Neurological Results in Spinal Cord Metastases

Baldini, M; Gp, Tonnarelli; Princi, L; Vivenza, C.; Nizzoli,

doi:10.1055/s-0028-1090304

Cited by 5 publications

(8 citation statements)

References 5 publications

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“…And, in this experience as in others [1,6,8,10,15,16,20,21], the thoracic vertebral portion of the spine was most commonly involved. This has been explained on the basis of the greater 'number of vertebrae and capaciousness of the epidural space' [22] in this part of the spinal column.…”

Section: Discussionsupporting

confidence: 69%

“…With respect to treatment of ECMT (with operative decompression, radiotherapy or a combination of both methods) for pain relief, reported response rates have been from 19 percent to 70 percent [1,9,11,16,21,32].…”

Section: Discussionmentioning

confidence: 99%

“…Its characteristic natural progression of neurological symptomatology is often one of back or radicular pain alone preceding (by hours to months) the onset of weakness or paralysis of the extremities with or without associated sensory or autonomic bladder/rectal sphincter control impairment [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, Sherrah-Davies [14] said that, 'Early paraplegia, that is, a paraplegia with a history of about 48 h or less, is one of the very few radiotherapy emergencies which warrant opening up the therapy department out of working hours for the paraplegia can disappear completely'. Recent reports [1,15], in contrast, have indicated that the prognosis for neurological recovery in such patients is poor despite prompt (instituted in less than 24 hours of the appearance of paraplegia) therapy. Moreover, 'Unfortunately, many patients are sent for treatment with a fully established paraplegia and a history of weeks' rather than days' duration.…”

Section: Introductionmentioning

confidence: 99%

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Epidural compression from metastatic tumor with resultant paralysis

Ampil

1989

J Neuro-Oncol

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To determine the value of the usually given 'urgent' palliative radiotherapy in paraplegic patients with epidural compression from metastatic tumor, 20 consecutive cases treated between 1981 and 1986 were retrospectively analyzed. Bronchogenic and prostatic carcinoma were the more common extraspinal sources of metastasis. Epidural metastasis involved the thoracic spine in most cases. The onset of neurological symptomatology was frequently within two weeks prior to hospitalization. The majority of the subjects received at least 3000 cGy given in 10 to 15 fractions. Symptomatic (pain relief) response rate was 78 (7/9) percent. The observed period of survival averaged 2.5 months after treatment. This study reaffirmed the little chance for recovery of lost limb(s0 motor function. None of the patients (most of whom were paraplegic from two to 90 days pre-irradiation) became ambulatory including the two in whom irradiation was administered within 24 hours from the onset of paraplegia.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Epidural compression from metastatic tumor with resultant paralysis

Ampil

1989

J Neuro-Oncol

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“…Epidural spinal cord compression thus usually results when tumors extend dorsally from the vertebral body into the spinal canal. [3,4,6,8,20,22,24,25,38] The important point to consider is that laminectomy is not the proper surgical procedure on which to base such comparisons. The rationale for this stems from reports in which results from radiation therapy alone are compared with those from radiotherapy combined with laminectomy.…”

Section: Discussionmentioning

confidence: 99%

Transthoracic vertebrectomy for metastatic spinal tumors

Gokaslan¹,

York²,

Walsh³

et al. 1998

FOC

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Anterior approaches to the spine for the treatment of spinal tumors have gained acceptance; however, in most published reports, patients with primary, metastatic, or chest wall tumors involving cervical, thoracic, or lumbar regions of the spine are combined. The purpose of this study was to provide a clear perspective of results that can be expected in patients who undergo anterior vertebral body resection, reconstruction, and stabilization for spinal metastases that are limited to the thoracic region. Outcome is presented for 72 patients with metastatic spinal tumors who were treated by transthoracic vertebrectomy at The University of Texas M. D. Anderson Cancer Center. The predominant primary tumors included renal cancer in 19 patients, breast cancer in 10, melanoma or sarcoma in 10, and lung cancer in nine patients. The most common presenting symptoms were back pain, which occurred in 90% of patients, and lower-extremity weakness, which occurred in 64% of patients. All patients underwent transthoracic vertebrectomy, decompression, reconstruction with methylmethacrylate, and anterior fixation with locking plate and screw constructs. Supplemental posterior instrumentation was required in seven patients with disease involving the cervicothoracic or thoracolumbar junction, which was causing severe kyphosis. After surgery, pain improved in 60 of 65 patients. This improvement was found to be statistically significant (p < 0.001) based on visual analog scales and narcotic analgesic medication use. Thirty-five of the 46 patients who presented with neurological dysfunction improved significantly (p < 0.001) following the procedure. Thirty-three patients had weakness but could ambulate preoperatively. Seventeen of these 33 regained normal strength, 15 patients continued to have weakness, and one patient was neurologically worse postoperatively. Of the 13 preoperatively nonambulatory patients, 10 could walk after surgery and three were still unable to walk but showed improved motor function. Twenty-one patients had complications ranging from minor atelectasis to pulmonary embolism. The 30-day mortality rate was 3%. The 1-year survival rate for the entire study population was 62%. These results suggest that transthoracic vertebrectomy and spinal stabilization can improve the quality of life considerably in cancer patients with spinal metastasis by restoring or preserving ambulation and by controlling intractable spinal pain with acceptable rates of morbidity and mortality.

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