BACKGROUNDThe authors sought to identify treatment‐related factors that influenced survival after surgical treatment for metastatic spinal tumors and to evaluate the relationship between survival and postoperative ambulation time as a factor related to quality of life.METHODSThe medical records of 81 patients with metastatic spinal tumors who underwent palliative surgery at the study institution were assessed. Univariate analysis for factors influencing survival used the Kaplan–Meier log rank statistic and multivariate analysis used the Cox proportional hazards model. The Spearman correlation test was used to analyze the relationship between postoperative ambulation and survival time.RESULTSThe patients had a median age of 59.9 years and a median survival of 10.6 months after surgery. For patients, postoperative ambulatory median survival was 16.5 months and median ambulation time was 13.8 months. By univariate analysis, anatomic site of the primary tumor, postoperative ambulation, and combined adjuvant therapy (chemotherapy plus radiotherapy) were associated with prolonged survival (P < 0.05). Multivariate analysis identified primary site and postoperative ambulatory function as independent predictors of prolonged survival (P < 0.0001). Significant correlations were found between ambulation time and survival time of patients who were able to walk after surgery (P < 0.0001), even in patients with liver (P < 0.05) or lung carcinoma (P < 0.05).CONCLUSIONSThe anatomic site of primary carcinoma and postoperative ambulation were associated with longer survival after palliative surgery for metastatic spinal tumor. When ambulation is attained after surgery, it can be preserved until late in remaining life even when the primary tumor is unfavorable. Palliative surgery for spinal metastasis can improve the quality and quantity of life. Cancer 2003;97:476–84. © 2003 American Cancer Society.DOI 10.1002/cncr.11039

No abstract

This paper reports the results of a radiological population study on the ossification of the posterior longitudinal ligament (OPLL) in both the cervical and the thoracic spine among Japanese. The study was carried out in the Yachiho-mura district in the central part of Japan, where 5074 people were living. X-ray examinations were made of 1058 of the people; there were 440 men and 618 women, 50 or more years of age. The roentgenograms showed 34 cases of OPLL in the cervical spine (3.2%): 19 men (4.3%) and 15 women (2.4%). The condition was most frequently observed at the level of C-4. Radiological classification showed 18 cases of the segmental type, 11 of the continuous type, and five of a mixed type. There were eight cases of OPLL in the thoracic spine (0.8%), four in men (0.9%) and four in women (0.6%). OPLL in the thoracic spine was most frequently observed at the midthoracic levels. All eight cases showed a continuous type of ossification. There were three subjects with OPLL in both the cervical and the thoracic spine. Therefore, the number of subjects with OPLL in either the cervical or the thoracic spine was 39 (3.7%) total.

No abstract

✓ Two cases of eosinophilic granuloma (EG) of the spine associated with neurological deficits are presented. The patients were treated conservatively by using external fixation with a brace as well as bed rest. Neurological deficits and pain diminished and finally disappeared as the tumor mass decreased in size, as seen on magnetic resonance (MR) imaging. During the 5-year follow-up period no recurrence of the tumors was detected on MR images. Surgical treatment for spinal EG in children presenting with typical vertebra plana is not recommended except for those with severe or progressive palsy and for those in whom the disease requires differential diagnosis.

Object. A new dorsolateral decompressive procedure involving a unilateral approach has been devised for the treatment of cervical compressive myelopathy. In this operation, the posterior spinal elements of the contralateral side are not disturbed, and thus, postoperative deformity of the cervical spine can be avoided. Following decompressive surgery via the unilateral approach, the cervical spine was kept more stable compared with the results obtained after wide laminectomy or other expansive laminoplasty procedures. Methods. Twenty-six patients underwent dorsolateral decompressive surgery, and the patients' clinical and radiological results were examined during the follow-up period to evaluate neurological function and postoperative deformities of the cervical spine. The underlying conditions for myelopathy were cervical spondylosis (19 patients), ossification of posterior longitudinal ligament (three patients), and ossification of yellow ligament (four patients). The follow-up period ranged from 6 to 110 months (average 35.5 months). Functional recovery, which was rated by using the Japanese Orthopaedic Association scoring system, was an average of 56% in all patients (100% being equal to full recovery). The recovery rate was compatible with those attained after other expansive laminoplasty procedures. Radiographically, progression to swan-neck or kyphotic deformity was not observed in any patient. No postoperative spinal instability was noted. Based on computerized tomography myelograph evaluation, the average transectional area of the dural tube at the C4–5 level was expanded from 122 mm2 to 169 mm2, and the transectional area of the spinal cord at the C4–5 level was expanded from 39.6 mm2 to 52.9 mm2 after surgery. Conclusions. The authors conclude that this operative procedure could be used as a new option for the treatment of cervical compressive myelopathy.

Objective: To evaluate whether reconstructive hand surgery could improve the ability of tetraplegic patients to perform clean intermittent self-catheterization (CIC). Materials and methods: The subjects were patients with complete traumatic tetraplegia admitted to the Nagano Rehabilitation Center between 1977 and 1996. A total of 63 subjects were included in this study with an age range of 18 ± 73 years (mean 38.2 years). Reconstructive hand surgery was performed on 44 hands (28 cases). Current urological conditions were assessed by interview or mail questionnaire. Results: Fifty-one per cent (22/43) of the patients with C6 level of tetraplegia and 86% (12/ 14) of those with C7 or C8 neurological level of injury could perform CIC independently and only one subject needed assisted CIC. Conclusion: CIC is the preferred option for people with tetraplegia. Reconstructive hand surgery is thus recommended to make urological management more independent for a selected group of people with tetraplegia. Spinal Cord (2000) 38, 541 ± 545

Background. Quality of life (QOL) is a concern in patients with lumbar spinal stenosis (LSS).