Don't Wait for a Sensory Level–Listen to the Symptoms: a Prospective Audit of the Delays in Diagnosis of Malignant Cord Compression

2002 ◽  
Vol 14 (6) ◽  
pp. 472-480 ◽  
Author(s):  
P. Levack ◽  
J. Graham ◽  
D. Collie ◽  
R. Grant ◽  
J. Kidd ◽  
...  
Keyword(s):  
Cord Compression ◽  
Sensory Level ◽  
Prospective Audit ◽  
Delays In Diagnosis

scholarly journals Cervical C7 ganglion cyst causing compressive myelopathy: A rare case report

2019 ◽  
Vol 10 ◽  
pp. 61
Author(s):  
Charandeep Singh Gandhoke ◽  
Siu Kei David Mak ◽  
Nishal Kishinchand Primalani ◽  
Eng Tah Goh ◽  
Hwei Yee Lee ◽  
...  
Keyword(s):  
Ganglion Cyst ◽  
Cord Compression ◽  
Sensory Level ◽  
Facet Joints ◽  
Complete Excision ◽  
Lower Extremity Weakness ◽  
Ganglion Cysts ◽  
Rare Case Report ◽  
History Of ◽  
Compressive Myelopathy

Background: Juxtafacet cysts, synovial and ganglion cysts, emanate from the facet joints. Patients with these cysts are typically asymptomatic but may rarely present with radiculopathy and/or myelopathy. Case Description: A 72-year-old female presented with a 1-month history of progressive lower extremity weakness (left more than right), numbness, and urinary incontinence. Notably, she also had a C7 sensory level to pin appreciation of 1-month duration. The magnetic resonance imaging showed an extradural C7 cystic lesion whose capsule enhanced with gadolinium, causing severe cord compression. The patient underwent a left C7 hemilaminectomy for complete excision of the cyst; postoperatively in 2-weeks duration, she regained full neurological function. The final histopathology was consistent with a ganglion cyst. Conclusion: Cervical juxtafacet cysts rarely cause compressive myelopathy. They may be readily diagnosed and resected with excellent postoperative outcomes.

Nocardial Osteomyelitis of the Spine with Epidural Spinal Cord Compression-a Case Report

Neurosurgery ◽  
1984 ◽  
Vol 15 (2) ◽  
pp. 254-256 ◽  
Author(s):  
Issam Awad ◽  
Janet W. Bay ◽  
John M. Petersen
Keyword(s):  
Vertebral Osteomyelitis ◽  
Cord Compression ◽  
Nocardia Asteroides ◽  
Sensory Level ◽  
Thoracic Myelopathy ◽  
Underlying Malignancy ◽  
Rare Manifestation ◽  
Specimen Processing ◽  
Epidural Compression ◽  
Diagnostic Work

Abstract A 53-year-old man presented with complaints of back pain and weakness in his lower extremities. Physical examination demonstrated a thoracic myelopathy with a sensory level at T-4, The diagnostic work-up revealed vertebral osteomyelitis of the thoracic spine with epidural compression at T-2-T-4 causing a nearly complete block on myelography. A decompressive laminectomy and debridement were performed, followed by anterior spinal fusion. Nocardia asteroides was cultured from the epidural space. The patient was concurrently treated with sulfonamides. No underlying malignancy or immunosuppression could be demonstrated, but a primary pulmonary nocardial infection was suspected. A satisfactory recovery was accomplished. Only four other cases of nocardial osteomyelitis of the spine have been reported in the literature. These are discussed, and possible mechanisms are proposed for the pathophysiology of this rare manifestation. Current recommendations on the specimen processing, diagnosis, and therapy of nocardial infections are briefly reviewed.

scholarly journals A retrospective study of delays in diagnosis and treatment for malignant spinal cord compression

2015 ◽  
Vol 10 (3) ◽  
pp. 305-309 ◽  
Author(s):  
Chieko Kudo ◽  
Tomohiko Niitani ◽  
Hitoshi Wada ◽  
Yuko Sato ◽  
Sonoko Ichikawa ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Retrospective Study ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Diagnosis And Treatment ◽  
Delays In Diagnosis

scholarly journals Surgical management of vertebral metastatic gastrointestinal stromal tumor: Case illustration, literature review, and pooled analysis

2020 ◽  
Vol 11 ◽  
pp. 343
Author(s):  
Yu Tung Lo ◽  
David Siu Kei Mak ◽  
Colum Patrick Nolan
Keyword(s):  
Kinase Inhibitors ◽  
Systemic Disease ◽  
Cord Compression ◽  
Pooled Analysis ◽  
Sensory Level ◽  
Management Options ◽  
Limb Weakness ◽  
Term Survival ◽  
Neurological Outcomes ◽  
Surgical Fixation

Background: Gastrointestinal stromal tumors (GISTs) very rarely metastasize to the vertebrae. Tyrosine kinase inhibitors (TKIs) confer favorable long-term survival and durable disease control for metastatic disease. Here, we reviewed a case and the literature to determine the various management options, and neurological outcomes for these patients. Case Description: A 63-year-old Chinese female with metastatic jejunal GIST previously treated with various TKIs presented with the left lower limb weakness and a sensory level at T10. MRI revealed a T9 vertebral body tumor with cord compression. The tumor was excised and surgical fixation was performed. She received 30Gy of fractionated adjuvant radiotherapy. She achieved near-complete neurological recovery but died 2 months later from systemic disease progression. Conclusion: Based on this case and a review of the literature, surgical intervention and treatment with TKIs with adjuvant RT can lead to comparable survival and neurological outcomes.

CIDP PRESENTING AS MYELORADICULOPATHY

2021 ◽  
pp. 50-51
Author(s):  
Sundarachary. N.V ◽  
Mythri. A.
Keyword(s):  
Peripheral Nerves ◽  
Urge Incontinence ◽  
Cauda Equina ◽  
Cord Compression ◽  
Nerve Conduction Studies ◽  
Lower Limbs ◽  
Sensory Level ◽  
Nerve Roots ◽  
Sensory Disturbances ◽  
Progressive Disorder

Chronic inammatory demyelinating polyradiculoneuropathy (CIDP) is a relapsing or chronic progressive disorder which is one of the causes of hypertrophic neuropathy. Enlarged nerve roots were identied in few patients. We now report a case of CIDP with highly thickened or enlarged nerve roots severe enough to cause cord compression and myelopathy. A 38 year old woman presented with weakness and sensory disturbances in lower limbs with sensory level at L1 and bladder disturbances in form of urgency and urge incontinence . MRI showed a non enhancing isointense mass lesion from L1 to S1 causing compression over conus . During surgery the cauda equina nerve roots were found to be thickened , entangled with ' bag of worms' appearance. Nerve conduction studies showed all her peripheral nerves to be inexcitable. Her CSF protein was mildly elevated. Diagnosis of CIDP with thickened nerve roots was considered and she was started on steroids and subsequently showed improvement. Thus, CIDP may present with symptoms of myeloradiculopathy due to thickened nerve roots causing cord compression.

Minimally Invasive Tubular Separation Surgery for Metastatic Spinal Cord Compression: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Rafael De la Garza Ramos ◽  
Murray Echt ◽  
Yaroslav Gelfand ◽  
Vijay Yanamadala ◽  
Reza Yassari
Keyword(s):  
Spinal Cord ◽  
Minimally Invasive ◽  
Posterior Longitudinal Ligament ◽  
Cord Compression ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Sensory Level ◽  
Safe Delivery ◽  
Stereotactic Body Radiation ◽  
Patient Consent

Abstract Symptomatic cord compression affects approximately 20% of patients with spinal metastatic disease. Direct decompressive surgery followed by conventional radiation was shown to be superior to radiation alone in a landmark trial published in 2005.1 For radioresistant tumors causing high-grade compression, however, “separation surgery” followed by stereotactic body radiation therapy was developed. The main goal of this newer technique is to decompress and create a distance between the spinal cord and tumor to allow for safe delivery of radiation.2 This technique has shown to provide durable local tumor control, pain relief, and preservation of neurological function.3,4 In this study, we describe a minimally invasive tubular separation surgery technique used to treat symptomatic cord compression in a 59-yr-old man with metastatic prostate adenocarcinoma to T9. The patient presented with acute motor weakness and sensory level. A tubular retraction system was used to dock over the pedicle at T9 bilaterally and a posterior decompression with ligamentectomy was first performed. This was followed by transpedicular decompression and ventral removal of the posterior longitudinal ligament. Space was created between the ventral tumor and spinal cord to allow for postoperative stereotactic body radiation. The patient had a significant improvement in his strength and gait postoperatively.  Patient consent was obtained for videotaping prior to surgical intervention.

scholarly journals Suspected malignant cord compression – improving time to diagnosis via a ‘hotline’: a prospective audit

2009 ◽  
Vol 100 (12) ◽  
pp. 1867-1872 ◽  
Author(s):  
L Allan ◽  
L Baker ◽  
J Dewar ◽  
S Eljamel ◽  
R M Grant ◽  
...  
Keyword(s):  
Cord Compression ◽  
Prospective Audit ◽  
Time To Diagnosis

scholarly journals Idiopathic Hypertrophic Spinal Pachymeningitis: A Diagnostic Challenge: A Case Report and Review of the Literature

2019 ◽  
Vol 11 (01) ◽  
pp. 175-177
Author(s):  
Abdulla Alsulaiman
Keyword(s):  
Surgical Intervention ◽  
Cord Compression ◽  
Sensory Level ◽  
Review Of The Literature ◽  
Resonance Imaging ◽  
Neurological Damage ◽  
Hypertrophic Pachymeningitis ◽  
Diagnostic Challenge ◽  
Spinal Compression ◽  
Early Surgical Intervention

AbstractIdiopathic hypertrophic pachymeningitis (IHP) can resemble other disorders associated with spinal compression. It is a rare inflammatory fibrosing disease of the dura of unidentified etiology and is considered a diagnosis of exclusion. We present a case of idiopathic hypertrophic spinal pachymeningitis occupying a long segment of cervical dura. This is a case of 38-year-old female patient, who suffered progressive neck pain for 2-year duration. Examination revealed spasticity in all four limbs, plus three symmetric reflexes all over, and the sensory level at T4. Magnetic resonance imaging showed spinal cord compression by a thickened anterior and posterior dura adjacent to the cord from C2 to C7. The diagnosis of spinal IHP was confirmed through biopsy. The patient improved after treatment with corticosteroids. Early surgical intervention with postoperative corticosteroid therapy is a known treatment for this disease, as a way to prevent irreversible neurological damage.

scholarly journals Compressive Dorsal Myelopathy Secondary to Extramedullary Hematopoiesis in a Thalassemic Patient

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Ismail Ibrahim Ismail ◽  
Fathi Massoud ◽  
K. J. Alexander ◽  
Jasem Youssef Al-Hashel
Keyword(s):  
Extramedullary Hematopoiesis ◽  
Cord Compression ◽  
Lower Limbs ◽  
Beta Thalassemia ◽  
Sensory Level ◽  
Compensatory Mechanism ◽  
Hematopoietic Tissue ◽  
Thalassemic Patient ◽  
Low Dose Radiotherapy ◽  
Magnetic Resonance Imaging Mri

Background. Extramedullary hematopoiesis (EMH) is one of the rare causes of spinal cord compression (SCC). It results from noncancerous proliferation of hematopoietic tissue outside the bone marrow as a compensatory mechanism for ineffective erythropoiesis. It occurs in the paraspinal area in 11–15% of thalassemic patients in intermediate and severe cases causing a paraspinal compressive mass. We present a rare case of spinal EMH with thoracic cord compression in a 22-year-old female with beta thalassemia who presented with paraparesis and we provide a review of literature. Case Report. A 22-year-old female patient with a known history of beta thalassemia presented with subacute onset of weakness and numbness of both lower limbs with a sensory level at T6. Magnetic resonance imaging (MRI) of the dorsal spine showed cord compression secondary to paraspinal EMH from T2 to T9 with most prominent compression over T5. She was managed with blood transfusion and low-dose radiotherapy. Conclusion. Although rare, EMH should be suspected in thalassemic patients presenting with paraplegia. Treatment with blood transfusions is usually effective. Other options include radiotherapy, surgery, hydroxyurea or a combination of these modalities.

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