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1.
J Natl Cancer Inst ; 116(7): 1087-1094, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38704149

RESUMO

PURPOSE: This article reports detailed quality-of-life data including preferred and actual place of care from SCORAD, the only large prospective randomized trial in metastatic spinal cord compression (MSCC). METHODS: SCORAD compared 2 doses of radiotherapy in patients with MSCC: 8 Gy single fraction and 20 Gy in 5 fractions. In total, 686 patients were randomized, of whom 590 had Health-Related Quality of Life (HRQoL) data collected at baseline and at least 1 later time point. HRQoL was measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 supplemented with the QLU-C10D and data on place of care at weeks 1, 4, 8, and 12 postrandomization. Quality-of-Life Adjusted Survival was computed by multiplying Kaplan-Meier survival probabilities with the UK utility weights obtained from the QLU-C10D. RESULTS: Patients with a baseline physical functioning score of above 50 demonstrated a 28% reduction in the risk of death (hazard ratio [HR] = 0.72, 99% confidence interval [CI] = 0.54 to 0.95; P = .003). An increased risk of death was associated with fatigue (HR = 1.35, 99% CI = 1.03 to 1.76; P = .0040), dyspnea (HR = 1.61, 99% CI = 1.24 to 2.08; P < .001), and appetite loss (HR = 1.25, 99% CI = 0.99 to 1.59; P = .014). The preferred place of care for the majority was at home or with relatives (61%-74% across the 12 weeks) but achieved by only 53% at 8 weeks. CONCLUSIONS: Prolonged survival in patients with MSCC was associated with better HRQoL. More than 60% of patients preferred to be cared for at home or with relatives, but only half were able to achieve this. There was no difference in HRQoL between the multifraction and single-fraction groups. TRIAL REGISTRATION: ISRCTN97555949 and ISRCTN97108008.


Assuntos
Qualidade de Vida , Compressão da Medula Espinal , Humanos , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/radioterapia , Compressão da Medula Espinal/terapia , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Neoplasias da Coluna Vertebral/secundário , Neoplasias da Coluna Vertebral/radioterapia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/mortalidade , Neoplasias da Coluna Vertebral/psicologia , Estudos Prospectivos , Inquéritos e Questionários , Estimativa de Kaplan-Meier
2.
Oncol Res Treat ; 47(6): 287-295, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38432228

RESUMO

INTRODUCTION: The management of metastatic spinal cord compression (mSCC) is a demanding task. The main challenges of mSCC include various manifestations and unpredictable outcomes with indiscriminate treatment recommendations. Because of attendant urgency with potentially devastating health consequences, the SCC is an emotionally disturbing experience whose management could take an impulsive rather than rational approach. The treatment strategy is particularly problematic when mSCC is caused by a malignant lymphoma with its protean attributes. CASE REPORT: A 68-year-old female presented with generalized body pain and weight loss. Imaging studies revealed a vast bulk of the disease involving lymph nodes, spleen, visceral organs, musculature, marrow, and bones including vertebrae with extension into the spinal canal. A biopsy of the chest wall mass showed high-grade diffuse large B-cell lymphoma. A magnetic resonance imaging (MRI) of the spine demonstrated diffuse marrow replacement by the tumor of the thoracic and lumbar spine with compression of the cord. The prompt treatment with corticosteroids and immunochemotherapy (ICT) was recommended, but the patient elected to seek a second opinion. After two doses of radiation therapy, the patient's general condition rapidly deteriorated and she was hospitalized for systemic ICT. Despite the treatment, her condition continued to deteriorate, and she died 3 weeks after the presentation. CONCLUSION: The presented case demonstrates some hitherto unaddressed challenges in evaluation and treatment of mSCC caused by aggressive non-Hodgkin lymphoma (LSSC). The case scrutinizes the role of MRI in uncommon clinical situations. The case has also exposed some ethical issues associated with the proper management of LSCC.


Assuntos
Compressão da Medula Espinal , Humanos , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/terapia , Feminino , Idoso , Evolução Fatal , Linfoma Difuso de Grandes Células B/terapia , Linfoma Difuso de Grandes Células B/patologia , Linfoma de Células B/terapia , Linfoma de Células B/complicações , Linfoma de Células B/patologia , Neoplasias da Coluna Vertebral/secundário , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/terapia , Imageamento por Ressonância Magnética
3.
Spine J ; 24(7): 1302-1312, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38432298

RESUMO

BACKGROUND CONTENT: Spinal cord compression is a source of pathology routinely seen in clinical practice. However, there remain unanswered questions surrounding both the understanding of pathogenesis and the best method of treatment. This arises from limited real-life testing of the mechanical properties of the spinal cord, either through cadaveric human specimens or animal testing, both of which suffer from methodological, as well as ethical, issues. PURPOSE: To conduct a review of the literature on the mechanical properties of the spinal cord. STUDY DESIGN/SETTING: A systematic review of the literature on the mechanical properties of the spinal cord is undertaken. PATIENT SAMPLE: All literature reporting the testing of the mechanical properties of the spinal cord. OUTCOME MEASURES: Reported physiological mechanical properties of the spinal cord. METHODS: The methodological quality of the studies has been assessed within the ARRIVE guidelines using the CAMARADES framework and SYRCLE's risk of bias tool. This paper details the methodologies and results of the reported testing. RESULTS: We show that (1) the research quality of previous work does not follow published guidelines on animal treatment or risk of bias, (2) no standard protocol has been employed for sample preparation or mechanical testing, (3) this leads to a wide distribution of results for the tested mechanical properties, not applicable to the living human or animal, and (4) animal testing is not a good proxy for human application. CONCLUSIONS: The findings summarize the sum of current knowledge inherent to the mechanical properties of the spinal cord and may contribute to the development of a physical model which is applicable to the living human for analysis and testing in a controlled and repeatable fashion. Such a model would be the basis for further clinical research to improve outcomes from spinal cord compression.


Assuntos
Compressão da Medula Espinal , Medula Espinal , Animais , Humanos , Fenômenos Biomecânicos , Medula Espinal/fisiologia , Medula Espinal/fisiopatologia , Compressão da Medula Espinal/terapia , Guias como Assunto
6.
Turk J Pediatr ; 65(5): 801-808, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37853971

RESUMO

BACKGROUND: The spinal cord compression causes irreversible long-term permanent neurological sequelae. This study aims to increase awareness of childhood cancers that cause cord compression by comparing histopathological diagnosis, treatments, and survival rates to the literature. METHODS: Seventy-three patients (38 male, 35 female) with spinal cord compression, among 1085 patients diagnosed with solid tumors at Gazi University Department of Pediatric Oncology between 1991 and 2021 were retrospectively evaluated. RESULTS: The mean time between the onset of complaints and diagnosis was 27.5± 24.9 (2-150) days. The first three most common tumors that caused cord compression; were central nervous system tumors in 22 (30%), neuroblastoma in 17 (23%), and malignant germ cell tumors in 8 (10%) cases. Of the patients, 46 (63%) had compression due to extradural masses, and 27 (37%) patients had an intradural compression. The most common symptoms were pain in 60 (82%), weakness in 57 (78%), and pins and needles in 28 (38%) patients, respectively. The clinical physical neurological examination findings were motor deficit in 62 (84%), and deep tendon reflex changes in 54 patients (73.9%). Compression findings were detected in 58 (79.5%) patients at diagnosis, and in 15 (20.5%) of them during follow-up. The most common level of compression was seen in the thoracolumbar region in 19 (26%) cases. In 65 (89%) patients with cord compression, corticosteroids were given as anti-edema treatment. Surgical excision was performed in 39 (53%) patients. Spinal radiotherapy was given to 35 patients (48%) with radiosensitive tumors. Chemotherapy protocols were started in 52 (71.2%) cases according to their diagnoses. Complete neurological recovery was achieved in 33 (45%) patients. The 5-year overall survival rates for solid tumors with extradural compression and intradural compression were 62% and 22%, respectively (p=0.002). CONCLUSIONS: Neurological sequela-free recovery is possible with early diagnosis and urgent treatment. Spinal compression must be detected by detailed systemic and neurological examination and imaging methods. Patients should be rapidly transferred to pediatric oncology units after starting anti-edema treatment.


Assuntos
Neuroblastoma , Compressão da Medula Espinal , Humanos , Masculino , Criança , Feminino , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/terapia , Compressão da Medula Espinal/diagnóstico , Estudos Retrospectivos , Neuroblastoma/complicações , Neuroblastoma/terapia , Dor
7.
J Cancer Educ ; 38(6): 1939-1947, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37656394

RESUMO

High-fidelity simulation (HFS) training is suited to high-stakes, uncommon situations such as malignant spinal cord compression (MSCC), allowing for rare hands-on practice. This pilot study was created as the first of its kind to examine educational outcomes of a radiation therapist (RTT)-led multidisciplinary radiation oncology (RO) emergency simulation course. A multidisciplinary course design team composed of RO residents, radiation oncologists, RTT course instructors, and medical physicists created a high-fidelity MSCC simulation course using collaboratively developed learning goals. Fifteen learners including RO residents, senior RTT students, and a medical physics (MP) resident participated in a live, RTT-facilitated simulation. Participants completed anonymized pre- and post-simulation standard interdisciplinary education perception (IEP) scales and a course evaluation assessing educational outcomes. Standard IEP questionnaire results showed highly favorable perceptions of respondents' own specialty and other allied specialties, with mean total pre-simulation scores of 91.76 and post-simulation scores of 94.23. The course evaluation assessed 10 learning objective domains, with significant improvements seen in self-rated post-course knowledge in 9 domains. Pre-course evaluations showed that 6/15 participants agreed or strongly agreed that they felt comfortable in their knowledge of all included domains; after course completion, 14/15 participants agreed or strongly agreed they felt comfortable in all domains. Collaboratively designed and led HFS courses are not only viable but can be an effective means of improving learning outcomes for RO residents, RTT students, and MP residents.


Assuntos
Treinamento com Simulação de Alta Fidelidade , Compressão da Medula Espinal , Humanos , Projetos Piloto , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/terapia , Aprendizagem , Pessoal Técnico de Saúde
8.
Eur Spine J ; 32(12): 4306-4313, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37338630

RESUMO

BACKGROUND: Malignant spinal cord compression (MSCC) has been noted in 3-5% of children with primary tumours. MSCC can be associated with permanent neurological deficits and prompt treatment is necessary. Our aim was to perform a systematic review on MSCC in children < 18 years to help formulate national guidelines. METHODS: A systematic review of the English language was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search criteria included 'MSCC in children, paediatric and metastases' for papers published between January1999 and December 2022. Isolated case reports/case series with < 10 patients were excluded. RESULTS: From a total of 17 articles identified, a final 7 were analysed (Level III/IV). Neuroblastoma constituted the most common cause for MSCC in children (62.7%) followed by sarcoma (14.2%). Soft tissue sarcomas were the most frequent cause of MSCC in children > 5 years old, while for neuroblastomas, the mean age of presentation was 20 months. The median age at time of diagnosis for the entire cohort of patients was 50.9 months (14.8-139). The median follow-up duration was 50.7 months (0.5-204). Motor deficits were the presenting symptom in 95.6% of children followed by pain in 65.4% and sphincter disturbance in 24%. There was a delay of about 26.05 days (7-600) between the onset of symptoms and diagnosis. A multimodality approach to treatment was utilised depending on the primary tumour. The prognosis for neurological recovery was found to be inversely proportional to the degree of neurological deficits and duration of symptoms in four studies. CONCLUSION: Neuroblastoma is the most common cause for MSCC in children (62.7%) followed by sarcoma (14.2%), whilst soft tissue sarcomas constituted the most frequent cause of MSCC in children > 5 years old. The majority of patients presented with motor deficit, followed by pain. In children with neuroblastoma /lymphoma, chemotherapy was the primary treatment. Early surgery should be a consideration with rapid deterioration of neurology despite chemotherapy. A multimodality approach including chemo-radiotherapy and surgery should be the treatment of choice in metastatic sarcomas. It is worth noting that multi-level laminectomy/decompression and asymmetrical radiation to the spine can lead to spinal column deformity in the future.


Assuntos
Neuroblastoma , Sarcoma , Compressão da Medula Espinal , Neoplasias da Medula Espinal , Neoplasias da Coluna Vertebral , Humanos , Criança , Lactente , Pré-Escolar , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/terapia , Prognóstico , Dor/complicações , Sarcoma/complicações , Neuroblastoma/complicações , Neuroblastoma/terapia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/terapia , Neoplasias da Coluna Vertebral/diagnóstico , Estudos Retrospectivos
9.
J Vasc Interv Radiol ; 34(4): 613-618, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36649805

RESUMO

PURPOSE: To evaluate the safety and effectiveness of preoperative embolization with n-butyl cyanoacrylate (nBCA) performed for metastatic spinal cord compression (MSCC) in limiting blood loss (BL). MATERIALS AND METHODS: In this institutional review board-approved retrospective study, clinical records from 2017 to 2022 were reviewed. Twenty consecutive patients (11 men and 9 women; mean age, 65.8 years ± 10.0; range, 45-82 years) underwent 21 preoperative spine tumor embolizations with nBCA. Angiograms were used to calculate the percentage reduction in tumor vascularity, and relevant clinical data (levels studied and embolized, fluoroscopy time [FT], reference dose [RD], and Kerma area product [KAP]) and operative data (BL and operative time [OT]) were analyzed. Adverse events and outcomes were recorded. RESULTS: A median of 2 levels were embolized per procedure (range, 1-5) but 4.9 were studied (range, 1-10). After embolization, tumor blush was reduced by a median of 87.3% (range, 50%-90%). The mean FT was 41 minutes ± 15.4 (range, 16-67 minutes), the mean RD was 1,977.1 mGy ± 1,794.3 (range, 450.2-6,319 mGy), and the mean KAP was 180.5 Gy·cm2 ± 166.2 (range, 30.4-504 Gy·cm2). The adverse event rate was 1 (4.7%) of the 21 embolizations because a weakness of lower extremities related to swelling was observed. Surgery was performed at a mean of 1.4 days ± 1 (range, 1-5 days) after embolization. The mean surgical estimated BL was 432.5 mL ± 328.5 (range, 25-1,100 mL), and the mean OT was 210.1 minutes ± 97.4 (range, 57-489 minutes). CONCLUSIONS: Preoperative embolization of tumors resected for MSCC with nBCA is a safe procedure allowing for performance of surgery with acceptable BL.


Assuntos
Embolização Terapêutica , Embucrilato , Compressão da Medula Espinal , Masculino , Humanos , Feminino , Idoso , Embucrilato/efeitos adversos , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/terapia , Estudos Retrospectivos , Resultado do Tratamento , Perda Sanguínea Cirúrgica , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos
10.
Dis Mon ; 69(2): 101355, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35379468

RESUMO

Oncological emergencies are defined as an acute life-threatening event in a patient with a tumor occurring as part of their complex treatment regimen or secondarily to their underlying malignancy. These events can occur at any time from the initial diagnosis of their cancer to end-stage disease. These oncological emergencies are broadly classified into four major categories; metabolic, structural, hematological and treatment-related causes; and can be encountered in any clinical setting, ranging from primary care physician and emergency department visits to a variety of subspecialty environments. This study aims to cover an in-depth review of the underlying pathogenesis, clinical presentation, and updated management protocol of most common emergencies belonging to the above-mentioned categories. An all-language literature search was conducted on 15th October 2021 and 10th March 2022, limited to 5 years on PubMed database using the following search strings: oncological emergencies, malignant spinal cord compression, febrile neutropenia, hyperviscosity syndrome, superior vena cava syndrome, immune related adverse events, tumor lysis syndrome, hypercalcemia of malignancy, corrected calcium, malignant pericardial effusion and chemotherapy extravasation.


Assuntos
Hipercalcemia , Neoplasias , Compressão da Medula Espinal , Síndrome da Veia Cava Superior , Síndrome de Lise Tumoral , Humanos , Emergências , Síndrome da Veia Cava Superior/diagnóstico , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/terapia , Neoplasias/complicações , Neoplasias/terapia , Síndrome de Lise Tumoral/etiologia , Hipercalcemia/diagnóstico , Hipercalcemia/etiologia , Hipercalcemia/terapia , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/terapia
11.
J Neurol Sci ; 443: 120453, 2022 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-36308844

RESUMO

STUDY DESIGN: Prospective observational cohort study linked with administrative data. OBJECTIVES: Magnetic Resonance Imaging (MRI) is routinely performed after traumatic spinal cord injury (TSCI), facilitating early, accurate diagnosis to optimize clinical management. Prognosis from early MRI post-injury remains unclear, yet if available could guide early intervention. The aim of this study was to determine the association of spinal cord intramedullary haematoma and/or extent of cord compression evident on initial spine MRI with neurological grade change after TSCI. METHODS: Individuals with acute TSCI ≥16 years of age; MRI review. Neurological gradings (American Spinal Injury Association Impairment Scale (AIS)) were compared with initial MRI findings. Various MRI parameters were evaluated for prediction of neurological improvement pre-discharge. RESULTS: 120 subjects; 79% male, mean (SD) age 51.0 (17.7) years. Motor vehicle crashes (42.5%) and falls (40.0%) were the most common injury mechanisms. Intramedullary spinal cord haematoma was identified by MRI in 40.0% of patients and was associated with more severe neurologic injury (58.3% initially AIS A). Generalised linear regression showed higher maximum spinal cord compression (MSCC) was associated with lower likelihood of neurological improvement from initial assessment to follow up prior to rehabilitation discharge. Combined thoracic level injury, intramedullary haematoma, and MSCC > 25% resulted in almost 90% probability of pre-discharge AIS (grade A) remaining unchanged from admission assessment. CONCLUSIONS: MRI is a vital tool for evaluating the severity and extent of TSCI, assisting in appropriate management decision-making early in TSCI patient care. This study adds to the body of knowledge assisting clinicians in prognostication.


Assuntos
Compressão da Medula Espinal , Traumatismos da Medula Espinal , Traumatismos da Coluna Vertebral , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/terapia , Estudos Prospectivos , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Medula Espinal/terapia , Traumatismos da Coluna Vertebral/complicações , Hematoma/etiologia , Hematoma/complicações , Recuperação de Função Fisiológica
12.
Rev Med Chil ; 150(3): 339-352, 2022 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-36156719

RESUMO

Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. Its prevalence is increasing as a result of population aging. The diagnosis of DCM is often delayed or overlooked, resulting in secondary neurologic morbidity. The natural course of DCM typically presents as a gradual neurological deterioration, with symptoms ranging from muscle weakness to complete paralysis, with variable degrees of sensory deficits and sphincter dysfunction. Magnetic resonance imaging (MRI) and electrophysiological studies allow the assessment of spinal cord function and its structural damage to determine treatment and clinical outcomes. All patients with signs and symptoms consistent with DCM should be referred to a spine surgeon for assessment and tailored treatment. Those patients with mild DCM can be managed non-operatively but require close monitoring and education about potentially alarming signs and symptoms. Surgery is not currently recommended for asymptomatic patients with evidence of spinal cord compression or cervical spinal stenosis on MRI, but they require a structured follow-up. Patients with moderate or severe DCM require surgical decompression to avoid further progression. The objective of this review is to raise awareness of degenerative cervical myelopathy and its increasing prevalence as well as to aid non-surgical healthcare workers for a timely diagnosis and management of this disabling condition.


Assuntos
Compressão da Medula Espinal , Doenças da Medula Espinal , Adulto , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/patologia , Progressão da Doença , Humanos , Imageamento por Ressonância Magnética , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/terapia , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/terapia
13.
Pan Afr Med J ; 41: 163, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35655677

RESUMO

Introduction: prostate cancer represents the 3rd primary neoplasia responsible for metastatic spinal cord compression (MSCC). MSCC is an extreme oncological emergency, because it involves both functional and vital prognosis. The present study aimed to establish a pattern of MSCC in prostate cancer patients in Douala and Yaoundé general hospitals (Cameroon). Methods: this was a descriptive and retrospective study in the Radiotherapy and Medical Oncology services at both Douala and Yaoundé General Hospitals. The explored variables were general characteristics of the study population, clinical and paraclinical features, management and outcomes. Furthermore 5-year survival was analyzed by the Kaplan-Meier method. Logistic regression by determining the odd ratios and their 95% confidence was done using "Statistical Package for Social Sciences" (SPSS 23) software. The difference was considered significant at p < 0.05. Results: our series consisted of 151 patients out of which the mean age was 66.88 (SD: 8.71) years (95% CI: 44-88). Pain was the most common clinical symptom (53.33%; n= 80) and fracture-settlement accounted for majority (60%; n= 90.61) of the pain. Thoracic spine damage was encountered by 47.02% (n= 71). Patients received a total doses of irradiation between 20 and 30 gray (Gy). The main toxicity due to radiotherapy were asthenia (45.70%; n= 69.11). The overall survival at 5 years was 90.11%. Factors associated with fracture-settlement were smoking (aOR 10.04, 95% CI: 2.09-48.12; p = 0.004) and the localization of MSCC occurred (aOR 0.21, 95% CI: 0.05-0.77; p = 0.02). Conclusion: in summary the average age for developing the condition is 66.88 years and factors associated with fracture-settlement were smoking and the localization of MSCC. Back pain was the most common clinical sign and fracture-settlement was the first type of injury on medical magnetic resonance imaging. Therefore, we recommend that emphasis should be placed on increasing awareness of the population on the importance of early diagnosis.


Assuntos
Neoplasias da Próstata , Compressão da Medula Espinal , Neoplasias da Coluna Vertebral , Idoso , Camarões/epidemiologia , Humanos , Masculino , Dor , Neoplasias da Próstata/complicações , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/terapia , Estudos Retrospectivos , Compressão da Medula Espinal/epidemiologia , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/terapia , Neoplasias da Coluna Vertebral/epidemiologia , Neoplasias da Coluna Vertebral/terapia , Centros de Atenção Terciária
14.
Medicine (Baltimore) ; 101(25): e29334, 2022 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-35758362

RESUMO

INTRODUCTION: Spinal cord compression secondary to extramedullary hematopoiesis (EMH) is a rare condition. Variable treatment options have been reported with different efficacy and recurrence rate. Due to its rarity, no clear optimal management guidelines have been established yet. PATIENT CONCERNS AND DIAGNOSIS: We report a recurrence of spinal cord compression secondary to EMH in a 19-year-old male, with a background of transfusion-dependent beta-thalassemia on luspatercept, who presented with weakness in both lower limbs. INTERVENTIONS AND OUTCOMES: He was treated successfully both times with radiotherapy. CONCLUSION: Early diagnosis and management of EMH compressing the spinal cord are essential to prevent permanent neurological damage. Diagnosis should be suspected based on the clinical presentation and magnetic resonance imaging findings in a patient with a history of ineffective hemopoiesis. Treatment option remains controversial. Radiotherapy option seems effective, even in recurrent cases, and valid, particularly for those at high risk of surgery or who do not prefer it.


Assuntos
Hematopoese Extramedular , Compressão da Medula Espinal , Talassemia , Talassemia beta , Adulto , Hematopoese , Humanos , Imageamento por Ressonância Magnética/efeitos adversos , Masculino , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/terapia , Adulto Jovem , Talassemia beta/tratamento farmacológico , Talassemia beta/terapia
15.
Rev. méd. Chile ; 150(3): 339-352, mar. 2022. tab, graf, ilus
Artigo em Espanhol | LILACS | ID: biblio-1409807

RESUMO

Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. Its prevalence is increasing as a result of population aging. The diagnosis of DCM is often delayed or overlooked, resulting in secondary neurologic morbidity. The natural course of DCM typically presents as a gradual neurological deterioration, with symptoms ranging from muscle weakness to complete paralysis, with variable degrees of sensory deficits and sphincter dysfunction. Magnetic resonance imaging (MRI) and electrophysiological studies allow the assessment of spinal cord function and its structural damage to determine treatment and clinical outcomes. All patients with signs and symptoms consistent with DCM should be referred to a spine surgeon for assessment and tailored treatment. Those patients with mild DCM can be managed non-operatively but require close monitoring and education about potentially alarming signs and symptoms. Surgery is not currently recommended for asymptomatic patients with evidence of spinal cord compression or cervical spinal stenosis on MRI, but they require a structured follow-up. Patients with moderate or severe DCM require surgical decompression to avoid further progression. The objective of this review is to raise awareness of degenerative cervical myelopathy and its increasing prevalence as well as to aid non-surgical healthcare workers for a timely diagnosis and management of this disabling condition.


Assuntos
Humanos , Adulto , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/terapia , Doenças da Medula Espinal/terapia , Doenças da Medula Espinal/diagnóstico por imagem , Imageamento por Ressonância Magnética , Vértebras Cervicais/patologia , Vértebras Cervicais/diagnóstico por imagem , Progressão da Doença
16.
Ugeskr Laeger ; 183(33)2021 08 16.
Artigo em Dinamarquês | MEDLINE | ID: mdl-34477101

RESUMO

Metastatic spinal cord compression is an oncologic emergency, and the most frequent initial symptom is radicular backpain. Urgent diagnostics with acute MRI and early treatment is essential to prevent permanent neurologic damage. Treatment is mainly palliative. For patients who have a good prognosis, the treatment of choice is decompressive surgery followed by radiotherapy, but only few patients are candidates to surgery due to significant comorbidities and poor performance status. Optimal therapy is required to maintain high quality of life at an acceptable risk, as argued in this review.


Assuntos
Compressão da Medula Espinal , Neoplasias da Coluna Vertebral , Descompressão Cirúrgica , Humanos , Cuidados Paliativos , Qualidade de Vida , Compressão da Medula Espinal/cirurgia , Compressão da Medula Espinal/terapia , Neoplasias da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/terapia
17.
Cardiovasc Intervent Radiol ; 44(12): 1945-1953, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34341875

RESUMO

PURPOSE: To evaluate the efficacy of chemoembolization for inoperable metastatic epidural spinal cord compression (MESCC) refractory to re-radiotherapy. METHODS: Nineteen consecutive patients with recurrent MESCC after re-radiotherapy who had undergone chemoembolization were retrospectively analyzed. Outcome measures were pain relief rate, neurological improvement rate, objective response rate, and adverse events. MESCC degree classification was assessed using Bilsky grades. Pain assessment was performed using Numerical Rating Scale, and neurological function was evaluated using the Frankel classification. RESULTS: The median follow-up period was 7 (range 2-44) months. All participants had MESCC grade 2 or higher and had severe pain. Fifteen patients (79%) had neurological deficits, and ten had Frankel classification C and five had D. Symptoms were relieved in almost all patients the day following chemoembolization. Pain relief was achieved in 18 of 19 (95%) patients; the median decrease in Numerical Rating Scale score was 8 (range 0-10; p < 0.001). Neurological improvement was achieved in 11 of 15 patients (73%); the median increase in Frankel classification was 1 (range 0-2; p = 0.006). Ten of 19 (53%) patients showed a reduction in MESCC; the median decrease in Bilsky grade was 1 (range 0-2; p = 0.005). There was no correlation between the change in Bilsky grade and pain relief (p = 0.421). However, the decrease in Bilsky grade significantly improved neurological symptoms (p = 0.01). No serious adverse events occurred. CONCLUSION: Chemoembolization may be a useful palliative treatment modality for MESCC refractory to re-radiotherapy. LEVEL OF EVIDENCE: Level 3b, Follow up Study.


Assuntos
Embolização Terapêutica , Compressão da Medula Espinal , Neoplasias da Coluna Vertebral , Seguimentos , Humanos , Estudos Retrospectivos , Compressão da Medula Espinal/terapia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/radioterapia
18.
Oncology (Williston Park) ; 35(3): 128-133, 2021 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-33818050

RESUMO

Spinal cord compression is a potentially devastating consequence of cancer. Early recognition of the signs and symptoms permit diagnosis prior to the development of irreversible neurological damage. This complication occurs in 5% to 10% of patients with malignancy, often at the end stages of the patient's illness; however, it can be the presenting manifestation of malignancy in up to 23% of patients. With the advances in surgical, radiation, and medical oncology approaches, the outcomes of patients with malignant spinal cord compression continue to improve. We discuss the case of a previously healthy man, aged 65 years, who presented with back pain and large T8 spinal mass, leading to a diagnosis of multiple myeloma with spinal cord compromise.


Assuntos
Dor nas Costas/etiologia , Mieloma Múltiplo/complicações , Compressão da Medula Espinal/etiologia , Idoso , Humanos , Masculino , Mieloma Múltiplo/terapia , Compressão da Medula Espinal/patologia , Compressão da Medula Espinal/terapia , Vértebras Torácicas/patologia
19.
Ann N Y Acad Sci ; 1503(1): 38-47, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-33660862

RESUMO

We describe symptomatic spinal cord compression associated with pseudohypoparathyroidism (PHP) in a young female patient and reviewed similar cases previously reported in the literature. The characteristics of these cases were analyzed from etiology, clinical subtypes, symptoms, treatment, and prognosis. Neurological examination revealed functional upper extremities with bilateral lower extremity paraplegia. Laboratory tests showed hypocalcemia, hyperphosphatemia, and elevated parathyroid hormone; high-throughput sequencing showed a heterozygous GNAS mutation in exon 12, specifically c.1006C > T (p.R336W). Imaging findings showed multilevel spinal stenosis with significant spinal cord compression at the T2-T3 level. Seventeen cases with similar characteristics were reviewed. We found that the primary clinical manifestation of these patients was bilateral lower extremity spastic paraplegia. Multilevel spinal cord compression was commonly observed, especially at the lower cervical and upper thoracic spinal cord. Most of the patients had poor surgical treatment outcome and prognosis. Clinicians should be aware of paraplegia due to spinal cord compression as a rare neurological complication in patients with PHP. Early diagnosis and treatment of PHP is one basis for preventing severe spinal cord-related complications.


Assuntos
Pseudo-Hipoparatireoidismo/complicações , Pseudo-Hipoparatireoidismo/diagnóstico , Compressão da Medula Espinal/complicações , Compressão da Medula Espinal/diagnóstico , Alelos , Biomarcadores , Cromograninas/genética , Análise Mutacional de DNA , Gerenciamento Clínico , Suscetibilidade a Doenças , Feminino , Subunidades alfa Gs de Proteínas de Ligação ao GTP/genética , Heterozigoto , Humanos , Imageamento por Ressonância Magnética , Mutação , Pseudo-Hipoparatireoidismo/etiologia , Pseudo-Hipoparatireoidismo/terapia , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/terapia , Avaliação de Sintomas
20.
Crit Rev Oncol Hematol ; 160: 103205, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33387626

RESUMO

Spinal cord compression (SCC) is a devastating complication of multiple myeloma and has the potential to cause loss of neurological function. The common symptoms of SCC are back pain, motor weakness, and sensory change. Once diagnosed, the patient should be managed as soon as possible to prevent permanent loss of neurological function. Currently, there have been a number of studies describing the mechanism and management experience of SCC in patients with myeloma. The clinical features, diagnostic strategies, and the roles of different therapeutic options are herein reviewed.


Assuntos
Mieloma Múltiplo , Compressão da Medula Espinal , Humanos , Mieloma Múltiplo/complicações , Mieloma Múltiplo/terapia , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/terapia
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