Introduction: Metastatic spinal tumors (MST) refer to secondary involvement of the vertebral column by hematogenously-disseminated metastatic cells. They could affect either the bony structures or the spinal cords. Me...Introduction: Metastatic spinal tumors (MST) refer to secondary involvement of the vertebral column by hematogenously-disseminated metastatic cells. They could affect either the bony structures or the spinal cords. Mechanical instability and neurologic deficits resulting from spinal cord compression are the most common manifestations. Surgical intervention remains the most effective treatment for about 20% of patients who present with spinal cord compression. The prognosis is relatively poor. This work has as objectives to describe: the diagnostic tools, the different modalities of management and the prognostic elements of spine metastasis. Methodology: We conducted an ambispective cross-sectional descriptive study;with retrospective data collection from January 2015 to December 2021 and prospective collection from January to April 2022 in the “Neurosurgery” unit of the Yaounde Central Hospital and the “Oncology and Neurosurgery” units of Yaounde General Hospital. Result: We included 101 patients. The M/F sex ratio was 1.66. The average age of the participants was 56.44 years (±14.19 SD) with a median of 58 years. Metastatic spinal tumors were discovered in 61.39% of patients with a previously known primary tumor and 21.78% of patients had newly discovered tumors. The neurologic examination revealed a vertebral syndrome in 79.21% of cases, radicular syndrome in 60.40% and sub-lesional syndrome in 59.89%. Sensory disorders accounted for 39.60% and sphincter disorders accounted for 34.65%. According to the degree of severity, the lesions were classified as Frankel E (37.62%) followed by Frankel D (21.78%). Metastatic lesions were mostly found at the thoracic vertebrae (68.25%) and lumbar vertebrae (22.22%). The most represented primary tumors were: prostate tumors (41.58%) and breast tumors (23.76%);followed by malignant hemopathies (15.84%). Computed-tomography scan (CT-scan) was the most frequent diagnostic imaging technique used (71.28%). Analgesic treatment mostly involved level II analgesia (64.36%). High dose steroid therapy (greater than 80mg/24h) was used in more than half of the patients. Radiation therapy was performed in 24.75% of the patients, chemotherapy in 55.44% and specific surgical interventions performed in 20.79%. The most frequent surgical indication was complete motor deficit according to the Frankel classification (47.21%). One patient in four (23.76%) experienced improvement in functional prognosis with increased muscle strength after a period of 2 weeks to 5 months of treatment. About 1 in 10 patients (8.8%) rather had worsening of their neurologic status. We observed that there was a correlation between spine surgery and improvement in muscle strength (P-value less than 0.05). Patients (12) who had better recovery or preserved gait were those with partial compression (P-value = 0.0143). Four out of five patients (81.18%) of our series had an estimated survival of less than one year according to the Tokuhashi score. Conclusion: MSTs are frequent in our context. Most patients sought consultation late after the first symptoms appeared (principally back pain). The clinical examination revealed a high proportion of patients with spinal cord compression syndrome. Medical treatment was first-line for the management of pain and most patients who underwent surgical treatment had complete neurologic deficits. The functional prognosis was found to be improved by surgery and the vital prognosis depended on the Tokuhashi score, with better accuracy when the prediction is more than 12 months.展开更多
Objective To investigate the clinical symptoms experienced by patients with thoracic spinal tumors and verify the associated symptoms that are predictive of a decline in muscle strength in the lower limbs.Methods A si...Objective To investigate the clinical symptoms experienced by patients with thoracic spinal tumors and verify the associated symptoms that are predictive of a decline in muscle strength in the lower limbs.Methods A single-center,retrospective cross-sectional study was conducted on in-patients diagnosed with epidural thoracic spinal tumors between January 2011 and May 2021.The study involved a review of electronic medical records and radiographs and the collection of clinical data.The differences in clinical manifestations between patients with constipation and those without constipation were analyzed.Binary logistic regression analyses were performed to identify risk factors associated with a decline in muscle strength in the lower limbs.Results A total of 227 patients were enrolled,including 131 patients with constipation and 96 without constipation.The constipation group had a significantly higher proportion of patients who experienced difficulty walking or paralysis compared to those without constipation prior to surgery(83.2%vs.17.7%,χ~2=99.035,P 0.001).Constipation(OR=9.522,95%CI:4.150±21.849,P 0.001)and urinary retention(OR=14.490,95%CI:4.543±46.213,P 0.001)were independent risk factors for muscle strength decline in the lower limbs.Conclusions The study observed that patients with thoracic spinal tumors who experienced constipation symptoms had a higher incidence of lower limb weakness.Moreover,the analysis revealed that constipation and urinary retention were independent risk factors associated with a preoperative decline in muscle strength of lower limbs.展开更多
Objective To explore the feasibility and clinical results of circumferential decompression and three column reconstruction through single-stage posterior transpedicular approach for spinal tumor treatment. Methods Tot...Objective To explore the feasibility and clinical results of circumferential decompression and three column reconstruction through single-stage posterior transpedicular approach for spinal tumor treatment. Methods Totally, 24 patients with spinal tumor underwent tumor resection and spinal reconstruc tion through single-stage posterior transpedicular approach. Preoperatively, according to the Frankel classification, 12 patients were grade E, 9 grade D, and 3 grade C. Anterior column was reconstructed with non-expandable titanium cages. Posterior segmental instrumentation was used to maintain the stability of spine in all cases. Anterior and posterolateral fusion was performed with autograft and allogenic bone. The following data were followed up in these patients: deformity angle, local recurrence, neurological function, and spinal bony fusion. Results The average operating time and blood loss was 5.6 hours and 3 400 ml respectively. No intraoperative and postoperative complications were observed in this group. Postoperatively, 21 patients were Frankel grade E, 2 grade D, and 1 grade C. Four patients reported significant functional restoration and twenty patients reported complete resolution of pain. At follow-up (range, 6-42 months), implant failure or recurrent neurological symptoms was not found. Conclusions The tumor resection and spinal reconstruction through single-stage posterior transpedicular approach is a safe and effective technique for the treatment of spinal tumor. It can fully decompress the neurological structures, correct the kyphosis, and achieve early weight-bearing. This technique can improve life quality for the patients with spinal tumor.展开更多
To investigate the effect of early rehabilitation on neurofunctional outcome after surgery in children with spinal tumors, this study reviewed the medical charts and radiographic records of 70 pediatric patients(1–17...To investigate the effect of early rehabilitation on neurofunctional outcome after surgery in children with spinal tumors, this study reviewed the medical charts and radiographic records of 70 pediatric patients(1–17 years old) who received spinal tumor surgical removal. The peddiatric patients received rahabilitation treatment at 4(range, 2–7) days after surgery for 10(range, 7–23) days. Results from the Modified McCormick Scale, Functional Independence Measure for Children, American Spinal Injury Association Impairment Scale and Karnofsky Performance Status Scale demonstrated that the sensory function, motor function and activity of daily living of pediatric children who received early rehabilitation were significantly improved. Results also showed that tumor setting and level localization as well as patients' s clinical symptoms have no influences on neurofunctional outcomes.展开更多
To investigate the feasibility and early efficacy of 3D-printed vertebral body implantation combined with robotic radiosurgery in the treatment of spinal tumors.This study included 14 patients with spinal tumors from ...To investigate the feasibility and early efficacy of 3D-printed vertebral body implantation combined with robotic radiosurgery in the treatment of spinal tumors.This study included 14 patients with spinal tumors from December 2017 to June 2018.Before surgery,all patients were subjected to CT scan and 3D data of the corresponding vertebral segments were collected.Titanium alloy formed 3D-printed vertebral body implantation and robotic stereotactic radiotherapy were performed because of the risk of postoperative residual,high risk of recovery,or recurrence after surgery.The main outcomes included the remission of symptoms,vertebral body stability,robotic stereotactic surgical precision,and local tumor control.All patients received complete and successful combination therapy,and all healed primarily without complications.The error of the coverage accuracy for robotic radiosurgery was less than 0.5 mm,and the error of the rotation angle was less than 0.5.The therapeutic toxicity was limited(mainly in grades 1–2),and adverse events were uncommon.The evaluation of vertebral body stability and histocompatibility for all patients met the postoperative clinical requirements.For patients with post spinal injury,the pain symptoms were reduced or disappeared(93%),and nerve function was improved or even recovered after treatment(100%).During our follow-up period,most tumors were locally well controlled(93%).3D-printed vertebral body implantation combined with robotic radiosurgery may offer a new treatment of spinal tumors.Chinese clinical trial registry:ChiCTR-ONN-17013946.展开更多
Arachnoiditis ossificans is an intradural extramedullary lesion resulting from an unusual chronic meningeal inflammatory process and it is thought to be the sequela of end-stage adhesive arachnoiditis secondary to sur...Arachnoiditis ossificans is an intradural extramedullary lesion resulting from an unusual chronic meningeal inflammatory process and it is thought to be the sequela of end-stage adhesive arachnoiditis secondary to surgery, trauma, arachnoid hemorrhage, meningeal irritation, myelography (particularly oil-based contrast agents), and spinal anesthesia. The spinal arachnoiditis ossificans may be silent or cause a variety of symptoms depending on its location and uncommonly happen to cause spinal cord compression. Very little attention has been paid to the management and outcome of this rare condition in the neurosurgical reem. We report the case of a 45 years old man admitted with L1 - L2 arachnoiditis ossificans revealed by polyradiculopathy on incomplete cauda equina syndrome mimicking spinal canal tumors. The patient underwent surgery and we performed the laminectomy of L1 - L2, total resection of the lesion, followed by a complete remission of the hemiparesis after three months of kinesitherapy nursing.展开更多
Objective: In the present study, spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis were quantitatively analyzed using dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) to assess the v...Objective: In the present study, spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis were quantitatively analyzed using dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) to assess the value of DCE-MRI in the differential diagnosis of these diseases.Methods: Patients with brucellar spondylitis, spinal tuberculosis or a spinal metastatic tumor(30 cases of each)received conventional MRI and DCE-MRI examination. The volume transfer constant(K^(trans)), rate constant(K_(ep)),extravascular extracellular volume fraction(V_e) and plasma volume fraction(V_p) of the diseased vertebral bodies were measured on the perfusion parameter map, and the differences in these parameters between the patients were compared.Results: For pathological vertebrae in cases of spinal metastatic tumor, brucellar spondylitis and spinal tuberculosis, respectively, the K^(trans) values(median ± quartile pitch) were 0.989±0.014, 0.720±0.011 and0.317±0.005 min^(–1); the K_(ep) values were 2.898±0.055, 1.327±0.017 and 0.748±0.006 min^(–1); the V_e values were 0.339±0.008, 0.542±0.013 and 0.428±0.018; the V_p values were 0.048±0.008, 0.035±0.004 and 0.028±0.009; the corresponding H values were 50.25(for K_(trans)), 52.47(for K_(ep)), 48.33(for V_e) and 46.56(for V_p), and all differences were statistically significant(two-sided P<0.05).Conclusions: The quantitative analysis of DCE-MRI has a certain value in the differential diagnosis of spinal metastatic tumor, brucellar spondylitis and spinal tuberculosis.展开更多
Background: Spinal canal tumors are difficult to diagnose and treat. The traditional surgical approaches for attempting a complete excision of these lesions frequently involve big incisions and tissue dissection with ...Background: Spinal canal tumors are difficult to diagnose and treat. The traditional surgical approaches for attempting a complete excision of these lesions frequently involve big incisions and tissue dissection with high risk of postop instability and cerebrospinal fluid leakage. Also, there is a risk of neurological worsening, sometimes irreversible. Methods: We present our experience in a patient series with spinal canal tumors and describe the surgical approach with minimally invasive techniques (MIS). All of them were performed by the Neurosurgery team of the Hospital Universitario San Ignacio during the period of 2011-2016. Results: We reviewed forty patients with spinal canal tumors surgically treated with MIS techniques. 15 patients (37.5%) had Meningioma diagnosis (complete resection in 11 (73.3%), subtotal in 3 (20%) and biopsy in one patient), 10 patients (25%) with Schwannomas reached complete resection in 70% and subtotal in 30%. 5 patients had spinal cord metastasis, with complete resection in 4 patients (80%) and subtotal in 1 (20%). Other included ependymoma, astrocytoma, and miscellaneous. No patient has had cerebrospinal fluid leakage and no postoperative fusion has been required. Conclusions: The minimally invasive approach allowed complete tumors removal in a high number of patients and good postoperative results. These findings are similar and in some cases, better than the reported with traditional techniques. This MIS technique provides encouraging results. It requires a wide learning curve and a high degree of surgical experience.展开更多
Objective To investigate the clinical value of different magnetic resonance (MR) pulse sequences in diagnosis of spinal metastatic tumor. Methods Fifteen patients with clinically suspected spinal metastatic tumor were...Objective To investigate the clinical value of different magnetic resonance (MR) pulse sequences in diagnosis of spinal metastatic tumor. Methods Fifteen patients with clinically suspected spinal metastatic tumor were included in this study. These patients were with documented primary tumors. Four MR pulse sequences, T1-weighted spin echo (T1WI SE), T2-weighted fast spin echo (T2WI FSE), short time inversion recovery (STIR), and gradient echo 2-D multi echo data imaging combination (GE Me-2D) were used to detect spinal metastasis. Results Fifteen vertebral bodies were entire involvement, 38 vertebral bodies were section involvement, and totally 53 vertebral bodies were involved. There were 19 focal infections in pedicle of vertebral arch, 15 metastases in spinous process and transverse process. Fifty-three vertebral bodies were abnormal in T1WI SE and GE Me-2D, 35 vertebral bodies were found abnormal in T2WI FSE, and 50 vertebral bodies were found abnormal in STIR. The verges of focal signal of involved vertebral bodies were comparatively clear in T1WI SE, comparatively clear or vague in T2WI FSE, vague in STIR, and clear in GE Me-2D.Conclusions GE Me-2D may be the most sensitive technique to detect metastases. So three sequences (T1WI SE, T2WI FSE, GE Me-2D) can demonstrate the early changes of spinal metastasis roundly.展开更多
BACKGROUND: Numerous studies have shown that tumor necrosis factor α (TNF-α) is closely correlated with spinal cord injury (SCI), but the mechanisms of TNF-α and therapeutic treatments for SCI are still poorly unde...BACKGROUND: Numerous studies have shown that tumor necrosis factor α (TNF-α) is closely correlated with spinal cord injury (SCI), but the mechanisms of TNF-α and therapeutic treatments for SCI are still poorly understood. OBJECTIVE: To determine the role of TNF-α in the pathogenesis of SCI. DESIGN, TIME AND SETTING: An in vivo experiment based on genetically engineered animals was performed at the Medical University of South Carolina, Charleston, South Carolina, USA, between June 2007 and October 2008. MATERIALS: TNF-α transgenic rats (Xenogen Biosciences in Cranbury, New Jersey, USA) were utilized in this study. METHODS: TNF-α transgenic (tg) and wild-type (WT) rats underwent a complete single-level laminectomy at the 10th thoracic vertebra (T10). MAIN OUTCOME MEASURES: Motor function of rat hindlimb was assessed using the Basso, Beattie, and Bresnahan hindlimb locomotor rating scale. Histological evaluation of spinal cord tissue loss was conducted. Immunohistochemistry for astrocytes, microglia/macrophages, and TNF receptors (TNFRs) was performed on spinal cord tissue sections. TNF-α mRNA expression was detected by real-time polymerase chain reaction. The concentrations of nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) in the supernatant were determined using an enzyme-linked immunosorbent assay kit for rat NGF or BDNF, respectively. The rats were injected subcutaneously with etanercept to verify that TNF-α was the direct effect of the modulation of behavioral and neurodegenerative outcomes in the TNF-α tg rats. RESULTS: TNF-α tg rats showed higher expression of TNF-α mRNA in the spinal cord prior to SCI. TNF-α tg rats showed worse motor deficits than WT rats in the acute period (< 3 days) after SCI (P < 0.01), while in the chronic period, TNF-α tg rats exhibited persistent elevated baseline levels of TNF-α mRNA and improved recovery in motor function and tissue healing compared to WT rats (P < 0.01). Following SCI, the number of microglia/macrophages in TNF-α tg rat was always greater than in WT rat (P < 0.01). There were no significant differences in NGF and BDNF levels in the supernatant of spinal cord homogenates. TNFR1 expression was significantly greater in the TNF-α tg rats compared to the WT rats (P < 0.01). However, TNFR2 expression did not reveal a significant increase in the TNF-α tg rats compared to the WT rats. Finally, treatment with etanercept reduced injury acutely, but exacerbated the injury chronically. CONCLUSION: Overexpression of TNF-α is deleterious in the acute phase, but beneficial in the chronic phase in the response to SCI. The role of TNF-α post-injury may depend on TNF-α expression in the spinal cord and its differential binding to TNFR1. Our observations may have clinical relevance that antagonists or inhibitors of TNF-α could be administered within the early time window post-injury, and appropriate amounts of TNF-α could be administered during the chronic stage, in order to improve the final neurological recovery in patients with SCI.展开更多
Intramedullary spinal cord metastasis(ISCM) is very rare and its optimal treatment remains controversial. Pancreatic neuroendocrine tumor(pNET) is a rare tumor that usually presents with hepatic metastasis. Hepatic fa...Intramedullary spinal cord metastasis(ISCM) is very rare and its optimal treatment remains controversial. Pancreatic neuroendocrine tumor(pNET) is a rare tumor that usually presents with hepatic metastasis. Hepatic failure due to tumor progression is the major cause of death in cases of pNET. To date,no report has described a case of ISCM from pNET. Although spinal cord metastasis of a solid tumor is uncommon,it is a critical condition that can cause a potentially irreversible loss of neurologic function. Here,we report the case of a 45-year-old man who presented with leg weakness and voiding difficulty,and was found to have ISCM from pNET. Surgical treatment prevented further neurological deterioration. This is the first case report of ISCM from pNET.展开更多
PURPOSE:To review the efficacy and patterns of failure in average-risk medulloblastoma patients treated withconcurrent chemotherapy and reduced-dose cranial spinal irradiation and a conformal tumor bed boost.METH-ODS ...PURPOSE:To review the efficacy and patterns of failure in average-risk medulloblastoma patients treated withconcurrent chemotherapy and reduced-dose cranial spinal irradiation and a conformal tumor bed boost.METH-ODS AND MATERIALS:Thirty-three patients with average risk(defined as<==1.5 cm(2)of residual tumorafter resection,age>3 years,and no involvement of the cerebrospinal fluid or spine)medulloblastoma werediagnosed at our institution between January 1994 and December 2001.They were enrolled in an institutional展开更多
Objective To study the clinical features, surgical treatments and the prognosis of the 103 patients with the metastatic tumors in the spine. Methods From Jan. 1996 to Dec. 2001,103 cases were treated by operation in o...Objective To study the clinical features, surgical treatments and the prognosis of the 103 patients with the metastatic tumors in the spine. Methods From Jan. 1996 to Dec. 2001,103 cases were treated by operation in our department, there were 62 males and 41 females, aging from 33 to 79 years old (average,59 years). The lesions were located at cervical spines in 34 cases, thoracic spines in 39,lumbar spines in 25 and sacrum in 5. The patients underwnet anterior, prosterior,combined or staged antero-posterior operations based on the location of lesions in the spine. Most of the patients were adopted vertebral reconstruction and internal fixation depending on the conditions. Preoperative clinical evaluation included of general conditions,X-ray films,CT scan.MRI and ECT in odrer to decide the endurance of the patient to the surgical treatment. The operation was only considered when the patient could have the expected survival time more than 6 months. Operative indications, surgical methods and prognosis展开更多
BACKGROUND & OBJECTIVE: The majority of intramedullary spinal cord tumors (IMSCT) are low-grade gliomas. Radical resection for IMSCTs remains challenging. Recently, improved neuroimaging and advanced microsurgical...BACKGROUND & OBJECTIVE: The majority of intramedullary spinal cord tumors (IMSCT) are low-grade gliomas. Radical resection for IMSCTs remains challenging. Recently, improved neuroimaging and advanced microsurgical technique have made great success in surgical management of the intramedullary spinal cord tumors. METH-ODS & RESULTS: Twenty-nine patients with intramedullary spinal cord tumors were treated by radical resection dur-ing the past 4 years in our institute. The histological results were as follows: 12 ependymomas, 4 astrocytomas, 4 heman-gioblastomas, 4 epidermoids, 1 cavernoma, 2 lipomas, 2 metastatics. A gross -total resection (】 95%) was achieved in 25 surgical procedures. Subtotal resections (80-95% ) were performed in 4 cases. There was no surgical death.When comparing the preoperative and 3-month postoperative functional grades, 12 patients were stable 14 improved,and 3 deteriorated. Patients with either no deficit or only mild deficit before surgery were rarely impaired by the proce-dure, reinforcing the importance of early diagnosis and treatment. The major determinant of long-term survival was histologi-cal composition of the tumor. Patients in whom an IMSCT was only partially resected (【80% ) fared significantly worse. CONCLUSIONS: The long-term survival and quality of life for patients with low-grade gliomas treated by radi-cal resection alone is comparable or superior to minimal resection plus radiotherapy. The optimal therapy for patients with high-grade glioma is yet to be determined. For benign lesion, such as hemangioblastoma and cavernoma could be cured by total resection of the tumor. For lipoma and epidermoid, fibrous adhesions to the cord make total removal difficult,and thus, removal is not the goal of surgery. The carbon dioxide laser is particularly useful during surgery for this lesion.展开更多
Objective To sum up the clinical experience in diagnosis and treatment of spinal primitive neuroectodermal tumor(PNET). Methods Thirteen patients with spinal PNET were included in the study from 1999 to 2009.There wer...Objective To sum up the clinical experience in diagnosis and treatment of spinal primitive neuroectodermal tumor(PNET). Methods Thirteen patients with spinal PNET were included in the study from 1999 to 2009.There were 8 males and 5展开更多
文摘Introduction: Metastatic spinal tumors (MST) refer to secondary involvement of the vertebral column by hematogenously-disseminated metastatic cells. They could affect either the bony structures or the spinal cords. Mechanical instability and neurologic deficits resulting from spinal cord compression are the most common manifestations. Surgical intervention remains the most effective treatment for about 20% of patients who present with spinal cord compression. The prognosis is relatively poor. This work has as objectives to describe: the diagnostic tools, the different modalities of management and the prognostic elements of spine metastasis. Methodology: We conducted an ambispective cross-sectional descriptive study;with retrospective data collection from January 2015 to December 2021 and prospective collection from January to April 2022 in the “Neurosurgery” unit of the Yaounde Central Hospital and the “Oncology and Neurosurgery” units of Yaounde General Hospital. Result: We included 101 patients. The M/F sex ratio was 1.66. The average age of the participants was 56.44 years (±14.19 SD) with a median of 58 years. Metastatic spinal tumors were discovered in 61.39% of patients with a previously known primary tumor and 21.78% of patients had newly discovered tumors. The neurologic examination revealed a vertebral syndrome in 79.21% of cases, radicular syndrome in 60.40% and sub-lesional syndrome in 59.89%. Sensory disorders accounted for 39.60% and sphincter disorders accounted for 34.65%. According to the degree of severity, the lesions were classified as Frankel E (37.62%) followed by Frankel D (21.78%). Metastatic lesions were mostly found at the thoracic vertebrae (68.25%) and lumbar vertebrae (22.22%). The most represented primary tumors were: prostate tumors (41.58%) and breast tumors (23.76%);followed by malignant hemopathies (15.84%). Computed-tomography scan (CT-scan) was the most frequent diagnostic imaging technique used (71.28%). Analgesic treatment mostly involved level II analgesia (64.36%). High dose steroid therapy (greater than 80mg/24h) was used in more than half of the patients. Radiation therapy was performed in 24.75% of the patients, chemotherapy in 55.44% and specific surgical interventions performed in 20.79%. The most frequent surgical indication was complete motor deficit according to the Frankel classification (47.21%). One patient in four (23.76%) experienced improvement in functional prognosis with increased muscle strength after a period of 2 weeks to 5 months of treatment. About 1 in 10 patients (8.8%) rather had worsening of their neurologic status. We observed that there was a correlation between spine surgery and improvement in muscle strength (P-value less than 0.05). Patients (12) who had better recovery or preserved gait were those with partial compression (P-value = 0.0143). Four out of five patients (81.18%) of our series had an estimated survival of less than one year according to the Tokuhashi score. Conclusion: MSTs are frequent in our context. Most patients sought consultation late after the first symptoms appeared (principally back pain). The clinical examination revealed a high proportion of patients with spinal cord compression syndrome. Medical treatment was first-line for the management of pain and most patients who underwent surgical treatment had complete neurologic deficits. The functional prognosis was found to be improved by surgery and the vital prognosis depended on the Tokuhashi score, with better accuracy when the prediction is more than 12 months.
文摘Objective To investigate the clinical symptoms experienced by patients with thoracic spinal tumors and verify the associated symptoms that are predictive of a decline in muscle strength in the lower limbs.Methods A single-center,retrospective cross-sectional study was conducted on in-patients diagnosed with epidural thoracic spinal tumors between January 2011 and May 2021.The study involved a review of electronic medical records and radiographs and the collection of clinical data.The differences in clinical manifestations between patients with constipation and those without constipation were analyzed.Binary logistic regression analyses were performed to identify risk factors associated with a decline in muscle strength in the lower limbs.Results A total of 227 patients were enrolled,including 131 patients with constipation and 96 without constipation.The constipation group had a significantly higher proportion of patients who experienced difficulty walking or paralysis compared to those without constipation prior to surgery(83.2%vs.17.7%,χ~2=99.035,P 0.001).Constipation(OR=9.522,95%CI:4.150±21.849,P 0.001)and urinary retention(OR=14.490,95%CI:4.543±46.213,P 0.001)were independent risk factors for muscle strength decline in the lower limbs.Conclusions The study observed that patients with thoracic spinal tumors who experienced constipation symptoms had a higher incidence of lower limb weakness.Moreover,the analysis revealed that constipation and urinary retention were independent risk factors associated with a preoperative decline in muscle strength of lower limbs.
文摘Objective To explore the feasibility and clinical results of circumferential decompression and three column reconstruction through single-stage posterior transpedicular approach for spinal tumor treatment. Methods Totally, 24 patients with spinal tumor underwent tumor resection and spinal reconstruc tion through single-stage posterior transpedicular approach. Preoperatively, according to the Frankel classification, 12 patients were grade E, 9 grade D, and 3 grade C. Anterior column was reconstructed with non-expandable titanium cages. Posterior segmental instrumentation was used to maintain the stability of spine in all cases. Anterior and posterolateral fusion was performed with autograft and allogenic bone. The following data were followed up in these patients: deformity angle, local recurrence, neurological function, and spinal bony fusion. Results The average operating time and blood loss was 5.6 hours and 3 400 ml respectively. No intraoperative and postoperative complications were observed in this group. Postoperatively, 21 patients were Frankel grade E, 2 grade D, and 1 grade C. Four patients reported significant functional restoration and twenty patients reported complete resolution of pain. At follow-up (range, 6-42 months), implant failure or recurrent neurological symptoms was not found. Conclusions The tumor resection and spinal reconstruction through single-stage posterior transpedicular approach is a safe and effective technique for the treatment of spinal tumor. It can fully decompress the neurological structures, correct the kyphosis, and achieve early weight-bearing. This technique can improve life quality for the patients with spinal tumor.
文摘To investigate the effect of early rehabilitation on neurofunctional outcome after surgery in children with spinal tumors, this study reviewed the medical charts and radiographic records of 70 pediatric patients(1–17 years old) who received spinal tumor surgical removal. The peddiatric patients received rahabilitation treatment at 4(range, 2–7) days after surgery for 10(range, 7–23) days. Results from the Modified McCormick Scale, Functional Independence Measure for Children, American Spinal Injury Association Impairment Scale and Karnofsky Performance Status Scale demonstrated that the sensory function, motor function and activity of daily living of pediatric children who received early rehabilitation were significantly improved. Results also showed that tumor setting and level localization as well as patients' s clinical symptoms have no influences on neurofunctional outcomes.
基金This research was funded by key clinical projects of Peking University Third Hospital(Peking University talent introduction fund,BYSY2017030).
文摘To investigate the feasibility and early efficacy of 3D-printed vertebral body implantation combined with robotic radiosurgery in the treatment of spinal tumors.This study included 14 patients with spinal tumors from December 2017 to June 2018.Before surgery,all patients were subjected to CT scan and 3D data of the corresponding vertebral segments were collected.Titanium alloy formed 3D-printed vertebral body implantation and robotic stereotactic radiotherapy were performed because of the risk of postoperative residual,high risk of recovery,or recurrence after surgery.The main outcomes included the remission of symptoms,vertebral body stability,robotic stereotactic surgical precision,and local tumor control.All patients received complete and successful combination therapy,and all healed primarily without complications.The error of the coverage accuracy for robotic radiosurgery was less than 0.5 mm,and the error of the rotation angle was less than 0.5.The therapeutic toxicity was limited(mainly in grades 1–2),and adverse events were uncommon.The evaluation of vertebral body stability and histocompatibility for all patients met the postoperative clinical requirements.For patients with post spinal injury,the pain symptoms were reduced or disappeared(93%),and nerve function was improved or even recovered after treatment(100%).During our follow-up period,most tumors were locally well controlled(93%).3D-printed vertebral body implantation combined with robotic radiosurgery may offer a new treatment of spinal tumors.Chinese clinical trial registry:ChiCTR-ONN-17013946.
文摘Arachnoiditis ossificans is an intradural extramedullary lesion resulting from an unusual chronic meningeal inflammatory process and it is thought to be the sequela of end-stage adhesive arachnoiditis secondary to surgery, trauma, arachnoid hemorrhage, meningeal irritation, myelography (particularly oil-based contrast agents), and spinal anesthesia. The spinal arachnoiditis ossificans may be silent or cause a variety of symptoms depending on its location and uncommonly happen to cause spinal cord compression. Very little attention has been paid to the management and outcome of this rare condition in the neurosurgical reem. We report the case of a 45 years old man admitted with L1 - L2 arachnoiditis ossificans revealed by polyradiculopathy on incomplete cauda equina syndrome mimicking spinal canal tumors. The patient underwent surgery and we performed the laminectomy of L1 - L2, total resection of the lesion, followed by a complete remission of the hemiparesis after three months of kinesitherapy nursing.
基金funded by the National Natural Science Foundation of China (No. 81460259)
文摘Objective: In the present study, spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis were quantitatively analyzed using dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) to assess the value of DCE-MRI in the differential diagnosis of these diseases.Methods: Patients with brucellar spondylitis, spinal tuberculosis or a spinal metastatic tumor(30 cases of each)received conventional MRI and DCE-MRI examination. The volume transfer constant(K^(trans)), rate constant(K_(ep)),extravascular extracellular volume fraction(V_e) and plasma volume fraction(V_p) of the diseased vertebral bodies were measured on the perfusion parameter map, and the differences in these parameters between the patients were compared.Results: For pathological vertebrae in cases of spinal metastatic tumor, brucellar spondylitis and spinal tuberculosis, respectively, the K^(trans) values(median ± quartile pitch) were 0.989±0.014, 0.720±0.011 and0.317±0.005 min^(–1); the K_(ep) values were 2.898±0.055, 1.327±0.017 and 0.748±0.006 min^(–1); the V_e values were 0.339±0.008, 0.542±0.013 and 0.428±0.018; the V_p values were 0.048±0.008, 0.035±0.004 and 0.028±0.009; the corresponding H values were 50.25(for K_(trans)), 52.47(for K_(ep)), 48.33(for V_e) and 46.56(for V_p), and all differences were statistically significant(two-sided P<0.05).Conclusions: The quantitative analysis of DCE-MRI has a certain value in the differential diagnosis of spinal metastatic tumor, brucellar spondylitis and spinal tuberculosis.
文摘Background: Spinal canal tumors are difficult to diagnose and treat. The traditional surgical approaches for attempting a complete excision of these lesions frequently involve big incisions and tissue dissection with high risk of postop instability and cerebrospinal fluid leakage. Also, there is a risk of neurological worsening, sometimes irreversible. Methods: We present our experience in a patient series with spinal canal tumors and describe the surgical approach with minimally invasive techniques (MIS). All of them were performed by the Neurosurgery team of the Hospital Universitario San Ignacio during the period of 2011-2016. Results: We reviewed forty patients with spinal canal tumors surgically treated with MIS techniques. 15 patients (37.5%) had Meningioma diagnosis (complete resection in 11 (73.3%), subtotal in 3 (20%) and biopsy in one patient), 10 patients (25%) with Schwannomas reached complete resection in 70% and subtotal in 30%. 5 patients had spinal cord metastasis, with complete resection in 4 patients (80%) and subtotal in 1 (20%). Other included ependymoma, astrocytoma, and miscellaneous. No patient has had cerebrospinal fluid leakage and no postoperative fusion has been required. Conclusions: The minimally invasive approach allowed complete tumors removal in a high number of patients and good postoperative results. These findings are similar and in some cases, better than the reported with traditional techniques. This MIS technique provides encouraging results. It requires a wide learning curve and a high degree of surgical experience.
文摘Objective To investigate the clinical value of different magnetic resonance (MR) pulse sequences in diagnosis of spinal metastatic tumor. Methods Fifteen patients with clinically suspected spinal metastatic tumor were included in this study. These patients were with documented primary tumors. Four MR pulse sequences, T1-weighted spin echo (T1WI SE), T2-weighted fast spin echo (T2WI FSE), short time inversion recovery (STIR), and gradient echo 2-D multi echo data imaging combination (GE Me-2D) were used to detect spinal metastasis. Results Fifteen vertebral bodies were entire involvement, 38 vertebral bodies were section involvement, and totally 53 vertebral bodies were involved. There were 19 focal infections in pedicle of vertebral arch, 15 metastases in spinous process and transverse process. Fifty-three vertebral bodies were abnormal in T1WI SE and GE Me-2D, 35 vertebral bodies were found abnormal in T2WI FSE, and 50 vertebral bodies were found abnormal in STIR. The verges of focal signal of involved vertebral bodies were comparatively clear in T1WI SE, comparatively clear or vague in T2WI FSE, vague in STIR, and clear in GE Me-2D.Conclusions GE Me-2D may be the most sensitive technique to detect metastases. So three sequences (T1WI SE, T2WI FSE, GE Me-2D) can demonstrate the early changes of spinal metastasis roundly.
基金the ES016774-01A1VA Merit Award and National Science Foundation EPSCoR grant, No. EPS-0132573+1 种基金EPS-0447660 (MSK)NS050452-05 (JJH)
文摘BACKGROUND: Numerous studies have shown that tumor necrosis factor α (TNF-α) is closely correlated with spinal cord injury (SCI), but the mechanisms of TNF-α and therapeutic treatments for SCI are still poorly understood. OBJECTIVE: To determine the role of TNF-α in the pathogenesis of SCI. DESIGN, TIME AND SETTING: An in vivo experiment based on genetically engineered animals was performed at the Medical University of South Carolina, Charleston, South Carolina, USA, between June 2007 and October 2008. MATERIALS: TNF-α transgenic rats (Xenogen Biosciences in Cranbury, New Jersey, USA) were utilized in this study. METHODS: TNF-α transgenic (tg) and wild-type (WT) rats underwent a complete single-level laminectomy at the 10th thoracic vertebra (T10). MAIN OUTCOME MEASURES: Motor function of rat hindlimb was assessed using the Basso, Beattie, and Bresnahan hindlimb locomotor rating scale. Histological evaluation of spinal cord tissue loss was conducted. Immunohistochemistry for astrocytes, microglia/macrophages, and TNF receptors (TNFRs) was performed on spinal cord tissue sections. TNF-α mRNA expression was detected by real-time polymerase chain reaction. The concentrations of nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) in the supernatant were determined using an enzyme-linked immunosorbent assay kit for rat NGF or BDNF, respectively. The rats were injected subcutaneously with etanercept to verify that TNF-α was the direct effect of the modulation of behavioral and neurodegenerative outcomes in the TNF-α tg rats. RESULTS: TNF-α tg rats showed higher expression of TNF-α mRNA in the spinal cord prior to SCI. TNF-α tg rats showed worse motor deficits than WT rats in the acute period (< 3 days) after SCI (P < 0.01), while in the chronic period, TNF-α tg rats exhibited persistent elevated baseline levels of TNF-α mRNA and improved recovery in motor function and tissue healing compared to WT rats (P < 0.01). Following SCI, the number of microglia/macrophages in TNF-α tg rat was always greater than in WT rat (P < 0.01). There were no significant differences in NGF and BDNF levels in the supernatant of spinal cord homogenates. TNFR1 expression was significantly greater in the TNF-α tg rats compared to the WT rats (P < 0.01). However, TNFR2 expression did not reveal a significant increase in the TNF-α tg rats compared to the WT rats. Finally, treatment with etanercept reduced injury acutely, but exacerbated the injury chronically. CONCLUSION: Overexpression of TNF-α is deleterious in the acute phase, but beneficial in the chronic phase in the response to SCI. The role of TNF-α post-injury may depend on TNF-α expression in the spinal cord and its differential binding to TNFR1. Our observations may have clinical relevance that antagonists or inhibitors of TNF-α could be administered within the early time window post-injury, and appropriate amounts of TNF-α could be administered during the chronic stage, in order to improve the final neurological recovery in patients with SCI.
基金Supported by Grant from Gachon University Gil Medical Center,No.2013-37
文摘Intramedullary spinal cord metastasis(ISCM) is very rare and its optimal treatment remains controversial. Pancreatic neuroendocrine tumor(pNET) is a rare tumor that usually presents with hepatic metastasis. Hepatic failure due to tumor progression is the major cause of death in cases of pNET. To date,no report has described a case of ISCM from pNET. Although spinal cord metastasis of a solid tumor is uncommon,it is a critical condition that can cause a potentially irreversible loss of neurologic function. Here,we report the case of a 45-year-old man who presented with leg weakness and voiding difficulty,and was found to have ISCM from pNET. Surgical treatment prevented further neurological deterioration. This is the first case report of ISCM from pNET.
文摘PURPOSE:To review the efficacy and patterns of failure in average-risk medulloblastoma patients treated withconcurrent chemotherapy and reduced-dose cranial spinal irradiation and a conformal tumor bed boost.METH-ODS AND MATERIALS:Thirty-three patients with average risk(defined as<==1.5 cm(2)of residual tumorafter resection,age>3 years,and no involvement of the cerebrospinal fluid or spine)medulloblastoma werediagnosed at our institution between January 1994 and December 2001.They were enrolled in an institutional
文摘Objective To study the clinical features, surgical treatments and the prognosis of the 103 patients with the metastatic tumors in the spine. Methods From Jan. 1996 to Dec. 2001,103 cases were treated by operation in our department, there were 62 males and 41 females, aging from 33 to 79 years old (average,59 years). The lesions were located at cervical spines in 34 cases, thoracic spines in 39,lumbar spines in 25 and sacrum in 5. The patients underwnet anterior, prosterior,combined or staged antero-posterior operations based on the location of lesions in the spine. Most of the patients were adopted vertebral reconstruction and internal fixation depending on the conditions. Preoperative clinical evaluation included of general conditions,X-ray films,CT scan.MRI and ECT in odrer to decide the endurance of the patient to the surgical treatment. The operation was only considered when the patient could have the expected survival time more than 6 months. Operative indications, surgical methods and prognosis
文摘BACKGROUND & OBJECTIVE: The majority of intramedullary spinal cord tumors (IMSCT) are low-grade gliomas. Radical resection for IMSCTs remains challenging. Recently, improved neuroimaging and advanced microsurgical technique have made great success in surgical management of the intramedullary spinal cord tumors. METH-ODS & RESULTS: Twenty-nine patients with intramedullary spinal cord tumors were treated by radical resection dur-ing the past 4 years in our institute. The histological results were as follows: 12 ependymomas, 4 astrocytomas, 4 heman-gioblastomas, 4 epidermoids, 1 cavernoma, 2 lipomas, 2 metastatics. A gross -total resection (】 95%) was achieved in 25 surgical procedures. Subtotal resections (80-95% ) were performed in 4 cases. There was no surgical death.When comparing the preoperative and 3-month postoperative functional grades, 12 patients were stable 14 improved,and 3 deteriorated. Patients with either no deficit or only mild deficit before surgery were rarely impaired by the proce-dure, reinforcing the importance of early diagnosis and treatment. The major determinant of long-term survival was histologi-cal composition of the tumor. Patients in whom an IMSCT was only partially resected (【80% ) fared significantly worse. CONCLUSIONS: The long-term survival and quality of life for patients with low-grade gliomas treated by radi-cal resection alone is comparable or superior to minimal resection plus radiotherapy. The optimal therapy for patients with high-grade glioma is yet to be determined. For benign lesion, such as hemangioblastoma and cavernoma could be cured by total resection of the tumor. For lipoma and epidermoid, fibrous adhesions to the cord make total removal difficult,and thus, removal is not the goal of surgery. The carbon dioxide laser is particularly useful during surgery for this lesion.
文摘Objective To sum up the clinical experience in diagnosis and treatment of spinal primitive neuroectodermal tumor(PNET). Methods Thirteen patients with spinal PNET were included in the study from 1999 to 2009.There were 8 males and 5
