in the compressive epicenter and spontaneous locomotor and sensory function recovery were verified in the modeling rats. In particular, restoration of BSCB permeability and an evident increase in RVPA with wrapping proliferated astrocytic endfeet in gray matter and neuron survival and synaptic plasticity were confirmed in the adjacent level. TEM findings also proved ultrastructural restoration of the NVU. Thus, NVU compensation changes in the adjacent level may be one of the essential pathomechanisms of SFR in CSM, which could be a promising endogenous target for neurorestoration.
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Affiliation(s)
- Guang-Sheng Li
- Spinal Division of Orthopedic and Traumatology Center, The Affiliated Hospital of Guangdong Medical University, Zhanjiang 524002, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Guang-Hua Chen
- Spinal Division of Orthopedic and Traumatology Center, The Affiliated Hospital of Guangdong Medical University, Zhanjiang 524002, China
- Correspondence: (G.-H.C.); (Y.H.)
| | - Kang-Heng Wang
- Spinal Division of Orthopedic and Traumatology Center, The Affiliated Hospital of Guangdong Medical University, Zhanjiang 524002, China
| | - Xu-Xiang Wang
- Spinal Division of Orthopedic and Traumatology Center, The Affiliated Hospital of Guangdong Medical University, Zhanjiang 524002, China
| | - Xiao-Song Hu
- Spinal Division of Orthopedic and Traumatology Center, The Affiliated Hospital of Guangdong Medical University, Zhanjiang 524002, China
| | - Bo Wei
- Spinal Division of Orthopedic and Traumatology Center, The Affiliated Hospital of Guangdong Medical University, Zhanjiang 524002, China
| | - Yong Hu
- Spinal Division of Orthopedic and Traumatology Center, The Affiliated Hospital of Guangdong Medical University, Zhanjiang 524002, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
- Correspondence: (G.-H.C.); (Y.H.)
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9
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Song YS, Lee IS, Nam KH, Kim DH, Han IH, Lee H, Jeong YJ, Yeom JA. Imaging Characterization of Non-Rheumatoid Retro-Odontoid Pseudotumors: Comparison with Atlantoaxial Manifestation of Rheumatoid Arthritis. Medicina (Kaunas) 2022; 58:medicina58091307. [PMID: 36143984 PMCID: PMC9503343 DOI: 10.3390/medicina58091307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/03/2022] [Accepted: 09/09/2022] [Indexed: 11/23/2022]
Abstract
Backgroundand Objectives: To date, imaging characterization of non-rheumatic retro-odontoid pseudotumors (NRROPs) has been lacking; therefore, NRROPs have been confused with atlantoaxial joint involvement of rheumatoid arthritis (RA). It is important to differentiate these two disease because the treatment strategies may differ. The purpose of this study is to characterize imaging findings of NRROPs and compare them with those of RA. Material and Methods: From January 2015 to December 2019, 27 patients (14 women and 13 men) with NRROPs and 19 patients (15 women and 4 men) with RA were enrolled in this study. We evaluated various imaging findings, including atlantoaxial instability (AAI), and measured the maximum diameter of preodontoid and retro-odontoid spaces with magnetic resonance imaging (MRI) and computed tomography (CT). Results: Statistical significance was considered for p < 0.05. AAI was detected in eight patients with NRROPs and in all patients with RA (p < 0.0001). Seventeen patients with NRROPs and six patients with RA showed spinal cord compression (p = 0.047). Compressive myelopathy was observed in 14 patients with NRROPs and in 4 patients with RA (p = 0.048). Subaxial degeneration was observed in 25 patients with NRROPs and in 9 patients with RA (p = 0.001). Moreover, C2-3 disc abnormalities were observed in 11 patients with NRROPs and in 2 patients with RA (p = 0.02). Axial and longitudinal diameter of retro-odontoid soft tissue and preodontoid and retro-odontoid spaces showed significant differences between NRROP and RA patients (p < 0.0001). Furthermore, CT AAI measurements were differed significantly between NRROP and RA patients (p < 0.05). Conclusions: NRROPs showed prominent retro-odontoid soft tissue thickening, causing compressive myelopathy and a high frequency of subaxial and C2-3 degeneration without AAI.
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10
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Kamei N, Nakanishi K, Nakamae T, Tamura T, Tsuchikawa Y, Moisakos T, Harada T, Maruyama T, Adachi N. Differences between spinal cord injury and cervical compressive myelopathy in intramedullary high-intensity lesions on T2-weighted magnetic resonance imaging: A retrospective study. Medicine (Baltimore) 2022; 101:e29982. [PMID: 36042590 PMCID: PMC9410606 DOI: 10.1097/md.0000000000029982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Increases in aging populations have raised the number of patients with cervical spinal cord injury (SCI) without fractures due to compression of the cervical spinal cord. In such patients, it is necessary to clarify whether SCI or cervical compressive myelopathy (CCM) is the cause of disability after trauma. This study aimed to clarify the differences in magnetic resonance imaging (MRI) features between SCI and CCM. Overall, 60 SCI patients and 60 CCM patients with intramedullary high-intensity lesions on T2-weighted MRI were included in this study. The longitudinal lengths of the intramedullary T2 high-intensity lesions were measured using sagittal MRI sections. Snake-eye appearance on axial sections was assessed as a characteristic finding of CCM. The T2 values of the high-intensity lesions and normal spinal cords at the first thoracic vertebra level were measured, and the contrast ratio was calculated using these values. The longitudinal length of T2 high-intensity lesions was significantly longer in SCI patients than in CCM patients. Snake-eye appearance was found in 26 of the 60 CCM patients, but not in SCI patients. On both the sagittal and axial images, the contrast ratio was significantly higher in the SCI group than in the CCM group. Based on these results, a diagnostic scale was created. This scale made it possible to distinguish between SCI and CCM with approximately 90% accuracy.
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Affiliation(s)
- Naosuke Kamei
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- *Correspondence: Naosuke Kamei, Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan (e-mail: )
| | | | - Toshio Nakamae
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takayuki Tamura
- Department of Clinical Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuji Tsuchikawa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Taiki Moisakos
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takahiro Harada
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toshiaki Maruyama
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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11
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Prasad SN, Barman B, Singh V, Das KK. Combined endovascular and surgical management of a case of Cobb syndrome. BMJ Case Rep 2022; 15:e246821. [PMID: 35228229 PMCID: PMC8886381 DOI: 10.1136/bcr-2021-246821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 11/04/2022] Open
Abstract
Cobb syndrome is a rare neurocutaneous disorder characterised by spinal and cutaneous vascular malformations in a metameric distribution. Managing such cases is a challenge for the interventionists and neurosurgeons as the results are often suboptimal. We describe a case of Cobb syndrome in a young male child who presented clinically with acute paraparesis and lower backache. On radiological workup, an intradural perimedullary complex spinal arteriovenous fistula was seen with presence of subarachnoid haemorrhage in the spinal canal and compressive myelopathy. There was a haemangioma in paraspinal muscles and a maculopapular cutaneous lesion in the lower back. He was treated with combined endovascular embolisation and surgical intervention and showed significant clinical improvement on follow-up.
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Affiliation(s)
- Surya Nandan Prasad
- Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Bapi Barman
- Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vivek Singh
- Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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12
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Bayram N, Yaman Y, Elli M, Dogan MS, Ayyildiz S, Telhan L, Çakir A, Unal D, Sebirli F, Anak S. Unusual Clinical Presentation of Hodgkin Lymphoma in a Child: Both Spinal Cord Compression and Hydronephrosis. J Pediatr Hematol Oncol 2021; 43:e900-e902. [PMID: 34001784 DOI: 10.1097/mph.0000000000002186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 03/16/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hodgkin lymphoma (HL) is predominantly a nodal disease with extranodal presentation being uncommon. Presentation with neurological symptoms is not uncommon in adult patients with HL. Subdiaphragmatic involvements are less common especially in childhood. In the literature, there has been no case which presented with both spinal cord compression and bilateral hydronephrosis in pediatric patients with HL. OBSERVATION We report a 9-year-old boy diagnosed with HL who presented with bilateral hydronephrosis and epidural involvement. CONCLUSION Differential diagnosis of abdominal mass in patients presenting with spinal cord compression and/or hydronephrosis should include HL. Retrograde J ureteral stenting is the treatment of choice for malignant ureteral obstruction.
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Affiliation(s)
- Nihan Bayram
- Departments of Pediatric Hematology and Oncology
| | - Yontem Yaman
- Departments of Pediatric Hematology and Oncology
| | - Murat Elli
- Departments of Pediatric Hematology and Oncology
| | | | | | | | | | | | - Fatih Sebirli
- Pediatrics, Istanbul Medipol University, Istanbul, Turkey
| | - Sema Anak
- Departments of Pediatric Hematology and Oncology
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13
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Price MJ, Baëta C, Dalton TE, Nguyen A, Lavau C, Pennington Z, Sciubba DM, Goodwin CR. Animal Models of Metastatic Lesions to the Spine: a Focus on Epidural Spinal Cord Compression. World Neurosurg 2021; 155:122-134. [PMID: 34343682 DOI: 10.1016/j.wneu.2021.07.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/19/2022]
Abstract
Epidural spinal cord compression (ESCC) secondary to spine metastases is one of the most devastating sequelae of primary cancer as it may lead to muscle weakness, paresthesia, pain, and paralysis. Spine metastases occur through a multi-step process that can result in eventual ESCC; however, the lack of a preclinical model to effectively recapitulate each step of this metastatic cascade and the symptom burden of ESCC has limited our understanding of this disease process. In this review, we discuss animal models that best recapitulate ESCC; we start with a broad discussion of commonly used models of bone metastasis and end with a focused discussion of models used to specifically study ESCC. Orthotopic models offer the most authentic recapitulation of metastasis development; however, they rarely result in symptomatic ESCC and are challenging to replicate. Conversely, models that involve injection of tumor cells directly into the bloodstream or bone better mimic the symptoms of ESCC; however, they provide limited insight into the epithelial to mesenchymal transition (EMT) and natural hematogenous spread of tumor cell. Therefore, until an ideal model is created, it is critical to select an animal model that is specifically designed to answer the scientific question of interest.
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Affiliation(s)
- Meghan J Price
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - César Baëta
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Tara E Dalton
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Annee Nguyen
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Catherine Lavau
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
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14
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Paliwal M, Weber KA, Smith AC, Elliott JM, Muhammad F, Dahdaleh NS, Bodurka J, Dhaher Y, Parrish TB, Mackey S, Smith ZA. Fatty infiltration in cervical flexors and extensors in patients with degenerative cervical myelopathy using a multi-muscle segmentation model. PLoS One 2021; 16:e0253863. [PMID: 34170961 PMCID: PMC8232539 DOI: 10.1371/journal.pone.0253863] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/14/2021] [Indexed: 12/27/2022] Open
Abstract
Background In patients with degenerative cervical myelopathy (DCM) that have spinal cord compression and sensorimotor deficits, surgical decompression is often performed. However, there is heterogeneity in clinical presentation and post-surgical functional recovery. Objectives Primary: a) to assess differences in muscle fat infiltration (MFI) in patients with DCM versus controls, b) to assess association between MFI and clinical disability. Secondary: to assess association between MFI pre-surgery and post-surgical functional recovery. Study design Cross-sectional case control study. Methods Eighteen patients with DCM (58.6 ± 14.2 years, 10 M/8F) and 25 controls (52.6 ± 11.8 years, 13M/12 F) underwent 3D Dixon fat-water imaging. A convolutional neural network (CNN) was used to segment cervical muscles (MFSS- multifidus and semispinalis cervicis, LC- longus capitis/colli) and quantify MFI. Modified Japanese Orthopedic Association (mJOA) and Nurick were collected. Results Patients with DCM had significantly higher MFI in MFSS (20.63 ± 5.43 vs 17.04 ± 5.24, p = 0.043) and LC (18.74 ± 6.7 vs 13.66 ± 4.91, p = 0.021) than controls. Patients with increased MFI in LC and MFSS had higher disability (LC: Nurick (Spearman’s ρ = 0.436, p = 0.003) and mJOA (ρ = -0.399, p = 0.008)). Increased MFI in LC pre-surgery was associated with post-surgical improvement in Nurick (ρ = -0.664, p = 0.026) and mJOA (ρ = -0.603, p = 0.049). Conclusion In DCM, increased muscle adiposity is significantly associated with sensorimotor deficits, clinical disability, and functional recovery after surgery. Accurate and time efficient evaluation of fat infiltration in cervical muscles may be conducted through implementation of CNN models.
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Affiliation(s)
- Monica Paliwal
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
- * E-mail:
| | - Kenneth A. Weber
- Department of Anesthesiology, Systems Neuroscience and Pain Laboratory, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, United States of America
| | - Andrew C. Smith
- Department of Physical Medicine and Rehabilitation, School of Medicine, Physical Therapy Program, Aurora, Colorado, United States of America
| | - James M. Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Faculty of Medicine and Health, University of Sydney, Kolling Institute of Medical Research, St. Leonards, New South Wales, Australia
| | - Fauziyya Muhammad
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Nader S. Dahdaleh
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, Tulsa, Oklahoma, United States of America
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, United States of America
| | - Yasin Dhaher
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Todd B. Parrish
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Sean Mackey
- Department of Anesthesiology, Systems Neuroscience and Pain Laboratory, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, United States of America
| | - Zachary A. Smith
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
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15
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Shimizu T, Demura S, Kato S, Shinmura K, Yokogawa N, Yonezawa N, Oku N, Kitagawa R, Handa M, Annen R, Nojima T, Murakami H, Tsuchiya H. Radiation Disrupts the Protective Function of the Spinal Meninges in a Mouse Model of Tumor-induced Spinal Cord Compression. Clin Orthop Relat Res 2021; 479:163-176. [PMID: 32858719 PMCID: PMC7899484 DOI: 10.1097/corr.0000000000001449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/16/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent advances in multidisciplinary treatments for various cancers have extended the survival period of patients with spinal metastases. Radiotherapy has been widely used to treat spinal metastases; nevertheless, long-term survivors sometimes undergo more surgical intervention after radiotherapy because of local tumor relapse. Generally, intradural invasion of a spinal tumor seldom occurs because the dura mater serves as a tissue barrier against tumor infiltration. However, after radiation exposure, some spinal tumors invade the dura mater, resulting in leptomeningeal dissemination, intraoperative dural injury, or postoperative local recurrence. The mechanisms of how radiation might affect the dura have not been well-studied. QUESTIONS/PURPOSES To investigate how radiation affects the spinal meninges, we asked: (1) What is the effect of irradiation on the meningeal barrier's ability to protect against carcinoma infiltration? (2) What is the effect of irradiation on the meningeal barrier's ability to protect against sarcoma infiltration? (3) What is the effect of irradiation on dural microstructure observed by scanning electron microscopy (SEM)? (4) What is the effect of irradiation on dural microstructure observed by transmission electron microscopy (TEM)? METHODS Eighty-four 10-week-old female ddY mice were randomly divided into eight groups: mouse mammary tumor (MMT) implantation 6 weeks after 0-Gy irradiation (nonirradiation) (n = 11), MMT implantation 6 weeks after 20-Gy irradiation (n = 10), MMT implantation 12 weeks after nonirradiation (n = 10), MMT implantation 12 weeks after 20-Gy irradiation (n = 11), mouse osteosarcoma (LM8) implantation 6 weeks after nonirradiation (n = 11), LM8 implantation 6 weeks after 20-Gy irradiation (n = 11), LM8 implantation 12 weeks after nonirradiation (n = 10), and LM8 implantation 12 weeks after 20-Gy irradiation (n = 10); female mice were used for a mammary tumor metastasis model and ddY mice, a closed-colony mice with genetic diversity, were selected to represent interhuman diversity. Mice in each group underwent surgery to generate a tumor-induced spinal cord compression model at either 6 weeks or 12 weeks after irradiation to assess changes in the meningeal barrier's ability to protect against tumor infiltration. During surgery, the mice were implanted with MMT (representative of a carcinoma) or LM8 tumor. When the mice became paraplegic because of spinal cord compression by the growing implanted tumor, they were euthanized and evaluated histologically. Four mice died from anesthesia and 10 mice per group were euthanized (MMT-implanted groups: MMT implantation occurred 6 weeks after nonirradiation [n = 10], 6 weeks after irradiation [n = 10], 12 weeks after nonirradiation [n = 10], and 12 weeks after irradiation [n = 10]; LM8-implanted groups: LM8 implantation performed 6 weeks after nonirradiation [n = 10], 6 weeks after irradiation [n = 10], 12 weeks after nonirradiation [n = 10], and 12 weeks after irradiation [n = 10]); 80 mice were evaluated. The spines of the euthanized mice were harvested; hematoxylin and eosin staining and Masson's trichrome staining slides were prepared for histologic assessment of each specimen. In the histologic assessment, intradural invasion of the implanted tumor was graded in each group by three observers blinded to the type of tumor, presence of irradiation, and the timing of the surgery. Grade 0 was defined as no intradural invasion with intact dura mater, Grade 1 was defined as intradural invasion with linear dural continuity, and Grade 2 was defined as intradural invasion with disruption of the dural continuity. Additionally, we euthanized 12 mice for a microstructural analysis of dura mater changes by two observers blinded to the presence of irradiation. Six mice (three mice in the 12 weeks after nonirradiation group and three mice in the 12 weeks after 20-Gy irradiation group) were quantitatively analyzed for defects on the dural surface with SEM. The other six mice (three mice in the 12 weeks after nonirradiation group and three mice in the 12 weeks after 20-Gy irradiation group) were analyzed for layer structure of collagen fibers constituting dura mater by TEM. In the SEM assessment, the number and size of defects on the dural surface on images (200 μm × 300 μm) at low magnification (× 2680) were evaluated. A total of 12 images (two per mouse) were evaluated for this assessment. The days from surgery to paraplegia were compared between each of the tumor groups using the Kruskal-Wallis test. The scores of intradural tumor invasion grades and the number of defects on dural surface per SEM image were compared between irradiation group and nonirradiation group using the Mann-Whitney U test. Interobserver reliabilities of assessing intradural tumor invasion grades and the number of dural defects on the dural surface were analyzed using Fleiss'κ coefficient. P values < 0.05 were considered statistically significant. RESULTS There was no difference in the median (range) time to paraplegia among the MMT implantation 6 weeks after nonirradiation group, the 6 weeks after irradiation group, the 12 weeks after nonirradiation group, and the 12 weeks after irradiation group (16 days [14 to 17] versus 14 days [12 to 18] versus 16 days [14 to 17] versus 14 days [12 to 15]; χ2 = 4.7; p = 0.19). There was also no difference in the intradural invasion score between the MMT implantation 6 weeks after irradiation group and the 6 weeks after nonirradiation group (8 of 10 Grade 0 and 2 of 10 Grade 1 versus 10 of 10 Grade 0; p = 0.17). On the other hand, there was a higher intradural invasion score in the MMT implantation 12 weeks after irradiation group than the 12 weeks after nonirradiation group (5 of 10 Grade 0, 3 of 10 Grade 1 and 2 of 10 Grade 2 versus 10 of 10 Grade 0; p = 0.02). Interobserver reliability of assessing intradural tumor invasion grades in the MMT-implanted group was 0.94. There was no difference in the median (range) time to paraplegia among in the LM8 implantation 6 weeks after nonirradiation group, the 6 weeks after irradiation group, the 12 weeks after nonirradiation group, and the 12 weeks after irradiation group (12 days [9 to 13] versus 10 days [8 to 13] versus 11 days [8 to 13] versus 9 days [6 to 12]; χ2 = 2.4; p = 0.50). There was also no difference in the intradural invasion score between the LM8 implantation 6 weeks after irradiation group and the 6 weeks after nonirradiation group (7 of 10 Grade 0, 1 of 10 Grade 1 and 2 of 10 Grade 2 versus 8 of 10 Grade 0 and 2 of 10 Grade 1; p = 0.51), whereas there was a higher intradural invasion score in the LM8 implantation 12 weeks after irradiation group than the 12 weeks after nonirradiation group (3 of 10 Grade 0, 3 of 10 Grade 1 and 4 of 10 Grade 2 versus 8 of 10 Grade 0 and 2 of 10 Grade 1; p = 0.04). Interobserver reliability of assessing intradural tumor invasion grades in the LM8-implanted group was 0.93. In the microstructural analysis of the dura mater using SEM, irradiated mice had small defects on the dural surface at low magnification and degeneration of collagen fibers at high magnification. The median (range) number of defects on the dural surface per image in the irradiated mice was larger than that of nonirradiated mice (2 [1 to 3] versus 0; difference of medians, 2/image; p = 0.002) and the median size of defects was 60 μm (30 to 80). Interobserver reliability of assessing number of defects on the dural surface was 1.00. TEM revealed that nonirradiated mice demonstrated well-organized, multilayer structures, while irradiated mice demonstrated irregularly layered structures at low magnification. At high magnification, well-ordered cross-sections of collagen fibers were observed in the nonirradiated mice. However, disordered alignment of collagen fibers was observed in irradiated mice. CONCLUSION Intradural tumor invasion and disruptions of the dural microstructure were observed in the meninges of mice after irradiation, indicating radiation-induced disruption of the meningeal barrier. CLINICAL RELEVANCE We conclude that in this form of delivery, radiation is associated with disruption of the dural meningeal barrier, indicating a need to consider methods to avoid or limit Postradiation tumor relapse and spinal cord compression when treating spinal metastases so that patients do not experience intradural tumor invasion. Surgeons should be aware of the potential for intradural tumor invasion when they perform post-irradiation spinal surgery to minimize the risks for intraoperative dural injury and spinal cord injury. Further research in patients with irradiated spinal metastases is necessary to confirm that the same findings are observed in humans and to seek irradiation methods that prevent or minimize the disruption of meningeal barrier function.
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Affiliation(s)
- Takaki Shimizu
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoru Demura
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoshi Kato
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazuya Shinmura
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Noriaki Yokogawa
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Noritaka Yonezawa
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Norihiro Oku
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryo Kitagawa
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Makoto Handa
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryohei Annen
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takayuki Nojima
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hideki Murakami
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroyuki Tsuchiya
- T. Shimizu, S. Demura, S. Kato, K. Shinmura, N. Yokogawa, N. Yonezawa, N. Oku, R. Kitagawa, M. Handa, R. Annen, T. Nojima, H. Tsuchiya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- H. Murakami, Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Hu JX, Gong YN, Jiang XD, Jiang L, Zhuang HQ, Meng N, Liu XG, Wei F, Liu ZJ. Local Tumor Control for Metastatic Epidural Spinal Cord Compression Following Separation Surgery with Adjuvant CyberKnife Stereotactic Radiotherapy or Image-Guided Intensity-Modulated Radiotherapy. World Neurosurg 2020; 141:e76-e85. [PMID: 32360927 DOI: 10.1016/j.wneu.2020.04.183] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND We sought to compare local tumor control after conventionally fractionated image-guided intensity-modulated radiotherapy (IMRT) versus adjuvant CyberKnife stereotactic body radiotherapy (SBRT) in patients who underwent separation surgery for metastatic epidural spinal cord compression (MESCC). METHODS We retrospectively reviewed patients with MESCC who were treated at our hospital. The Kaplan-Meier method was used to estimate local progression and overall survival. RESULTS Fifty-six patients with MESCC underwent separation surgery between 2013 and 2018, among whom 6 were lost to follow-up, 24 received conventionally fractionated image-guided IMRT, and 26 were treated with CyberKnife SBRT. The median follow-up was 16.5 months (range, 2.1-47.5 months). Eleven patients experienced local failure including 9 and 2 from the IMRT and SBRT groups, respectively. The local progression-free survival rates were significantly higher in the SBRT group than IMRT group at 6 months (95.5% vs. 82.0%), 1 year (90.9% vs. 71.8%), and 2 years (90.9% vs. 57.6%) (P = 0.035). Multivariate Cox proportional hazards regression analysis identified radiotherapy method (P = 0.034) and receipt of preoperative radiotherapy (P = 0.047) as significant predictors of local control, while visceral metastasis (P = 0.048) and high-malignancy primary tumor type (P = 0.002) were negative predictors of overall survival. Moreover, postoperative SBRT was noninferior to IMRT in terms of pain control, adverse effects, and performance in treating irradiated spinal metastases. CONCLUSIONS Hybrid surgery-radiosurgery therapy is a safe and effective treatment option for patients with MESCC. SBRT provided higher local control rates compared with IMRT. Thus postoperative SBRT should be considered for patients expected to have relatively long survival.
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Affiliation(s)
- Jin Xin Hu
- Department of Orthopedics, Peking University Third Hospital, Haidian District, Beijing, China
| | - Yi Ning Gong
- Department of Orthopedics, Peking University Third Hospital, Haidian District, Beijing, China
| | - Xu Dong Jiang
- Department of Orthopedics, Peking University Third Hospital, Haidian District, Beijing, China
| | - Liang Jiang
- Department of Orthopedics, Peking University Third Hospital, Haidian District, Beijing, China.
| | - Hong Qing Zhuang
- Department of Radiation Oncology, Cancer Center, Peking University Health Science Center, Haidian District, Beijing, China
| | - Na Meng
- Department of Radiation Oncology, Cancer Center, Peking University Health Science Center, Haidian District, Beijing, China
| | - Xiao Guang Liu
- Department of Orthopedics, Peking University Third Hospital, Haidian District, Beijing, China
| | - Feng Wei
- Department of Orthopedics, Peking University Third Hospital, Haidian District, Beijing, China
| | - Zhong Jun Liu
- Department of Orthopedics, Peking University Third Hospital, Haidian District, Beijing, China
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Duarte C, Gilbert D, Sheridan AD, PharmaD SDW, Lam ET. Pneumocystis jirovecii Pneumonia in Patients With Metastatic Prostate Cancer on Corticosteroids for Malignant Spinal Cord Compression: Two Case Reports and a Guideline Review. Oncology (Williston Park) 2020; 34:692493. [PMID: 32212136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Pneumocystis jirovecii, formerly known as Pneumocystis carinii, is an atypical fungal pathogen best known for causing Pneumocystis jirovecii pneumonia (PCP). The epidemiology of PCP is changing such that patients without HIV infection now comprise the largest subset of individuals diagnosed with PCP. While those with hematologic malignancies and organ transplants are at greatest risk for non-HIV-related PCP, this review will focus on PCP in patients with solid tumors. They are at risk for PCP due to their chemotherapy regimens and use of steroids in the management of various complications of treatment, and possibly because of the immunosuppressive effect of the cancer itself. In particular, patients with solid tumors being treated for metastatic spinal cord compression are at great risk for PCP. Patients with solid tumors and PCP face greater mortality than those with HIV infection. Multiple reviews have attempted to describe the ideal regimen of corticosteroids for metastatic spinal cord compression, but there is little consensus. We present 2 cases of patients with metastatic spinal cord compression due to prostate cancer undergoing radiation therapy and treatment with corticosteroids. These cases highlight the difficulties in predicting the length of corticosteroid therapy and the dangers that patients face without appropriate prophylaxis. This article will also provide a review of the current guidelines for PCP prophylaxis in patients undergoing treatment for metastatic spinal cord compression. We recommend empiric treatment with trimethoprim-sulfamethoxazole or dapsone in those patients with a sulfa allergy in all patients with solid tumors when any high-dose steroids are started for the treatment of metastatic spinal cord compression. Further research is needed to assess the epidemiology of PCP in patients with solid tumors and additional trials are necessary to refine PCP prophylaxis.
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Abstract
RATIONALE Spinal involvement in adult Langerhans cell histiocytosis (LCH) is rare, and epidural involvement is unusual. LCH is mostly indistinguishable from other spinal lesions such as infection, lymphoma, and metastasis. So, it could be easily misdiagnosed without suspicion. PATIENT CONCERNS We report a case of a 33-year-old man who complained of gait disturbance with weakness in both legs and severe back pain. DIAGNOSES A continuous enhancing epidural lesion with cord compression from the T7 to L1 level was detected in magnetic resonance imaging. Laboratory analysis indicated the possibility of spinal infectious disease. We assumed that the lesion could be tuberculous spondylitis. INTERVENTIONS AND OUTCOMES The patient underwent posterior laminectomy with marginal excision of the epidural mass to relieve cord compression. Pathological examination confirmed the diagnosis of LCH. The 12-month follow-up evaluation revealed that the patient was neurologically intact and had no gait disturbance. LESSONS This case report presents a patient with epidural LCH of the thoracic spinal cord, which can mimic spinal infections such as tuberculous spondylitis with abscess formation. Therefore, LCH could be considered as a possible diagnosis when a patient presents with features of infectious spondylitis with vertebral involvement.
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Hilton B, Tempest-Mitchell J, Davies BM, Francis J, Mannion RJ, Trivedi R, Timofeev I, Crawford JR, Hay D, Laing RJ, Hutchinson PJ, Kotter MRN. Cord compression defined by MRI is the driving factor behind the decision to operate in Degenerative Cervical Myelopathy despite poor correlation with disease severity. PLoS One 2019; 14:e0226020. [PMID: 31877151 PMCID: PMC6932812 DOI: 10.1371/journal.pone.0226020] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 11/17/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The mainstay treatment for Degenerative Cervical Myelopathy (DCM) is surgical decompression. Not all cases, however, are suitable for surgery. Recent international guidelines advise surgery for moderate to severe disease as well as progressive mild disease. The goal of this study was to examine the factors in current practice that drive the decision to operate in DCM. STUDY DESIGN Retrospective cohort study. METHODS 1 year of cervical spine MRI scans (N = 1123) were reviewed to identify patients with DCM with sufficient clinical documentation (N = 39). Variables at surgical assessment were recorded: age, sex, clinical signs and symptoms of DCM, disease severity, and quantitative MRI measures of cord compression. Bivariate correlations were used to compare each variable with the decision to offer the patient an operation. Subsequent multivariable analysis incorporated all significant bivariate correlations. RESULTS Of the 39 patients identified, 25 (64%) were offered an operation. The decision to operate was significantly associated with narrower non-pathological canal and cord diameters as well as cord compression ratio, explaining 50% of the variance. In a multivariable model, only cord compression ratio was significant (p = 0.017). Examination findings, symptoms, functional disability, disease severity, disease progression, and demographic factors were all non-significant. CONCLUSIONS Cord compression emerged as the main factor in surgical decision-making prior to the publication of recent guidelines. Newly identified predictors of post-operative outcome were not significantly associated with decision to operate.
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Affiliation(s)
- Bryn Hilton
- School of Clinical Medicine, University of Cambridge, Cambridge, England, United Kingdom
| | | | - Benjamin M. Davies
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, England, United Kingdom
| | - Jibin Francis
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, England, United Kingdom
| | - Richard J. Mannion
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, England, United Kingdom
| | - Rikin Trivedi
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, England, United Kingdom
| | - Ivan Timofeev
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, England, United Kingdom
| | - John R. Crawford
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, England, United Kingdom
| | - Douglas Hay
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, England, United Kingdom
| | - Rodney J. Laing
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, England, United Kingdom
| | - Peter J. Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, England, United Kingdom
| | - Mark R. N. Kotter
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, England, United Kingdom
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Rades D, Hansen O, Jensen LH, Dziggel L, Staackmann C, Doemer C, Cacicedo J, Conde-Moreno AJ, Segedin B, Ciervide-Jurio R, Rubio-Rodriguez C, Perez-Romasanta LA, Alvarez-Gracia A, Dennis K, Ferrer-Albiach C, Navarro-Martin A, Lopez-Campos F, Jankarashvili N, Janssen S, Olbrich D, Holländer NH. Radiotherapy for metastatic spinal cord compression with increased radiation doses (RAMSES-01): a prospective multicenter study. BMC Cancer 2019; 19:1163. [PMID: 31783816 PMCID: PMC6884857 DOI: 10.1186/s12885-019-6390-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/21/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Patients with metastatic spinal cord compression (MSCC) and favorable survival prognoses can benefit from radiation doses greater than 30Gy in 10 fractions in terms of improved local progression-free survival (LPFS) and overall survival (OS). METHODS/DESIGN This prospective study mainly investigates LPFS after precision radiotherapy (volumetric modulated arc therapy or stereotactic body radiotherapy) with 18 × 2.33Gy in 3.5 weeks. LPFS is defined as freedom from progression of motor deficits during radiotherapy and an in-field recurrence of MSCC following radiotherapy. The maximum relative dose allowed to the spinal cord is 101.5% of the prescribed dose, resulting in an equivalent dose in 2Gy-fractions (EQD2) for radiation myelopathy is 45.5Gy, which is below the tolerance dose of 50Gy according to the Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC). The EQD2 of this regimen for tumor cell kill is 43.1Gy, which is 33% higher than for 30Gy in 10 fractions (EQD2 = 32.5Gy). Primary endpoint is LPFS at 12 months after radiotherapy. Secondary endpoints include the effect of 18 × 2.33Gy on motor function, ambulatory status, sensory function, sphincter dysfunction, LPFS at other follow-up times, overall survival, pain relief, relief of distress and toxicity. Follow-up visits for all endpoints will be performed directly and at 1, 3, 6, 9 and 12 months after radiotherapy. A total of 65 patients are required for the prospective part of the study. These patients will be compared to a historical control group of at least 235 patients receiving conventional radiotherapy with 10x3Gy in 2 weeks. DISCUSSION If precision radiotherapy with 18 × 2.33Gy results in significantly better LPFS than 10x3Gy of conventional radiotherapy, this regimen should be strongly considered for patients with MSCC and favorable survival prognoses. TRIAL REGISTRATION Clinicaltrials.gov NCT04043156. Registered 30-07-2019.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Olfred Hansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | | | - Liesa Dziggel
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Christian Staackmann
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Claudia Doemer
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Jon Cacicedo
- Department of Radiation Oncology, Cruces University Hospital, Barakaldo, Vizcaya Spain
| | - Antonio J. Conde-Moreno
- Department of Radiation Oncology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Barbara Segedin
- Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | | | | | - Ana Alvarez-Gracia
- Department of Radiation Oncology, ICO - University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Kristopher Dennis
- Division of Radiation Oncology, The Ottawa Hospital & University of Ottawa, Ottawa, Canada
| | - Carlos Ferrer-Albiach
- Department of Radiation Oncology, Consorcio Hospital Provincial de Castellón, Castellón, Spain
| | - Arturo Navarro-Martin
- Department of Radiation Oncology, Catalan Institute of Oncology, L’Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Stefan Janssen
- Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany
| | | | - Niels Henrik Holländer
- Department of Oncology and Palliative Units, Zealand University Hospital, Naestved, Denmark
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Vansteenkiste DP, Fenger JM, Fadda P, Martin‐Vaquero P, da Costa RC. MicroRNA expression in the cerebrospinal fluid of dogs with and without cervical spondylomyelopathy. J Vet Intern Med 2019; 33:2685-2692. [PMID: 31639228 PMCID: PMC6872614 DOI: 10.1111/jvim.15636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/24/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Osseous-associated cervical spondylomyelopathy (OA-CSM) is a common condition of the cervical vertebral column that affects giant dog breeds. MicroRNAs (miRNAs) are small RNAs that regulate gene expression, and recent data suggest that circulating miRNAs present in biological fluids may serve as potential biomarkers for disease. The miRNA profiles of cerebrospinal fluid (CSF) from healthy dogs and dogs clinically affected by OA-CSM have not been described. OBJECTIVE To characterize the expression levels of miRNAs present in the CSF of normal Great Danes and identify differentially expressed miRNAs in the CSF of Great Danes clinically affected with OA-CSM. ANIMALS Client-owned dogs: 12 control, 12 OA-CSM affected. METHODS Cerebrospinal fluid samples were collected prospectively. MicroRNA expression was evaluated using the NanoString nCounter platform and quantitative real-time PCR. RESULTS We identified 8 miRNAs with significant differential expression. MiR-299-5p and miR-765 had increased expression levels in the CSF of OA-CSM-affected dogs, whereas miR-494, miR-612, miR-302-d, miR-4531, miR-4455, and miR-6721-5p had decreased expression levels in OA-CSM affected dogs compared to clinically normal dogs. Quantitative real-time PCR was performed to validate the expression levels of 2 miRNAs (miR-494 and miR-612), and we found a 1.5-fold increase in miR-494 expression and a 1.2-fold decrease in miR-612 in the CSF of the OA-CSM affected group (P = .41 and .89, respectively). CONCLUSIONS AND CLINICAL IMPORTANCE Data generated from our study represent an initial characterization of the miRNA profile of normal canine CSF and suggest that a distinct CSF miRNA expression profile is associated with OA-CSM.
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Affiliation(s)
- Daniella P. Vansteenkiste
- Department of Veterinary Clinical SciencesThe Ohio State University, College of Veterinary MedicineColumbusOhio
| | - Joelle M. Fenger
- Department of Veterinary Clinical SciencesThe Ohio State University, College of Veterinary MedicineColumbusOhio
| | - Paolo Fadda
- Comprehensive Cancer Center, Genomics Shared ResourceThe Ohio State UniversityColumbusOhio
| | | | - Ronaldo C. da Costa
- Department of Veterinary Clinical SciencesThe Ohio State University, College of Veterinary MedicineColumbusOhio
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Abstract
BACKGROUND Cervical spine deformity in rhizomelic chondrodysplasia punctata (RCDP) has been described with different findings reported in the literature. However, available literature provides limited data from a few cases with magnetic resonance imaging (MRI) of the cervical spine. Our report describes the MRI findings in a group of children with RCDP, aiming to reach a better understanding of this pathology. METHODS An Institutional Review Board-approved RCDP Registry was created at our institution with the goal of identifying pertinent medical issues over the lifespan of individuals with RCDP. Records of children within the registry were evaluated, and magnetic resonance images obtained between 2004 and 2015, were available for review. The levels of spinal canal stenosis were recorded and the severity of the stenosis was decided based on adults' parameters. Cord compression and myelomalacia were confirmed on the axial images. Sagittal lumbar spine magnetic resonance images were also evaluated when available, and the presence of tethered cord and fatty filum was recorded. RESULTS Twenty-six children (15 boys and 11 girls) were identified in the RCDP Registry. Eleven children (6 boys and 5 girls) had sagittal MRI of the cervical spine available for review. Age at the time of MRI study was variable (1 wk to 32 mo). All patients except 1 had stenosis of the cervical spinal canal. Myelomalacia of the cord was noted only in this patient. CONCLUSIONS This study suggests that, in children with RCDP, cervical spinal stenosis and cord compression are a real risk, and children with this diagnosis should have monitoring for these issues. Tethered cord is also a possible finding that needs to be evaluated. Full sagittal spine MRI is necessary to detect the possible deformities at the cervical and lumbar levels.
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Affiliation(s)
- Oussama Abousamra
- Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
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Abstract
Hirayama disease is a rare juvenile amyotrophy that is often misdiagnosed as an unrelated, relentlessly progressive disease. We present the case of an 18-year-old man who presented with weakness and atrophy of the right forearm and hand. Dynamic cervical magnetic resonance imaging was used, revealing the classic findings of epidural venous plexus dilation and anterior displacement of the dural sac. In addition, dilation of the external vertebral venous plexus was visualized. We discuss the clinical utility of dynamic magnetic resonance imaging and the underlying pathophysiology of these findings in Hirayama disease.
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Affiliation(s)
- Mathew B Macey
- Department of Neurology, Lahey Hospital and Medical Center, Burlington, MA
| | - Doreen T Ho
- Department of Neurology, Lahey Hospital and Medical Center, Burlington, MA
| | | | - Juan E Small
- Department of Diagnostic Radiology, Lahey Hospital and Medical Center, Burlington, MA
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Szklarz M, Lipinska A, Slowikowska M, Niedzwiedz A, Marycz K, Janeczek M. Comparison of the clinical and radiographic appearance of the cervical vertebrae with histological and anatomical findings in an eight-month old warmblood stallion suffering from cervical vertebral stenotic myelopathy (CVSM). BMC Vet Res 2019; 15:296. [PMID: 31416466 PMCID: PMC6694563 DOI: 10.1186/s12917-019-2047-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 08/11/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Cervical vertebral stenotic myelopathy (CVSM) remains one of the most important abnormalities of the cervical spine resulting in neurological deficits in horses. The aim of the following study was to compare the results of the clinical and neurological examination, the results of myelography and the post mortem anatomical and histological appearance of the spinal cord and cervical vertebrae in a horse with CVSM. CASE PRESENTATION The following study describes a clinical case of an eight-month-old stallion with ataxia. Plain cervical radiographs indicated narrowing of the spinal canal. Conservative therapy using NSAIDs did not result in any improvement in the gait of the horse. Due to economic constraints, surgical intervention was excluded. The owner chose to humanely euthanise the horse. Immediately after euthanasia, post mortem myelography was performed, and measurements of the myelographic dye column were taken. They revealed a 67% DMC reduction and a 64% DD reduction at the C3/C4 level. Afterwards, an anatomical dissection was performed. The cervical vertebrae and vertebral canal were macroscopically inspected and measured and indicated a 44% narrowing of the canal at the C3/C4 level. The spinal cord was removed and underwent histological evaluation after staining. Microscopic lesions were visible at the level of the compression and included axonal degeneration with partial or complete loss of myelin in the white matter of the lateral and dorsal funiculi as well as the formation of dysfunctional so-called "spongy structures". An increase in the number of microglial cells and collagen was also observed. The formation of glial scars was excluded. Immunohistochemical studies revealed a negative transmembrane glycoprotein CD68(-) - monocyte response and a negative tumor necrosis alpha TNFα (-) reaction. CONCLUSIONS CVSM may be difficult to diagnose, even for experienced veterinary surgeons. Currently, an ex vivo histopathologic examination of the spinal cord is thought to be the gold standard in the diagnosis of CVSM. Our histological examination revealed no CVSM-specific glial scar formation and a CD68(-) negative and TNF-α negative reaction, which have not been previously reported. Histological lesions in CVSM may vary depending show inter-individual variability and on the treatment, which further hinders ex-vivo diagnostics.
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Affiliation(s)
- Magdalena Szklarz
- Department of Animal Physiology and Biostructure, Wroclaw University of Environmental and Life Sciences Faculty of Veterinary Medicine, ul Kozuchowska 1/3, 51-631 Wroclaw, Wrocław, Poland
| | - Anna Lipinska
- Department of Animal Physiology and Biostructure, Wroclaw University of Environmental and Life Sciences Faculty of Veterinary Medicine, ul Kozuchowska 1/3, 51-631 Wroclaw, Wrocław, Poland
| | - Malwina Slowikowska
- Department of Internal Diseases with Clinic for Horses, Dogs and Cats, Wroclaw Univeristy of Environmental and Life Sciences, Faculty of Veterinary Medicine, Pl. Grunwaldzki 47, 50-366 Wroclaw, Wrocław, Poland
| | - Artur Niedzwiedz
- Department of Internal Diseases with Clinic for Horses, Dogs and Cats, Wroclaw Univeristy of Environmental and Life Sciences, Faculty of Veterinary Medicine, Pl. Grunwaldzki 47, 50-366 Wroclaw, Wrocław, Poland
| | - Krzysztof Marycz
- Department of Experimental Biology, Wroclaw University of Environmental and Life Sciences, Faculty of Biology and Animal Science, ul Norwida 27B, 50-375 Wrocław, Poland
| | - Maciej Janeczek
- Department of Animal Physiology and Biostructure, Wroclaw University of Environmental and Life Sciences Faculty of Veterinary Medicine, ul Kozuchowska 1/3, 51-631 Wroclaw, Wrocław, Poland
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Chanchlani N, Reading NG. A middle aged man with back pain and heavy legs. BMJ 2019; 366:l2420. [PMID: 31315837 DOI: 10.1136/bmj.l2420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Guzzi G, Volpentesta G, Chirchiglia D, Della Torre A, Lavano F, Lavano A. Cervical spinal cord compression from delayed epidural scar tissue formation around plate lead for SCS. J Neurosurg Sci 2019; 63:337-343. [PMID: 26430719 DOI: 10.23736/s0390-5616.16.03449-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Giusy Guzzi
- Department of Neurosurgery, University "Magna Graecia", Campus "S. Venuta", Catanzaro, Italy
| | - Giorgio Volpentesta
- Department of Neurosurgery, University "Magna Graecia", Campus "S. Venuta", Catanzaro, Italy
| | - Domenico Chirchiglia
- Department of Neurosurgery, University "Magna Graecia", Campus "S. Venuta", Catanzaro, Italy
| | - Attilio Della Torre
- Department of Neurosurgery, University "Magna Graecia", Campus "S. Venuta", Catanzaro, Italy
| | - Francesco Lavano
- Department of Neurosurgery, University "Magna Graecia", Campus "S. Venuta", Catanzaro, Italy
| | - Angelo Lavano
- Department of Neurosurgery, University "Magna Graecia", Campus "S. Venuta", Catanzaro, Italy -
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Pluemvitayaporn T, Kunakornsawat S, Piyaskulkaew C, Pruttikul P, Pongpinyopap W. Chronic posterior atlantoaxial subluxation associated with os odontoideum: a rare condition. A case report and literature review. Spinal Cord Ser Cases 2018; 4:110. [PMID: 30588336 PMCID: PMC6300540 DOI: 10.1038/s41394-018-0143-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/16/2018] [Accepted: 11/19/2018] [Indexed: 01/04/2023] Open
Abstract
Introduction Os odontoideum is a rare cervical lesion. This unusual condition is sometimes associated with atlantoaxial subluxation, which is mostly anterior subluxation. Posterior atlantoaxial subluxation due to os odontoideum is extremely rare. Case presentation We report an unusual case of a 60-year-old Thai female, who was diagnosed as having chronic posterior atlantoaxial subluxation associated with os odontoideum with progressive myelopathy. The patient underwent posterior arch of C1 laminectomy and an occipito-C3 fusion using an occipital plate, C2 pedicle screws, C3 lateral mass screws and autologous iliac crest strut bone graft arthrodesis. During three years of follow-up, she was clinically significantly improved and postoperative radiographs showed a solid osseous fusion without loss of correction or implant failure. Discussion Chronic posterior atlantoaxial subluxation associated with os odontoideum is rare. This condition can cause occipital-cervical pain, myelopathy, intracranial symptoms, or death. Surgical decompression and stabilization is the treatment of choice. Principles of treatment are to prevent sudden death from neurological compromise, improve neurological status, stabilize the cervical spine, and improve quality of life. Surgical options include atlantoaxial fusion, occipito-C2 fusion, and occipito-C3 fusion. Decision making depends on the location of spinal cord compression, area for arthrodesis, and bone quality.
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Hoti YUD, Aziz A, Ishaque K, Abbas S, Ud Din TS. Clinical Outcome of Laminoplasty in Cervical Myelopathy. J Coll Physicians Surg Pak 2018; 28:466-469. [PMID: 29848425 DOI: 10.29271/jcpsp.2018.06.466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 02/26/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The objective of the study was to assess the effectiveness of laminoplasty in terms of improvement in the Japanese Orthopedics Association (JOA) score in cervical spondylotic myelopathy (CSM). STUDY DESIGN Descriptive study. PLACE AND DURATION OF STUDY Department of Neurosurgery, Lahore General Hospital, Lahore, from June 2014 to October 2016. METHODOLOGY All patients having CSM were assessed preoperatively and postoperatively by JOA score and radiological findings. Preoperative X-rays of cervical spine were done to rule out kyphotic deformity. CT scan and MRI of cervical spine were obtained preoperatively to assess the pathology. Single-door laminoplasty with modified trauma plates were applied in each case by making the hinge over the right side. Digital cervical spine X-rays and CT scans with axial reconstruction were obtained postoperatively in all patients, ensuring spinal canal widening and stability. RESULTS Among the 36 patients, 24 were males and 12 females, age ranging from 35 to 80 years. All the patients did extremely well with marked improvement in the symptomatology. The JOA scored improved in 32 patients, remained static in three patients and one patient had slight deterioration, which later on improved. Three patients developed postoperative kyphotic deformity, which settled in three months. Postoperative radiology showed significant increase in the axial diameter of spine. CONCLUSION Cervical laminoplasty remains an effective method for posterior decompression of spine. The most promising approach to cervical myelopathy ought to take into account both the features of patients and disease, as well as the competency and skills of the surgeon.
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Affiliation(s)
| | - Amir Aziz
- Department of Neurosurgery Unit II, Lahore General Hospital, Lahore
| | - Khurram Ishaque
- Department of Neurosurgery Unit II, Lahore General Hospital, Lahore
| | - Sadia Abbas
- Department of Neurosurgery Unit II, Lahore General Hospital, Lahore
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Amelot A, Terrier LM, Lot G. Predictive factors of neurological recovery after chronic craniovertebral brainstem compression. Acta Neurochir (Wien) 2018; 160:1243-1250. [PMID: 29582153 DOI: 10.1007/s00701-018-3523-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/15/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neurologic manifestations of craniovertebral junction (CVJ) disease may generate dramatic brainstem damage, which could evolve to paralysis. In most cases, patients are referred with advanced neurological symptoms such as tetraplegia/paresis. The aim of this study was to identify predictive factors of favorable neurological evolution after non-traumatic brainstem compression. METHODS A prospective study evaluated 143 consecutive patients who had undergone CVJ anterior brainstem decompression. The mean age was 45.1 ± 19.1 years. The study analyzed clinical, surgical, and imagery characters to determine predictive factors of neurological improvement. RESULTS The mean follow-up of our series was 10.2 years (range 0.5-23.9). Seventy-one (49.6%) presented initial tetrapalsies resulting from spinal cord compression. Multivariable analysis revealed that Frankel score [odds ratio (OR) 5.7, CI 95% 1.01-31.8; p < 0.04] and preoperative symptoms < 6 months [OR 0.33, CI 95% 0.125-0.9; p < 0.025] were independently associated with partial neurological improvement, while the only independent factor associated with total neurologic recovery was the preoperative symptom evolution <6 months [odd ratio (OR) 4.3, CI 95% 1.6-11.4; p < 0.003]. None of the following were identified as predictive factors: demographic characteristics, medical history, the etiology of compression, or initial spinal cord MRI. CONCLUSION The earlier the decompression is performed, the better the neurological improvement. Whatever the initial Frankel score, if neurological palsy or disorders evolved for less than 6 months, complete recovery is possible.
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Affiliation(s)
- Aymeric Amelot
- Department of Neurosurgery, Fondation Adolphe de Rothschild, 25 Rue Manin, 75019, Paris, France.
- Department of Neurosurgery, Centre Hospitalier Universitaire de Tours, Tours, France.
| | - Louis-Marie Terrier
- Department of Neurosurgery, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Guillaume Lot
- Department of Neurosurgery, Fondation Adolphe de Rothschild, 25 Rue Manin, 75019, Paris, France
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Bonelli MDA, Shah A, Goel V, Costa FS, da Costa RC. Development of a finite element model of the ligamentous cervical vertebral column of a Great Dane. Res Vet Sci 2018; 118:97-100. [PMID: 29421491 DOI: 10.1016/j.rvsc.2018.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/20/2017] [Accepted: 01/15/2018] [Indexed: 11/19/2022]
Abstract
Cervical spondylomyelopathy (CSM), also known as wobbler syndrome, affects mainly large and giant-breed dogs, causing compression of the cervical spinal cord and/or nerve roots. Structural and dynamic components seem to play a role in the development of CSM; however, pathogenesis is not yet fully understood. Finite element models have been used for years in human medicine to study the dynamic behavior of structures, but it has been mostly overlooked in veterinary studies. To our knowledge, no specific ligamentous spine models have been developed to investigate naturally occurring canine myelopathies and possible surgical treatments. The goal of this study was to develop a finite element model (FEM) of the C2-C7 segment of the ligamentous cervical vertebral column of a neurologically normal Great Dane without imaging changes. The FEM of the intact C2-C7 cervical vertebral column had a total of 188,906 elements (175,715 tetra elements and 12,740 hexa elements). The range of motion (in degrees) for the FEM subjected to a moment of 2Nm was approximately 27.94 in flexion, 25.86 in extension, 24.14 in left lateral bending, 25.27 in right lateral bending, 17.44 in left axial rotation, and 16.72 in right axial rotation. We constructed a ligamentous FEM of the C2-C7 vertebral column of a Great Dane dog, which can serve as a platform to be modified and adapted for studies related to biomechanics of the cervical vertebral column and to further improve studies on osseous-associated cervical spondylomyelopathy.
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Affiliation(s)
- Marília de Albuquerque Bonelli
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, 601 Vernon Tharp St, Columbus, OH 43210, USA; Department of Veterinary Medicine, Federal Rural University of Pernambuco, R. Dom Manoel de Medeiros s/n, Recife, PE 52171-900, Brazil
| | - Anoli Shah
- Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Surgery, College of Engineering and Medicine, University of Toledo, 2801 West Bancroft St., Toledo, OH 43606, USA.
| | - Vijay Goel
- Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Surgery, College of Engineering and Medicine, University of Toledo, 2801 West Bancroft St., Toledo, OH 43606, USA.
| | - Fabiano Séllos Costa
- Department of Veterinary Medicine, Federal Rural University of Pernambuco, R. Dom Manoel de Medeiros s/n, Recife, PE 52171-900, Brazil
| | - Ronaldo Casimiro da Costa
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, 601 Vernon Tharp St, Columbus, OH 43210, USA.
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Nikoleishvili D, Koberidze G, Kutateladze M, Zumbadze G, Mariamidze A. BILATERAL ADRENOCORTICAL CARCINOMA: CASE REPORT AND REVIEW OF LITERATURE. Georgian Med News 2018:19-24. [PMID: 29461221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Adrenocortical carcinoma is a very rare and aggressive endocrinological malignancy arising from the adrenal cortex. The estimated incidence is 1 per million people, with an estimated 5-year survival rate of 16-47%. It can be bilateral in roughly 2-10% of cases, but the data is scarce and there is no conclusive evidence whether the contralateral mass is an independent tumor or a metastasis from the other adrenal gland cancer. Radical surgical excision is the only curative treatment. Therefore, careful pre- and intraoperative surgical planning is critically important. Open adrenalectomy has historically been the gold standard approach for surgical treatment of adrenocortical carcinoma. Laparoscopic adrenalectomy has emerged as a minimally invasive alternative, but its oncological safety and effectiveness has long been under debate. Current evidence suggests that in experienced hands laparoscopic adrenalectomy is as safe and effective as its open counterpart in the treatment of localized adrenocortical carcinoma and the adrenal masses ≤10 cm. Urologists have been tempted to apply laparoscopy also to bilateral disease, although the need to reposition the patient and a longer operative time can be limitations. Given the rarity of adrenocortical carcinoma and the lack of quality evidence for the bilateral disease, we used the conventional narrative strategy to review the available literature. We also report a case of nonfunctioning bilateral adrenocortical carcinoma in a 65-year old man, who was operated on with simultaneous bilateral laparoscopic adrenalectomy for suspected localized (stage 2) disease, which proved to be bilateral locally advanced carcinoma (stage 3). Postoperatively, the disease rapidly progressed to the fatal outcome. The case once again highlights the importance of detailed operative planning and the need of imaging studies as close as possible to the date of planned surgery.
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Affiliation(s)
- D Nikoleishvili
- Medical Center "MediClubGeorgia" Tbilisi; Pathology Research Center, Tbilisi, Georgia
| | - G Koberidze
- Medical Center "MediClubGeorgia" Tbilisi; Pathology Research Center, Tbilisi, Georgia
| | - M Kutateladze
- Medical Center "MediClubGeorgia" Tbilisi; Pathology Research Center, Tbilisi, Georgia
| | - G Zumbadze
- Medical Center "MediClubGeorgia" Tbilisi; Pathology Research Center, Tbilisi, Georgia
| | - A Mariamidze
- Medical Center "MediClubGeorgia" Tbilisi; Pathology Research Center, Tbilisi, Georgia
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Yang YM, Yoo WK, Yoo JH, Kwak YH, Oh JK, Song JS, Kim SW. The functional relevance of diffusion tensor imaging in comparison to conventional MRI in patients with cervical compressive myelopathy. Skeletal Radiol 2017; 46:1477-1486. [PMID: 28714054 DOI: 10.1007/s00256-017-2713-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/21/2017] [Accepted: 07/03/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the functional relevance of diffusion tensor imaging (DTI) metrics and conventional MRI (signal intensity change in T2, compression ratio) by measuring the correlation of these parameters with clinical outcome measured by the modified Japanese Orthopedic Association (mJOA) score. MATERIALS AND METHODS A total of 20 cervical myelopathy (CM) patients participated in this prospective cohort study. The severities of CM were assessed using the mJOA score. Conventional MRIs (T2-weighted images) measuring the signal changes of spinal cords and the degree of compression at the lesion level and DTI metrics [fractional anisotropy (FA), apparent diffusion coefficient (ADC)] at each lesion and below each lesion (C7/T1) level were acquired using a 3-T Achieva MRI. These parameters were correlated with the mJOA scores to determine the functional relevance. RESULTS Ninety percent of CM patients showed signal changes and 30 % of patients noted a more than 40% canal compression ratio in conventional MRIs at the lesion level; however, these findings were not correlated with the mJOA score (p < 0.05). In contrast, FA values on DTI showed high sensitivity to CM (100%), which was well correlated with the mJOA score (p = 0.034, r = 0.475) below the lesion level (C7/T1). CONCLUSIONS This study showed a meaningful symptomatic correlation between mJOA scores and FA values below the lesion levels in CM patients. It could give us more understanding of the pathological changes in spinal cords matched with various clinical findings in CM patients than the results from conventional MRI.
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Affiliation(s)
- Young-Mi Yang
- Spine Center, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, South Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang-si, South Korea
- Hallym Institute for Translational Genomics & Bioinformatics, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang-si, South Korea
| | - Je Hyun Yoo
- Department of Orthopaedic surgery, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang-si, South Korea
| | - Yoon Hae Kwak
- Department of Orthopaedic surgery, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang-si, South Korea
| | - Jae-Keun Oh
- Spine Center, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, South Korea
| | - Ji-Sun Song
- Spine Center, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, South Korea
| | - Seok Woo Kim
- Spine Center, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, South Korea.
- Department of Orthopaedic surgery, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang-si, South Korea.
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Dalolio M, Lucarella F, Rampini P, Bulfamante GP, Aldea S, Graveleau P, Gaillard S, Scarone P. Neurosurgical aspects of dialysis-related spinal amyloidosis: Report of three cases and a review of the literature. Neurochirurgie 2017; 63:314-319. [PMID: 28882602 DOI: 10.1016/j.neuchi.2016.11.110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/12/2016] [Accepted: 11/09/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Osteoarticular manifestations of beta-2 microglobulin amyloidosis are often diagnosed in long-term dialyzed patients. However, spinal involvement is rare (10-25% of patients), and generally not associated with neurological deterioration. Compression of the spinal cord or roots is extremely rare, and probably under-recognized. METHODS The authors describe three cases of spinal stenosis presenting with neurological signs in long-term dialyzed patients, prospectively collected over 2 years in two different institutions and treated by surgical decompression. In all three cases, the main cause of neural compression was amyloid deposition in the spine, either extradurally in the ligamentum flavum or intradurally. RESULTS All patients improved after surgery and did not present any postoperative complications. However, two out of three patients with amyloid in the cervical spine required surgical revision to obtain a satisfactory decompression of the spinal cord. DISCUSSION The authors discuss spinal amyloidosis which is a well-known complication of long-term dialysis. However, neurological complications such as spinal cord or radicular symptoms have been rarely reported and, when present in dialyzed patients, are symptoms that are often attributed to other causes. To our knowledge, this is the first case series that demonstrates the relationship between neurological deterioration and amyloid depositions in the spinal canal that occur in long-term dialyzed patients. The prevalence of spinal stenosis related to the presence of amyloid in this specific subgroup of patients is probably underestimated.
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Affiliation(s)
- M Dalolio
- Neurosurgery, department of neurological sciences, Università degli Studi di Milano, Fondazione IRCSS Cà Granda - Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - F Lucarella
- Neurosurgery, department of neurological sciences, Università degli Studi di Milano, Fondazione IRCSS Cà Granda - Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - P Rampini
- Neurosurgery, department of neurological sciences, Università degli Studi di Milano, Fondazione IRCSS Cà Granda - Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - G P Bulfamante
- Unit of human pathology, department of health sciences, San Paolo hospital medical school, 20100 Milan, Italy
| | - S Aldea
- Department of neurology and neurosurgery, hôpital Foch, 92150 Sureness, France
| | - P Graveleau
- Department of neurology and neurosurgery, hôpital Foch, 92150 Sureness, France
| | - S Gaillard
- Department of neurology and neurosurgery, hôpital Foch, 92150 Sureness, France
| | - P Scarone
- Neurosurgery, department of neurological sciences, Università degli Studi di Milano, Fondazione IRCSS Cà Granda - Ospedale Maggiore Policlinico, 20122 Milan, Italy.
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Schaal SM, Kitay BM, Cho KS, Lo TP, Barakat DJ, Marcillo AE, Sanchez AR, Andrade CM, Pearse DD. Schwann Cell Transplantation Improves Reticulospinal Axon Growth and Forelimb Strength after Severe Cervical Spinal Cord Contusion. Cell Transplant 2017; 16:207-28. [PMID: 17503734 DOI: 10.3727/000000007783464768] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Schwann cell (SC) implantation alone has been shown to promote the growth of propriospinal and sensory axons, but not long-tract descending axons, after thoracic spinal cord injury (SCI). In the current study, we examined if an axotomy close to the cell body of origin (so as to enhance the intrinsic growth response) could permit supraspinal axons to grow onto SC grafts. Adult female Fischer rats received a severe (C5) cervical contusion (1.1 mm displacement, 3 KDyn). At 1 week postinjury, 2 million SCs ex vivo transduced with lentiviral vector encoding enhanced green fluorescent protein (EGFP) were implanted within media into the injury epicenter; injury-only animals served as controls. Animals were tested weekly using the BBB score for 7 weeks postimplantation and received at end point tests for upper body strength: self-supported forelimb hanging, forearm grip force, and the incline plane. Following behavioral assessment, animals were anterogradely traced bilaterally from the reticular formation using BDA-Texas Red. Stereological quantification revealed a twofold increase in the numbers of preserved NeuN+ neurons rostral and caudal to the injury/graft site in SC implanted animals, corroborating previous reports of their neuroprotective efficacy. Examination of labeled reticulospinal axon growth revealed that while rarely an axon was present within the lesion site of injury-only controls, numerous reticulospinal axons had penetrated the SC implant/lesion milieu. This has not been observed following implantation of SCs alone into the injured thoracic spinal cord. Significant behavioral improvements over injury-only controls in upper limb strength, including an enhanced grip strength (a 296% increase) and an increased self-supported forelimb hanging, accompanied SC-mediated neuroprotection and reticulospinal axon growth. The current study further supports the neuroprotective efficacy of SC implants after SCI and demonstrates that SCs alone are capable of supporting modest supraspinal axon growth when the site of axon injury is closer to the cell body of the axotomized neuron.
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Affiliation(s)
- S M Schaal
- The Miami Project to Cure Paralysis, University of Miami School of Medicine, Miami, FL 33101, USA
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Orr MB, Simkin J, Bailey WM, Kadambi NS, McVicar AL, Veldhorst AK, Gensel JC. Compression Decreases Anatomical and Functional Recovery and Alters Inflammation after Contusive Spinal Cord Injury. J Neurotrauma 2017; 34:2342-2352. [PMID: 28381129 DOI: 10.1089/neu.2016.4915] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Experimental models of spinal cord injury (SCI) typically utilize contusion or compression injuries. Clinically, however, SCI is heterogeneous and the primary injury mode may affect secondary injury progression and neuroprotective therapeutic efficacy. Specifically, immunomodulatory agents are of therapeutic interest because the activation state of SCI macrophages may facilitate pathology but also improve repair. It is unknown currently how the primary injury biomechanics affect macrophage activation. Therefore, to determine the effects of compression subsequent to spinal contusion, we examined recovery, secondary injury, and macrophage activation in C57/BL6 mice after SCI with or without a 20 sec compression at two contusion impact forces (50 and 75 kdyn). We observed that regardless of the initial impact force, compression increased tissue damage and worsened functional recovery. Interestingly, compression-dependent damage is not evident until one week after SCI. Further, compression limits functional recovery to the first two weeks post-SCI; in the absence of compression, mice receiving contusion SCI recover for four weeks. To determine whether the recovery plateau is indicative of compression-specific inflammatory responses, we examined macrophage activation with immunohistochemical markers of purportedly pathological (CD86 and macrophage receptor with collagenous structure [MARCO]) and reparative macrophages (arginase [Arg1] and CD206). We detected significant increases in macrophages expression of MARCO and decreases in macrophage Arg1 expression with compression, suggesting a biomechanical-dependent shift in SCI macrophage activation. Collectively, compression-induced alterations in tissue and functional recovery and inflammation highlight the need to consider the primary SCI biomechanics in the design and clinical implementation of immunomodulatory therapies.
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Affiliation(s)
- Michael B Orr
- 1 Spinal Cord and Brain Injury Research Center and the Department of Physiology, the University of Kentucky , Lexington, Kentucky
- 3 Integrated Biomedical Sciences Graduate Program, the University of Kentucky , Lexington, Kentucky
| | - Jennifer Simkin
- 1 Spinal Cord and Brain Injury Research Center and the Department of Physiology, the University of Kentucky , Lexington, Kentucky
- 2 Department of Biology, the University of Kentucky , Lexington, Kentucky
| | - William M Bailey
- 1 Spinal Cord and Brain Injury Research Center and the Department of Physiology, the University of Kentucky , Lexington, Kentucky
| | - Neha S Kadambi
- 4 Math, Science, and Technology Center Program, Dunbar High School , Lexington, Kentucky
| | - Anna Leigh McVicar
- 1 Spinal Cord and Brain Injury Research Center and the Department of Physiology, the University of Kentucky , Lexington, Kentucky
| | - Amy K Veldhorst
- 1 Spinal Cord and Brain Injury Research Center and the Department of Physiology, the University of Kentucky , Lexington, Kentucky
| | - John C Gensel
- 1 Spinal Cord and Brain Injury Research Center and the Department of Physiology, the University of Kentucky , Lexington, Kentucky
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Abstract
CASE DESCRIPTION An 11-year-old English Cocker Spaniel was evaluated because of chronic progressive ataxia of the hind limbs. CLINICAL FINDINGS The dog had no history of previous illness, and findings of physical examination and laboratory tests were unremarkable. Neurologic examination revealed that the dog was ambulatory with severe ataxia of the hind limbs. Proprioception was decreased in the right and left hind limbs (right affected more than left), and spinal reflexes were bilaterally unremarkable. Moderate signs of pain were detected during palpation of the lumbar portion of the vertebral column. Findings suggested a lesion within the thoracolumbar or lumbar segments of the spinal cord. Magnetic resonance imaging revealed extradural spinal cord compression attributable to an extradural space-occupying lesion originating from or infiltrating the L4 lamina on the right side. TREATMENT AND OUTCOME Hemilaminectomy was performed to remove the extradural lesion. Histologic findings for tissue samples collected during the procedure were consistent with a neurenteric cyst. The late onset and progression of clinical signs of this rare congenital malformation were suspected to have been the result of enlargement of the neurenteric cyst through continuous production of mucus by goblet cells. The dog responded favorably to surgical decompression and was clinically normal 1 year after surgery. It was euthanized 2 years after surgery for an unrelated reason (end-stage heart disease), and no neurologic deficits were evident before that point. CLINICAL RELEVANCE Congenital neurenteric cysts should be considered as a differential diagnosis for neoplastic disease in dogs in which results of diagnostic imaging indicate the presence of an extradural mass affecting vertebral structures.
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Wang K, Chen Z, Zhang F, Song Q, Hou C, Tang Y, Wang J, Chen S, Bian Y, Hao Q, Shen H. Evaluation of DTI Parameter Ratios and Diffusion Tensor Tractography Grading in the Diagnosis and Prognosis Prediction of Cervical Spondylotic Myelopathy. Spine (Phila Pa 1976) 2017; 42:E202-E210. [PMID: 28207659 DOI: 10.1097/brs.0000000000001784] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort. OBJECTIVE To explore the correlations between diffusion tensor imaging (DTI) ratios and diffusion tensor tractography (DTT) grading with clinical symptoms and outcomes of cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA In addition to magnetic resonance imaging (MRI) and computed tomography, DTI may be useful in understanding pathophysiology of spinal cord in earlier stages of the CSM but it may be confounded by age and cervical level, and previous studies had small sample sizes. METHODS Controls (n = 36) and patients with CSM (n = 93) underwent magnetic resonance imaging (MRI) and DTI at the Changhai Hospital of Shanghai between September 2011 and March 2013. Apparent diffusion coefficient (ADC), fractional anisotropy (FA) of white matter (WM), and central grey matter (GM) were assessed. Patients were divided into three MRI grades: no abnormal signals; increased T2WI; and increased T2WI and low T1WI. DTT images were divided into three grades: no abnormal signals; abnormal local signal cord and disordered fiber tracts; and distortion of the spinal cord and interrupted fiber tracts. RESULTS FA and ADC both correlated with age in all three bilateral WM funiculi and GM, whereas FA and ADC ratios only showed correlation with age in the ventral funiculus (VF) and central GM. Differences were observed in ADC ratios and FA ratios from different Japanese Orthopedic Association (JOA) score subgroups and JOA recovery subgroups. For the three WM funiculi and GM, correlations between DTI ratios, JOA scores, and JOA recovery rates were consistently higher than those between DTI values, JOA scores, and JOA recovery rates (all P < 0.05). MRI grading was correlated with the JOA scores (r = -0.674, P < 0.001) but not JOA recovery rates (r = -0.197, P = 0.058), whereas DTT grading was correlated with both JOA scores (r = -0.813, P < 0.001) and JOA recovery rate (r = -0.429, P < 0.001). CONCLUSION DTI parameter ratios seemed to be less influenced by age than raw DTI results and could be more valuable than absolute DTI parameters for the evaluation of CSM. DTT grading is more valuable than MRI grading for diagnosis and prognostic prediction in CSM patients. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Kun Wang
- Orthopedics Department, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhi Chen
- Orthopedics Department, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fan Zhang
- Orthopedics Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qingxin Song
- Orthopedics Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Canglong Hou
- Orthopedics Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Yixing Tang
- Orthopedics Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Jun Wang
- Orthopedics Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Shiyue Chen
- Radiology Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Yun Bian
- Radiology Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Qiang Hao
- Radiology Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Hongxing Shen
- Orthopedics Department, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Janssen S, Bartscht T, Rades D. Prognosis of Patients with Metastatic Spinal Cord Compression from Adrenocortical Carcinoma. In Vivo 2016; 30:717-719. [PMID: 27566097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 06/27/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND/AIM Adrenocortical cancer is a rare aggressive type of cancer. The prognosis is poor, particularly for metastatic disease. This study focused on metastatic spinal cord compression (MSCC) from adrenocortical carcinoma. PATIENTS AND METHODS Data of three patients who received palliative irradiation of MSCC from adrenocortical carcinoma were retrospectively analyzed for motor function, ambulatory status and survival. RESULTS One patient died before completion of radiotherapy. The other two patients died two weeks and four weeks, respectively, following irradiation. In these patients, pre-radiotherapy pain scores were 9 and 10 points. In both patients, partial pain relief was achieved (scores of 5 and 4 points). All three patients were non-ambulatory before irradiation. In assessable patients, motor function remained unchanged following irradiation. CONCLUSION Palliative irradiation resulted in considerable pain relief, whereas motor function did not improve. Considering the extremely poor survival, supportive care alone may be considered if pain relief is achieved without irradiation.
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Affiliation(s)
- Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Tobias Bartscht
- Department of Hematology & Oncology, University of Lübeck, Lübeck, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
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Davies BM, McHugh M, Elgheriani A, Kolias AG, Tetreault LA, Hutchinson PJA, Fehlings MG, Kotter MRN. Reported Outcome Measures in Degenerative Cervical Myelopathy: A Systematic Review. PLoS One 2016; 11:e0157263. [PMID: 27482710 PMCID: PMC4970758 DOI: 10.1371/journal.pone.0157263] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/26/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Degenerative cervical myelopathy [DCM] is a disabling and increasingly prevalent group of diseases. Heterogeneous reporting of trial outcomes limits effective inter-study comparison and optimisation of treatment. This is recognised in many fields of healthcare research. The present study aims to assess the heterogeneity of outcome reporting in DCM as the premise for the development of a standardised reporting set. METHODS A systematic review of MEDLINE and EMBASE databases, registered with PROSPERO (CRD42015025497) was conducted in accordance with PRISMA guidelines. Full text articles in English, with >50 patients (prospective) or >200 patients (retrospective), reporting outcomes of DCM were eligible. RESULTS 108 studies, assessing 23,876 patients, conducted world-wide, were identified. Reported outcome themes included function (reported by 97, 90% of studies), complications (reported by 56, 52% of studies), quality of life (reported by 31, 29% of studies), pain (reported by 29, 27% of studies) and imaging (reported by 59, 55% of studies). Only 7 (6%) studies considered all of domains in a single publication. All domains showed variability in reporting. CONCLUSIONS Significant heterogeneity exists in the reporting of outcomes in DCM. The development of a consensus minimum dataset will facilitate future research synthesis.
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Affiliation(s)
- Benjamin M. Davies
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Maire McHugh
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Ali Elgheriani
- Toronto Western Hospital, University Health Network & University of Toronto, Toronto, Canada
| | - Angelos G. Kolias
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Lindsay A. Tetreault
- Toronto Western Hospital, University Health Network & University of Toronto, Toronto, Canada
| | - Peter J. A. Hutchinson
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, United Kingdom
- John van Geest Brain Repair Centre, University of Cambridge, Cambridge, United Kingdom
| | - Michael G. Fehlings
- Toronto Western Hospital, University Health Network & University of Toronto, Toronto, Canada
| | - Mark R. N. Kotter
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, United Kingdom
- WT MRC Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, United Kingdom
- Toronto Western Hospital, University Health Network & University of Toronto, Toronto, Canada
- John van Geest Brain Repair Centre, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
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Tsymbalyuk VI, Medvedyev VV, Semenova VM, Grydina NY, Yaminskyi YY, Senchyk YY, Draguntsova NG, Rybachuk OA, Dychko SM, Petriv TI. [[Durable persistence of a biocompatible foreign body in a vertebral channel in open penetrating trauma of a spinal cord: clinico-experimental and pathomorphological peculiarities].]. Klin Khir 2016:64-69. [PMID: 28661610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Simulation model of open penetrating wound of a spinal cord (SC) with its durable com- pression by biocompatible foreign body, was tasted. Experimental animals - mature male rats (inbred line, descendent from a Wistar breed); the trauma simulation model - a left- sided transsection of the SC half on the Txi level; experimental groups: the main (a SC trau- ma + homotopic implantation of microporous hydrogel fragment - foreign body [n=10]), groups of comparison (the SC trauma [n=16]; the SC trauma + homotopic implantation of chemically identical analogue of hydrogel - NeuroGelTM [n=20]). A SC compression by a foreign body worsens the regeneration process course essentially: during first 2 mo the function index of a hind ipsilateral extremity in experimental animals of the main group was the lowest in the experiment - (1.30 ? 0.94) points in accordance to BBB scale, during 3 - 4 mo - the function index had enhanced trustworthy - up to (2.35 ? 0.95) points in accor- dance to BBB scale, what is connected with lowering of a local pressure on a SC tissue due to change of the foreign body form and volume. In 24 weeks the function index of hind ipsi- lateral extremity had constituted (8.45 ? 0.92) points - while application of NeuroGeTM and (2.35 ? 0.95) points - of the foreign body; the tissue processes in the implants localization zone had differed essentially. The tasted simulation model reproduces satisfactory a mechanical component of the foreign body impact on a SC tissue. The SC compression reduction, even in a late follow-up period, had improved the conditions and results of recenerative process essentially.
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Mizuno J, Nakagawa H, Iwata K, Hashizume Y. Pathology of spinal cord lesions caused by ossification of the posterior longitudinal ligament, with special reference to reversibility of the spinal cord lesion. Neurol Res 2016; 14:312-4. [PMID: 1360625 DOI: 10.1080/01616412.1992.11740075] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This report describes pathological findings of the spinal cord damage, with ossification of the posterior longitudinal ligament (OPLL), with special reference to reversibility of such lesions. Twenty-five autopsy cases associated with OPLL were examined, and the spinal cord damage was pathologically classified into four categories based on degree of destruction (stage 0-3). In stage 0 and stage 1, major pathological changes in the gray matter and the degree of compression on the spinal cord were well correlated to deformity of the anterior horn. In stage 2 and stage 3, neurons were almost completely obliterated and necrosis with cavitation were frequently observed. Destruction of the spinal cord in stage 2 and stage 3 is considered to be irreversible; therefore, surgical treatment is recommended at stage 0 or stage 1.
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Affiliation(s)
- J Mizuno
- Department of Neurological Surgery, Aichi Medical University, Japan
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Badji N, Deme H, Akpo G, Ndong B, Toure MH, Diop SB, Niang EH. [The contribution of MRI in the management of slowly progressive nontraumatic spinal cord compression]. Pan Afr Med J 2016; 24:221. [PMID: 27800076 PMCID: PMC5075438 DOI: 10.11604/pamj.2016.24.221.8525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/28/2016] [Indexed: 11/11/2022] Open
Abstract
Slow spinal cord compressions are due to the development of an expansive lesion within the medullary canal. This is a very common condition whose diagnosis is primarily clinical. The magnetic resonance imaging occupies a central and currently irreplaceable position in diagnosis and localization as well as in etiological research. Etiology of cancer is predominant in Europe. This study aims to describe the MRI features of slow spinal cord compressions and to determine its etiologic profile. This is a retrospective study of 97 cases whose data were collected at the Department of Radiology, National University Hospital Centre (CHUN) of Fann, over a period of 30 months (from March 8, 2010 to September 29 2012). All patients referred for slow spinal compression occurred in a non traumatic context were included in the study. The average age of patients was 42.6 years, ranging between 04 months and 85 years. We studied the topography of lesions (spinal floor, ductal compartments), their enhancement and their etiological criteria. The review protocol allowed the realization of T1-weighted sequences with no injection of gado, T2-weighted sequences, STIR sequences and T2-weighted DRIVE sequences centered on lesions levels or suspicious areas. MRI allowed to determine the exact location and the extent of lesions. The involvement of the thoracic spine occurred in 42% of cases, followed by the cervical spine in 32% of cases. The lumbosacral damages and multi-stage damages were found in 18% and 8% of cases respectively. Extradural lesions were found in 87% of cases, followed by intradural extramedullary lesions in 08% of cases and intramedullary lesions in 05% of cases. The peculiarity of etiologic profile of our study is the prevalence of infectious epiduritis and the relative frequency of metastatic epiduritis compared to the Western series. The vertebral-medullary MRI occupies a crucial place in the positive, topographic and etiological diagnosis of spinal cord compressions.
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Affiliation(s)
- Nfally Badji
- Service de Radiologie Générale CHU Aristide Le Dantec, Dakar, Sénégal
| | - Hamidou Deme
- Service de Radiologie Générale CHU Aristide Le Dantec, Dakar, Sénégal
| | - Geraud Akpo
- Service de Radiologie Générale CHU Aristide Le Dantec, Dakar, Sénégal
| | - Boucar Ndong
- Service de Radiologie Générale CHU Aristide Le Dantec, Dakar, Sénégal
| | | | - Sokhna Ba Diop
- Service de Radiologie Générale CHUN FANN, Dakar, Sénégal
| | - El Hadji Niang
- Service de Radiologie Générale CHU Aristide Le Dantec, Dakar, Sénégal
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Janssen S, Bolm L, Käsmann L, Bartscht T, Rades D. Palliative Radiation Therapy for Spinal Cord Compression from Metastatic Soft Tissue Sarcoma. In Vivo 2016; 30:529-531. [PMID: 27381619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/28/2016] [Indexed: 06/06/2023]
Abstract
AIM Spinal cord compression (SCC) from metastatic soft tissue sarcoma is a rare condition. Little is known regarding its optimal treatment. It is not clear whether these patients should receive radiation therapy alone or neurosurgery plus radiation therapy. This study focused on outcomes of patients with SCC from soft tissue sarcoma after radiation therapy alone. PATIENTS AND METHODS The effect of radiotherapy on pain relief and motor function and overall survival were evaluated in four patients. RESULTS Complete pain relief was achieved in two (50%) and overall pain relief in three patients (75%). Motor function remained unchanged in all patients. Overall survival rates at three and six months following irradiation were 25% and 25%, respectively. CONCLUSION Radiotherapy alone resulted in high rates of pain relief in patients with SCC from metastatic soft tissue sarcoma. The effect on motor function was less favorable. Upfront neurosurgery is required for improvement of motor deficits.
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Affiliation(s)
- Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Louisa Bolm
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Lukas Käsmann
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Tobias Bartscht
- Department of Hematology&Oncology, University of Lübeck, Lübeck, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
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Body JJ, Pereira J, Sleeboom H, Maniadakis N, Terpos E, Acklin YP, Finek J, Gunther O, Hechmati G, Mossman T, Costa L, Rogowski W, Nahi H, von Moos R. Health resource utilization associated with skeletal-related events: results from a retrospective European study. Eur J Health Econ 2016; 17:711-21. [PMID: 26253584 PMCID: PMC4899504 DOI: 10.1007/s10198-015-0716-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 07/22/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Bone complications, also known as skeletal-related events (SREs), are common in patients with bone metastases secondary to advanced cancers. OBJECTIVE To provide a detailed estimate of the health resource utilization (HRU) burden associated with SREs across eight European countries. METHODS Eligible patients from centers in Austria, the Czech Republic, Finland, Greece, Poland, Portugal, Sweden, and Switzerland with bone metastases or lesions secondary to breast cancer, prostate, or lung cancer or multiple myeloma who had experienced at least one SRE (defined as radiation to bone, long-bone pathologic fracture, other bone pathologic fracture, surgery to bone or spinal cord compression) were entered into this study. HRU data were extracted retrospectively from the patients' charts from 3.5 months before the index SRE until 3 months after the index SRE (defined as an SRE preceded by an SRE-free period of at least 6.5 months). RESULTS Overall, the mean number of inpatient stays per SRE increased from baseline by approximately 0.5-1.5 stays, with increases in the total duration of inpatient stays of approximately 6-37 days per event. All SREs were associated with substantial increases from baseline in the frequency of procedures and the number of outpatient and day-care visits. CONCLUSIONS SREs are associated with substantial HRU owing to considerable increases in the number and duration of inpatient stays, and in the number of procedures, outpatient visits, and day-care visits. These data collectively provide a valuable summary of the real-world SRE burden on European healthcare systems.
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Affiliation(s)
| | - João Pereira
- Universidade Nova de Lisboa, National School of Public Health, Lisbon, Portugal
| | | | - Nikos Maniadakis
- Department of Health Services Management, National School of Public Health, Athens, Greece
| | - Evangelos Terpos
- University of Athens School of Medicine, Alexandra University Hospital, Athens, Greece
| | | | | | - Oliver Gunther
- Centre for Observational Research, Amgen Ltd, Uxbridge, UK
| | - Guy Hechmati
- Health Economics, Amgen (Europe) GmbH, Zug, Switzerland
| | | | - Luis Costa
- Serviço de Oncologia do Hospital de Santa Maria, Instituto de Medicina Molecular, Lisbon, Portugal
| | | | - Hareth Nahi
- Division of Hematology, Department of Medicine, Karolinska Institute, Huddinge, Stockholm, Sweden
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Duran E, Ilik K, Acar T, Yıldız M. Idiopathic Lumbar Epidural Lipomatosis Mimicking Disc Herniation: A Case Report. Acta Med Iran 2016; 54:337-338. [PMID: 27309484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2016] [Indexed: 06/06/2023] Open
Abstract
Spinal epidural lipomatosis is a rare condition which is described as the accumulation of fat in the extradural territory and often causes dural impingement. Spinal epidural lipomatosis has been implicated in causing a variety of neurologic impairments ranging from back pain, radiculopathy, claudication, myelopathy or even cauda equina syndrome. We report a 46-year-old female with obesity and a history of chronic back pain and radiculopathy who developed idiopathic Spinal epidural lipomatosis diagnosed by magnetic resonance imaging. The purpose of this report is to present a case of spinal epidural lipomatosis presenting with symptomatic cord compression and also remind this rare condition as a the differential diagnosis of epidural lesions in patients with risk factors.
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Affiliation(s)
- Efe Duran
- Department of Radiology, School of Medicine, Mevlana University, Konya, Turkey
| | - Kemal Ilik
- Department of Neurosurgery, School of Medicine, Mevlana University, Konya, Turkey
| | - Turker Acar
- Department of Radiology, School of Medicine, Mevlana University, Konya, Turkey
| | - Melda Yıldız
- Department of Radiology, School of Medicine, Mevlana University, Konya, Turkey
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Ahmad FU, Schallert E, Bregy A, Post JD, Vanni S. Disappearing large calcified thoracic disc herniation in a patient with thalassaemia. BMJ Case Rep 2016; 2016:bcr-2015-213166. [PMID: 26823353 DOI: 10.1136/bcr-2015-213166] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Regression of herniated disc fragments with subsequent improvement in clinical symptoms has been reported in the lumbar and cervical spine. Such regressions in the thoracic spine are extremely rare. We report a case of a 38-year-old patient with thalassaemia who had regression of a large calcified herniated thoracic disc causing cord compression, with subsequent herniation of a second calcified disc at a different level and discuss the possible aetiopathogenesis. This is the first such case reported in the thalassaemia population.
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Rades D, Conde-Moreno AJ, Cacicedo J, Segedin B, Veninga T, Schild SE. Metastatic Spinal Cord Compression: A Survival Score Particularly Developed for Elderly Prostate Cancer Patients. Anticancer Res 2015; 35:6189-6192. [PMID: 26504049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM Metastatic spinal cord compression (MSCC) is an oncological emergency. Many elderly patients cannot tolerate intensive treatment and need individual approaches accounting for a patient's remaining lifetime. The goal of the present study was to develop a survival score for elderly prostate cancer patients with MSCC. PATIENTS AND METHODS Nine characteristics were analyzed in 243 patients: age, performance status, interval from prostate cancer diagnosis until MSCC, affected vertebrae, ambulatory status, further bone lesions, visceral metastases, time developing motor deficits, fractionation schedule. RESULTS Pre-radiotherapy ambulatory status (p<0.001), visceral metastases (p<0.001) and time developing motor deficits (p<0.001) were significant for survival on Cox regression analysis and included in the survival score. Four groups were defined: 9-12, 13-16, 17-19 and 21-23 points. Six-month survival rates were 7%, 28%, 71% and 95%, respectively (p<0.001). CONCLUSION The present study identified four groups with different survival probabilities that require treatment strategies with different priorities ranging from symptom control to prolongation of life.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Antonio J Conde-Moreno
- Department of Radiation Oncology, Consorcio Hospital Provincial de Castellón, Castellón, Spain
| | - Jon Cacicedo
- Department of Radiation Oncology, Cruces University Hospital, Barakaldo, Vizcaya, Spain
| | - Barbara Segedin
- Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Theo Veninga
- Department of Radiotherapy, Dr. Bernard Verbeeten Institute, Tilburg, the Netherlands
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic Scottsdale, Scottsdale, AZ, U.S.A
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Rades D, Conde-Moreno AJ, Garcia R, Veninga T, Schild SE. A Tool to Estimate Survival of Elderly Patients Presenting with Metastatic Epidural Spinal Cord Compression (MESCC) from Cancer of Unknown Primary. Anticancer Res 2015; 35:6219-6222. [PMID: 26504054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM Cancers of unknown primary (CUP) account for about 10% in elderly patients with MESCC. Immediate treatment is indicated. Personalizing treatment for MESCC requires for clear understanding of the patients' survival prognosis. In this case, a tool for estimating survival would be valuable. PATIENTS AND METHODS In 104 elderly CUP patients, nine factors were investigated: age, gender, performance score, number of affected vertebrae, ability to walk at presentation for radiotherapy, additional bone metastases, visceral metastases, time developing motor weakness, radiotherapy program. RESULTS In multivariate analysis, the ability to walk (p=0.011) and visceral metastases (p<0.001) were associated with survival. The following scores were assigned: unable to walk=0, able to walk=1, visceral metastases=0, no visceral metastases=1. Three groups were formed (0, 1 and 2 points) with 6-month survival rates of 7%, 18% and 73% (p<0.001). CONCLUSION This specific tool assists the physician to estimate survival and select for the most suitable radiotherapy program in elderly CUP patients with MESCC.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Antonio J Conde-Moreno
- Department of Radiation Oncology, Consorcio Hospital Provincial de Castellón, Castellón, Spain
| | - Raquel Garcia
- Department of Radiation Oncology, Consorcio Hospital Provincial de Castellón, Castellón, Spain
| | - Theo Veninga
- Department of Radiotherapy, Dr. Bernard Verbeeten Institute, Tilburg, the Netherlands
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, U.S.A
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Perrini P, Gambacciani C, Martini C, Montemurro N, Lepori P. Anterior cervical corpectomy for cervical spondylotic myelopathy: Reconstruction with expandable cylindrical cage versus iliac crest autograft. A retrospective study. Clin Neurol Neurosurg 2015; 139:258-63. [PMID: 26528885 DOI: 10.1016/j.clineuro.2015.10.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 10/15/2015] [Accepted: 10/17/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To compare retrospectively the clinical and radiographic outcomes between cervical reconstruction with expandable cylindrical cage (ECC) and iliac crest autograft after one- or two-level anterior cervical corpectomy for spondylotic myelopathy. PATIENTS AND METHODS Forty-two patients underwent cervical reconstruction with either iliac crest autograft and plating (20 patients) or ECC and plating (22 patients). The average clinical and radiological follow-up period was 77.54 ± 44.28 months (range 14-155 months). The authors compared clinical parameters (Nurick Myelopathy Grade, modified Japanese Orthopedic Association (mJOA) scores), perioperative parameters (hospital stays, complications) and radiological parameters (Cobb's angles of the fused segments and C2-C7 segments, cervical subsidence, fusion rate). Fusion was assessed on flexion-extension X-ray films. RESULTS No significant differences between the two groups were found in demographics, neurological presentation, preoperative sagittal alignment, clinical improvement and length of hospitalization. Patients of the autograft group experienced more postoperative complications, although the difference between the two treatment groups was not statistically significant (15 versus 4.5%, p=0.232). The fusion rate was 100% in both groups. The average lordotic increase of the segmental angle was significantly greater in the ECC group (p<0.05). Other radiological parameters were not significantly different in the two groups. CONCLUSION Cervical reconstruction either with iliac crest autograft and plating or ECC and plating provides good clinical results and similar fusion rates after one- or two-level corpectomy for spondylotic myelopathy. However, the use of ECC obviates donor site complications and provides a more significant increase of lordosis in segmental angle.
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Affiliation(s)
- Paolo Perrini
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy.
| | - Carlo Gambacciani
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy
| | - Carlotta Martini
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy
| | - Paolo Lepori
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy
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