Treatment and outcomes of patients with metastatic spinal cord compression: a double-center study.

OBJECTIVE: Spinal metastases may only affect the bone tissue and result in spinal instability or may additionally result in epidural compression, leading to neurological deficits. Surgery has emerged as a popular method in treating metastatic epidural spinal cord compression (MESCC) due to the advances in surgical techniques and instrumentation. In this study, we evaluated patients with MESCC regarding neurological status, pain status, and survival rates, and presented our experience managing MESCC. PATIENTS AND METHODS: Clinical and radiographic records of 53 patients diagnosed with MESCC between January 2011 and March 2017 were retrospectively evaluated. The study included patients with a pathological diagnosis of primary cancer, those who complained of spinal metastasis, and those who had indications of MESCC on Magnetic Resonance Imaging (MRI). Bone structure and spinal stability were evaluated using assessed Computed Tomography (CT), and metastatic spread was considered using assessed Positron Emission Tomography (PET) in suitable cases. For each patient, the presence of a tumor compressing the spinal cord, age, gender, preoperative, and postoperative American Spinal Injury Association scores (ASIA), Tokuhashi prognostic score (TPS), affected spinal segment, pathological diagnosis, preoperative, and postoperative Visual Analog Scale (VAS), the status of spinal stability, follow-up period, and complications were evaluated. RESULTS: Forty-five patients (82.2% of them were women) underwent surgery with a mean age of 58.29 ± 15.14 years. The most frequent type of primary tumor was multiple myeloma (33.9%), followed by lung (24.6%), gastric (7.5%), and prostate (5.7%). The most common site of metastasis was the thoracic region (43.4%), followed by lumbar (24.5%), multiple (24.5%), and cervical (5.7%). The analysis indicated that a significant difference was found between the survival rates of the TPS categories. CONCLUSIONS: Common symptoms of MESCC include spinal pain and neurological deficit below the level of the injury. Prompt surgical treatment followed by oncological treatment leads to significant neurological recovery, more prolonged survival, pain relief, and improved quality of life in patients with a short survival time. Oncological treatments, including radiotherapy (RT), should be recommended after surgical treatment.

Intra-radicular lumbar disc herniation: report of two cases.

STUDY DESIGN: A case report. OBJECTIVES: To report two cases of intra-radicular disc herniation. SETTING: Kocatepe University Faculty of Medicine, Department of Neurosurgery, Afyon, Turkey, Vakif Gureba Training Hospital, Department of Neurosurgery, Istanbul, Turkey and Yeditepe University Faculty of Medicine, Department of Neurosurgery, Istanbul, Turkey. METHODS: Two cases with intra-radicular disc herniation at L2-3 level in one, and at L5-S1 level in the other were presented. Both patients were admitted with complaints of severe leg pain and motor weakness. In both cases, intra-radicular disc herniation was diagnosed during surgery. RESULTS: The patients had uneventful recovery. They had no complaints or neurological deficits 6 and 3 months after surgery, respectively. CONCLUSIONS: The possibility of an intradural disc herniation should be kept in mind for the success of the management of lumbar disc herniation. In some patients who did not benefit from surgery, intra-radicular or intradural disc herniations may be the cause of failure.