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1.
Phys Ther ; 100(3): 554-563, 2020 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-32043130

RESUMO

Bones are the third most common site for cancer metastases, and the axial skeleton is the most frequent skeletal location. In a postmortem study, bone metastases were reported in 70% of breast and prostate cancer patients. Bone metastases from breast, lung, prostate, thyroid, and kidney cancers account for 80% of all bone metastases. Bone lesions exist in 60% of newly diagnosed multiple myeloma patients. With increasing numbers of people who have survived cancer, many patients with cancer and axial skeletal bony metastases will be seen by physical and occupational therapists. Guidelines are lacking on how to perform physical examinations and provide exercise programs for these patients without compromising the diseased spine. In this article, we discuss the available evidence for similar spinal conditions, the biomechanics of spinal load, and changes associated with posture and weight load. We provide recommendations on how to assess a patient's strength, how to strengthen without compromising the diseased spine, and how to teach patients to use correct body mechanics during mobility and activities of daily living.


Assuntos
Sobreviventes de Câncer , Compressão da Medula Espinal/terapia , Neoplasias da Coluna Vertebral/secundário , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/prevenção & controle , Humanos , Instabilidade Articular/diagnóstico , Movimento/fisiologia , Postura/fisiologia , Fatores de Risco , Sensibilidade e Especificidade , Compressão da Medula Espinal/complicações , Compressão da Medula Espinal/diagnóstico , Fraturas da Coluna Vertebral/prevenção & controle , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/fisiopatologia , Suporte de Carga
2.
Am J Med ; 133(1): 60-72.e14, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31278933

RESUMO

BACKGROUND: Very little evidence is available on the prevalence of serious spinal pathologies and the diagnostic accuracy of red flags in patients presenting to the emergency department (ED). This systematic review aims to investigate the prevalence of serious spinal pathologies and the diagnostic accuracy of red flags in patients presenting with low back pain to the ED. METHODS: We systematically searched MEDLINE, PUBMED, EMBASE, Cochrane Library, and SCOPUS from inception to January 2019. Two reviewers independently reviewed the references and evaluated methodological quality. RESULTS: We analyzed 22 studies with a total of 41,320 patients. The prevalence of any requiring immediate/urgent treatment was 2.5%-5.1% in prospective and 0.7%-7.4% in retrospective studies (0.0%-7.2% for vertebral fractures, 0.0%-2.1% for spinal cancer, 0.0%-1.9% for infectious disorders, 0.1%-1.9% for pathologies with spinal cord/cauda equina compression, 0.0%-0.9% for vascular pathologies). Examples of red flags which increased the likelihood for a serious condition were suspicion or history of cancer (spinal cancer); intravenous drug use, indwelling vascular catheter, and other infection site (epidural abscess). CONCLUSION: We found a higher prevalence of serious spinal pathologies in the ED compared to the reported prevalence in primary care settings. As the diagnostic accuracy of most red flags was reported only by a single study, further validation in high-quality prospective studies is needed.


Assuntos
Síndrome da Cauda Equina/epidemiologia , Abscesso Epidural/epidemiologia , Dor Lombar/etiologia , Compressão da Medula Espinal/epidemiologia , Fraturas da Coluna Vertebral/epidemiologia , Neoplasias da Coluna Vertebral/epidemiologia , Cateteres de Demora , Síndrome da Cauda Equina/complicações , Síndrome da Cauda Equina/diagnóstico , Serviço Hospitalar de Emergência , Abscesso Epidural/complicações , Abscesso Epidural/diagnóstico , Humanos , Prevalência , Fatores de Risco , Compressão da Medula Espinal/complicações , Compressão da Medula Espinal/diagnóstico , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico , Abuso de Substâncias por Via Intravenosa , Dispositivos de Acesso Vascular
3.
Clin Nucl Med ; 45(1): e29-e31, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31652157

RESUMO

We report FDG PET/CT images of a 63-year-old woman referred for characterization of osteolytic lesions of the cervical spine. This patient with chronic renal failure had a history of follicular thyroid carcinoma with undifferentiated cells, treated by a total thyroidectomy, completed by radioactive iodine in 2017. Because of cancer history, a FDG PET/CT was performed and showed multiple moderately hypermetabolic osteolytic lesions of the spine from C3 to T1, with joint erosion on CT. A laminectomy was performed for cervical spinal cord decompression and revealed a gouty tophus.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Fluordesoxiglucose F18 , Gota/complicações , Gota/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compressão da Medula Espinal/complicações , Feminino , Humanos , Pessoa de Meia-Idade
4.
PLoS One ; 14(12): e0214351, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31821342

RESUMO

OBJECTIVE: Erythropoietin (EPO) is a clinically available hematopoietic cytokine. EPO has shown beneficial effects in the context of spinal cord injury and other neurological conditions. The aim of this study was to evaluate the effect of EPO on a rat model of spinal cord compression-induced cervical myelopathy and to explore the possibility of its use as a pharmacological treatment. METHODS: To develop the compression-induced cervical myelopathy model, an expandable polymer was implanted under the C5-C6 laminae of rats. EPO administration was started 8 weeks after implantation of a polymer. Motor function of rotarod performance and grip strength was measured after surgery, and motor neurons were evaluated with H-E, NeuN and choline acetyltransferase staining. Apoptotic cell death was assessed with TUNEL and Caspase-3 staining. The 5HT, GAP-43 and synaptophysin were evaluated to investigate the protection and plasticity of axons. Amyloid beta precursor protein (APP) was assessed to evaluate axonal injury. To assess transfer of EPO into spinal cord tissue, the EPO levels in spinal cord tissue were measured with an ELISA for each group after subcutaneous injection of EPO. RESULTS: High-dose EPO maintained motor function in the compression groups. EPO significantly prevented the loss of motor neurons and significantly decreased neuronal apoptotic cells. Expression of 5HT and synaptophysin was significantly preserved in the EPO group. APP expression was partly reduced in the EPO group. The EPO levels in spinal cord tissue were significantly higher in the high-dose EPO group than other groups. CONCLUSION: EPO improved motor function in rats with compression-induced cervical myelopathy. EPO suppressed neuronal cell apoptosis, protected motor neurons, and induced axonal protection and plasticity. The neuroprotective effects were produced following transfer of EPO into the spinal cord tissue. These findings suggest that EPO has high potential as a treatment for degenerative cervical myelopathy.


Assuntos
Modelos Animais de Doenças , Eritropoetina/administração & dosagem , Neurônios Motores/fisiologia , Proteínas Recombinantes/administração & dosagem , Recuperação de Função Fisiológica , Compressão da Medula Espinal/complicações , Doenças da Medula Espinal/terapia , Animais , Humanos , Masculino , Ratos , Ratos Wistar , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/patologia
5.
BMC Musculoskelet Disord ; 20(1): 471, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31651296

RESUMO

BACKGROUND: Although microendoscopic partial laminectomy for patients with degenerative cervical myelopathy (DCM) has been reported and demonstrated good results, a detailed comparison of its mid-term surgical results with those of laminoplasty (LP) has not been reported. The aim of this study was to compare the surgical outcomes, complications, and imaging parameters of cervical microendoscopic interlaminar decompression (CMID) via a midline approach versus conventional laminoplasty, with a minimum follow-up period of 2 years. METHODS: Two hundred and fifty-four patients who underwent either LP or CMID for DCM between May 2008 and April 2015 were enrolled. All patients routinely underwent LP (C3-6 or C3-7) before December 2011, whereas CMID was performed at the one or two affected level(s) only in patients with single- or two-level spinal cord compression after 2012. Surgical procedure (CMID): For single-level patients (e.g., C5-6), partial laminectomy of C5 and C6 was performed under a microendoscope. For two-level patients (e.g., C5-6-7), decompression was completed by performing a C6 laminectomy. We compared surgical outcomes and radiographic parameters between the CMID and LP groups. RESULTS: Of the 232 patients followed up for > 2 years, 87 patients with single- or two-level spinal cord compression, 46 that underwent CMID, and 41 that underwent LP were identified. There were no differences in the baseline demographic data of the patients between the groups. CMID showed better outcomes in terms of postoperative axial pain and quality of life, although both procedures showed good neurological improvement. Two and one patient complained of C5 palsy and hematoma, respectively, only in the LP group. The postoperative range of motion was worse and the degree of postoperative posterior spinal cord shift was larger in the LP group. CONCLUSION: Selective decompression by CMID demonstrated surgical outcomes equivalent to those of conventional LP, which raises a question regarding the requirement of extensive posterior spinal cord shift in such patients. Although the indications of CMID are limited and comparison with anterior surgery is mandatory, it can be a minimally invasive procedure for DCM. .


Assuntos
Descompressão Cirúrgica/métodos , Endoscopia/métodos , Laminectomia/métodos , Laminoplastia/métodos , Microcirurgia/métodos , Compressão da Medula Espinal/cirurgia , Idoso , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/instrumentação , Endoscopia/efeitos adversos , Endoscopia/instrumentação , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Laminectomia/efeitos adversos , Laminectomia/instrumentação , Laminoplastia/efeitos adversos , Laminoplastia/instrumentação , Masculino , Microcirurgia/efeitos adversos , Microcirurgia/instrumentação , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Qualidade de Vida , Radiografia , Amplitude de Movimento Articular , Compressão da Medula Espinal/complicações , Compressão da Medula Espinal/diagnóstico por imagem , Resultado do Tratamento
6.
Int J Radiat Oncol Biol Phys ; 105(4): 760-764, 2019 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-31415797

RESUMO

PURPOSE: To compare 4 Gy × 5 (1 week) to 3 Gy × 10 (2 weeks) in relieving pain and distress in patients with metastatic epidural spinal cord compression (MESCC). METHODS AND MATERIALS: The randomized SCORE-2 trial compared 4 Gy × 5 (n = 101) to 3 Gy × 10 (n = 102) for MESCC. In this additional analysis, these regimens were compared for their effect in relieving pain and distress. Distress was evaluated with the distress-thermometer (0 = no distress, 10 = extreme distress) and pain on a linear scale (0 = no pain, 10 = worst pain). Relief of distress was defined as decrease of ≥2 points; complete and partial pain relief were defined as achieving a score of 0 points and a decrease ≥2 points, respectively, without increase of analgesic use. This prospective secondary analysis of the SCORE-2 trial aimed to show that 4 Gy × 5 was not inferior to 3 Gy × 10 regarding distress and pain relief. Analyses were performed using the unconditional test of noninferiority for binomial differences based on restricted maximum likelihood estimates (noninferiority margin: -20%). Evaluations were performed before, directly after, and 1, 3, and 6 months after radiation therapy. (ClinicalTrials.gov: NCT02189473). RESULTS: At baseline, median distress scores were 8 (2-10) points in the 4 Gy × 5 group and 8 (2-10) points in the 3 Gy × 10 group. At 1 month, distress relief rates were 58.1% (43/74) and 62.7% (47/75) (difference: -4.6%; 95% confidence interval, -20.0% to +11.1%; P = .025). At baseline, median pain scores were 7 (2-10) and 7 (2-10) points, respectively. At 1 month, complete pain relief rates were 23.5% (16/68) versus 20.0% (14/70) (difference, +3.5%; 95% confidence interval, -10.4% to +17.5%; P < .001), and overall pain relief rates were 52.9% (36/68) versus 57.1% (40/70) (difference, -4.2%; 95% confidence interval, -20.5% to +12.3%; P = .029). Distress and pain relief rates after 4 Gy × 5 were largely comparable to 3 Gy × 10 at all time points. Associated 95% confidence intervals did not point toward any relevant differences. CONCLUSIONS: In patients with MESCC and poor to intermediate survival prognoses, 4 Gy × 5 appeared noninferior to 3 Gy × 10 regarding pain and distress relief.


Assuntos
Manejo da Dor/métodos , Medidas de Resultados Relatados pelo Paciente , Compressão da Medula Espinal/radioterapia , Neoplasias da Coluna Vertebral/radioterapia , Estresse Psicológico/terapia , Idoso , Feminino , Humanos , Masculino , Medição da Dor/estatística & dados numéricos , Prognóstico , Estudos Prospectivos , Qualidade de Vida , Dosagem Radioterapêutica , Compressão da Medula Espinal/complicações , Neoplasias da Coluna Vertebral/complicações , Fatores de Tempo
7.
World Neurosurg ; 132: 12-13, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31450000

RESUMO

BACKGROUND: Only a few cases of spinal cord compression after cervical laminectomy have been reported. CASE DESCRIPTION: We report a case of tetraparesis after executing a C3-C6 anterior and posterior decompression and fusion. Cervical magnetic resonance imaging demonstrated a spinal cord compression due to the impingement of the paraspinal muscles through the laminectomy. The patient experienced a spontaneous neurological recovery and the follow-up cervical magnetic resonance imaging showed resolution of the spinal cord compression. CONCLUSIONS: This rare complication should be considered among the others after executing a cervical laminectomy.


Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica , Laminectomia , Músculos Paraespinais/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Compressão da Medula Espinal/diagnóstico por imagem , Fusão Vertebral , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Quadriplegia/etiologia , Compressão da Medula Espinal/complicações , Compressão da Medula Espinal/cirurgia
8.
No Shinkei Geka ; 47(7): 795-798, 2019 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-31358699

RESUMO

A 35-year-old man with neurofibromatosis type I presented with right arm weakness and gait disturbance that had developed gradually. MR imaging revealed bilateral intra-and extradural tumors at the C1-2 level. Although the adjacent spinal cord was narrowed, there was no evident contact between the tumors and the spinal cord. Computed tomography myelography revealed that the tumors compressed the cord only during neck rotation. The tumors were resected to make an abundant subdural space around the affected cord. The patient's neurological symptoms improved postoperatively. Because contact between the masses and spinal cord only occurred upon neck rotation, we believe it is important to consider the possibility of intermittent compression, termed dynamic rotational canal stenosis, in patients with masses at the C1-2 level, even when such masses are not seen to be in contact with the cervical cord on routine radiological examination.


Assuntos
Neurofibromatose 1/complicações , Compressão da Medula Espinal , Doenças da Medula Espinal , Adulto , Vértebras Cervicais , Humanos , Imagem por Ressonância Magnética , Masculino , Mielografia , Pescoço , Rotação , Compressão da Medula Espinal/complicações , Compressão da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/etiologia
9.
World Neurosurg ; 130: 65-70, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31254697

RESUMO

BACKGROUND: Back pain is a leading reason for patients to seek medical attention. Although musculoskeletal causes are common, patients can also present with rarer etiologies. CASE DESCRIPTION: A 50-year-old man presented with 2 months of isolated upper back pain initially suspected to be secondary to overuse muscular strain. During the next 3 months, his pain worsened, and he developed lower extremity dysesthesia and subjective weakness, despite normal neurological examination findings. Nonrevealing laboratory workup included normal muscle enzymes, C-reactive protein, urinalysis, and human leukocyte antigen B27. Magnetic resonance imaging revealed a normal brain but a hypointense C7-T5 epidural mass, prompting a neurosurgical recommendation for laminectomy with evacuation of the suspected hematoma. His symptoms fully and promptly resolved after a 5-day course of prednisone 40 mg. When his symptoms recurred within 2 months, he underwent T4-T5 laminectomy with biopsy of a mass confluent with the dura mater. Initial pathological examination revealed fibrotic tissue of unclear etiology with polyclonal lymphoid infiltrate but no malignant cells, vasculitis, or granulomas. After months of recurrent, steroid-responsive symptoms, he presented to the rheumatology clinic. Repeat spinal magnetic resonance imaging demonstrated progression of epidural thickening with suspected spinal cord compression. Previous biopsy samples were then immunostained for IgG4, revealing focally dense IgG4-positive plasma cells, up to 29 cells per high power field, consistent with spinal IgG4-related hypertrophic pachymeningitis. He began rituximab therapy with a prednisone taper and demonstrated symptomatic and neurologic improvement with successful withdrawal from corticosteroids. CONCLUSIONS: To the best of our knowledge, the present case represents the 12th reported case of spinal IgG4-related hypertrophic pachymeningitis. An early diagnosis and treatment could prevent progression to permanent neurological impairment and functional disability.


Assuntos
Imunoglobulina G/sangue , Meningite/sangue , Compressão da Medula Espinal/sangue , Medula Espinal , Dor nas Costas/sangue , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/etiologia , Humanos , Hipertrofia/sangue , Hipertrofia/complicações , Hipertrofia/diagnóstico por imagem , Masculino , Meningite/complicações , Meningite/diagnóstico por imagem , Pessoa de Meia-Idade , Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/complicações , Compressão da Medula Espinal/diagnóstico por imagem
12.
BMJ Case Rep ; 12(4)2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975783

RESUMO

Degenerative cervical myelopathy (DCM) is the most common cause of adult spinal cord dysfunction, most classically presenting with a broad-based gait and clumsy hands. Limb sensory loss and paraesthesia are considered common symptoms of DCM. However, we report an unusual case of a patient presenting with prominent and atypical sensory symptoms. The patient repeatedly presented to accident and emergency complaining of her body resembling a wet gel-like substance that she attributed to the use of olive oil moisturising cream. The patient was found to have myelopathic signs on examination and MRI consistent with severe cervical myelopathy. She subsequently underwent successful decompressive anterior cervical discectomy, as recommended by international guidelines. This case serves to remind health professionals of uncommon presentations of common disease and the importance of maintaining a wide initial differential diagnosis.


Assuntos
Vértebras Cervicais , Parestesia/diagnóstico , Compressão da Medula Espinal/cirurgia , Descompressão Cirúrgica , Delusões , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Parestesia/etiologia , Parestesia/psicologia , Compressão da Medula Espinal/complicações , Compressão da Medula Espinal/diagnóstico por imagem
13.
Praxis (Bern 1994) ; 108(5): 341-345, 2019.
Artigo em Alemão | MEDLINE | ID: mdl-30940039

RESUMO

Reversible Paraplegia - Favorable Outcome After Delayed Diagnosis Abstract. A 74-year-old woman was referred for progressive gait disturbances. On presentation, she had a complete paraplegia (wheelchair-bound for 19 months) and bladder sphincter dyssynergia with sensory sacral sparing. Magnetic resonance imaging studies revealed a 24 × 13 × 17 mm intradural mass with compression of the spinal cord and myelomalacia between C6 and Th1. We performed unilateral laminectomies of C6-Th1 and microsurgical resection of a meningioma. Under intensive rehabilitation, the patient regained independent walking ability and recovery of bladder function and continence within six months postoperatively.


Assuntos
Diagnóstico Tardio , Neoplasias Meníngeas , Meningioma , Paraplegia , Compressão da Medula Espinal , Doenças da Medula Espinal , Idoso , Feminino , Humanos , Imagem por Ressonância Magnética , Neoplasias Meníngeas/complicações , Meningioma/complicações , Paraplegia/diagnóstico por imagem , Paraplegia/etiologia , Compressão da Medula Espinal/complicações , Compressão da Medula Espinal/etiologia
15.
Life Sci ; 222: 148-157, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30851336

RESUMO

AIMS: Identifying drugs that inhibit edema and glial scar formation and increase neuronal survival is crucial to improving outcomes after spinal cord injury (SCI). Here, we used 2-(nicotinamide)-1,3,4-thiadiazole (TGN-020), a potent selective inhibitor of aquaporin 4 (AQP4), to investigate the effects of TGN-020 on SCI in Sprague-Dawley rats. MAIN METHODS: We compressed the spinal cord at T10 using a sterile impounder (35 g, 5 min), to induce moderate injury. TGN-020 (100 mg/kg) or an equal volume of 10% dimethyl sulfoxide was then administered via intraperitoneal injection. Neurological function was evaluated using the Basso-Beattie-Bresnahan open-field locomotor scale 1, 3, 7, 14, 21, and 28 days after SCI. The degree of edema was assessed via determination of the precise spinal cord water content 3 days after SCI. Expression levels of AQP4, glial fibrillary acidic protein (GFAP), proliferating cell nuclear antigen (PCNA), and growth-associated protein-43 (GAP-43) were determined via western blotting and immunofluorescence staining 3 days after SCI and 4 weeks after SCI. Numbers of surviving neurons and glial scar sizes were determined using Nissl and hematoxylin-eosin staining, respectively. KEY FINDINGS: Our results showed that TGN-020 promoted functional recovery at days 3, 7, 14, 21, and 28, as well as reduced the degree of edema and inhibited the expression of AQP4, GFAP, PCNA at days 3 after SCI. Furthermore, observations 4 weeks after SCI revealed that TGN-020 inhibited the glial scar formation and upregulated GAP-43 expression. SIGNIFICANCE: TGN-020 can alleviate spinal cord edema, inhibit glial scar formation, and promote axonal regeneration, conferring beneficial effects on recovery in rats.


Assuntos
Astrócitos/efeitos dos fármacos , Cicatriz/prevenção & controle , Edema/tratamento farmacológico , Neuroglia/efeitos dos fármacos , Niacinamida/análogos & derivados , Compressão da Medula Espinal/tratamento farmacológico , Tiadiazóis/uso terapêutico , Animais , Astrócitos/metabolismo , Cicatriz/etiologia , Cicatriz/metabolismo , Edema/complicações , Edema/metabolismo , Feminino , Neuroglia/metabolismo , Niacinamida/farmacologia , Niacinamida/uso terapêutico , Ratos , Ratos Sprague-Dawley , Compressão da Medula Espinal/complicações , Compressão da Medula Espinal/metabolismo , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/tratamento farmacológico , Traumatismos da Medula Espinal/metabolismo , Tiadiazóis/farmacologia , Vértebras Torácicas
16.
Pediatr Neurosurg ; 54(2): 121-124, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30783063

RESUMO

A spinal neurenteric cyst is a rare entity. It commonly presents already at 5 weeks of age up to the 6th decade of life. The most common location is the cervical region followed by thoracic and lumbosacral regions. We report a 9-month-old male infant with sudden onset of weakness in both lower limbs. MRI revealed 2 cystic lesions at cervical and thoracic level with spinal cord compression. He underwent laminectomy and excision of the cervical lesion. The child improved significantly. The postoperative MRI shows complete excision of a dorsal lesion and presence of a cervical lesion. Later, he underwent cervical laminotomy and partial wall excision followed by shunt placement. The histopathological report revealed a neurenteric cyst. Two neurenteric cysts presented in the neuroaxis of the same patient: one was located ventral (thoracic) and the other dorsal (cervical). At the 2-year follow-up, the child was active and walking without support. Multiple cystic lesions in the neuroaxis can be neurenteric cysts.


Assuntos
Vértebras Cervicais/cirurgia , Defeitos do Tubo Neural/cirurgia , Compressão da Medula Espinal/cirurgia , Vértebras Torácicas/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Pré-Escolar , Descompressão Cirúrgica/métodos , Humanos , Lactente , Laminectomia/métodos , Masculino , Defeitos do Tubo Neural/complicações , Defeitos do Tubo Neural/diagnóstico por imagem , Compressão da Medula Espinal/complicações , Compressão da Medula Espinal/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem
17.
Clin Neurol Neurosurg ; 178: 1-6, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30660852

RESUMO

OBJECTIVE: To investigate preoperative factors affecting the presence of intramedullary increased signal intensity (ISI) on T2-weighted magnetic resonance imaging (MRI) in patients with cervical spondylotic myelopathy (CSM) and the impact of ISI on clinical manifestations. PATIENTS AND METHODS: Eighty-nine patients with CSM were retrospectively reviewed from January 2013 to December 2016 in our hospital. Based on the presence or absence of ISI on axial and sagittal T2-weighted MRI, patients were divided into ISI group (48 cases) and non-ISI group (41 cases). Factors such as age, sex, body mass index (BMI), duration of symptoms, clinical symptoms and signs, number and distribution of spinal cord compression levels, preoperative Japanese Orthopedic Association (JOA) score, preoperative C2-C7 lordotic angle, preoperative C2-C7 range of motion (ROM), maximal canal compromise (MCC) and maximal spinal cord compression (MSCC) were initially compared using univariate analysis. Factors with significant result in univariate analysis were included in multivariate logistic regression analysis. Receiver operating characteristic (ROC) curve and the area under the curve (AUC) were applied to evaluate the reliability of multivariate logistic regression model. RESULTS: Univariate analysis showed that the number of spinal cord compression levels, preoperative JOA score, MCC and MSCC might be related to the presence of ISI (P < 0.05). Furthermore, multivariate logistic regression analysis revealed that the number of spinal cord compression levels (OR = 0.203, P < 0.05), preoperative JOA score (OR = 4.274, P < 0.05) and MSCC (OR = 0.250, P < 0.05) were independent preoperative risk factors associated with the presence of ISI, yielding an AUC of 0.9558. Patients with ISI showed a trend of increasing clinical symptoms and signs, and also exhibited statistically significantly increased frequencies of clumsy hands, lower limb spasticity, impairment of gait, broad-based, unstable gait, weakness and motor deficits (P < 0.05). CONCLUSION: Multilevel spinal cord compression, lower preoperative JOA score and greater MSCC are independent preoperative risk factors related to the presence of ISI on T2-weighted MRI in patients with CSM. Patients with ISI tend to have more clinical symptoms and signs, especially in lower limb manifestations and motor deficits.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Procedimentos Ortopédicos/métodos , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Espondilose/diagnóstico por imagem , Espondilose/cirurgia , Adulto , Idoso , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Debilidade Muscular/etiologia , Doenças Neuromusculares/etiologia , Estudos Retrospectivos , Fatores de Risco , Compressão da Medula Espinal/complicações , Doenças da Medula Espinal/complicações , Espondilose/complicações , Resultado do Tratamento
18.
Cancer Res Treat ; 51(4): 1324-1335, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30699497

RESUMO

PURPOSE: The purpose of this study was to investigate the effectiveness and safety of spinal stereotactic radiosurgery (SRS) in treating spinal metastasis with epidural spinal cord compression (ESCC). Materials and Methods: During 2013-2016, 149 regions of spinal metastasis in 105 patients treated with singlefraction (12-24 Gy) spinal SRS were reviewed. Cord compression of Bilsky grade 2 (with visible cerebrospinal fluid [CSF]) or 3 (no visible CSF) was defined as ESCC. Local progression (LP) and vertebral compression fracture (VCF) rates after SRS were evaluated using multivariate competing-risk regression analysis. RESULTS: The 1-year cumulative incidences of LP for Bilsky grades 0 (n=80), 1 (n=39), 2 (n=21), and 3 (n=9) were 3.0%, 8.4%, 0%, and 24.9%, respectively. Bilsky grade 2 ESCC did not significantly increase the LP rate (no LP for grade 2). The 1-year cumulative incidences of VCF for Bilsky grades 0, 1, 2, and 3 were 6.6%, 5.2%, 17.1%, and 12.1%, respectively. ESCC may increase VCF risk (subhazard ratio [SHR] for grade 2, 5.368; p=0.035; SHR for grade 3, 2.215; p=0.460). Complete or partial pain response rates after SRS were 79%, 78%, 53%, and 63% for Bilsky grades 0, 1, 2, and 3, respectively (p=0.008). No neurotoxicity of grade ≥ 3 was observed. CONCLUSION: Spinal SRS for spinal metastasis with Bilsky grade 2 ESCC did not increase the LP rate, was not associated with severe neurotoxicity, and showed moderate VCF and pain response rates. Bilsky grade 3 had a high LP rate.


Assuntos
Compressão da Medula Espinal/líquido cefalorraquidiano , Fraturas da Coluna Vertebral/epidemiologia , Neoplasias da Coluna Vertebral/radioterapia , Neoplasias da Coluna Vertebral/secundário , Progressão da Doença , Estudos de Viabilidade , Feminino , Humanos , Masculino , Doses de Radiação , Radiocirurgia/efeitos adversos , Análise de Regressão , Estudos Retrospectivos , Compressão da Medula Espinal/complicações , Fraturas da Coluna Vertebral/líquido cefalorraquidiano , Resultado do Tratamento
19.
Pract Neurol ; 19(1): 72-74, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30282763

RESUMO

Compressive lesions of the spinal cord usually cause a syndrome of upper motor neurone weakness, spasticity and sensory loss below the level of the lesion. It has long been recognised that compressive cervical cord lesions may present as isolated lower motor neurone weakness of the upper limbs, a syndrome termed cervical spondylotic amyotrophy. We describe two patients presenting with isolated lower motor neurone weakness of the lower limbs in association with a compressive cord lesion at T11/12, a condition we have termed thoracic spondylotic amyotrophy.


Assuntos
Extremidade Inferior , Neurônios Motores/patologia , Debilidade Muscular/etiologia , Compressão da Medula Espinal/complicações , Espondilose/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome , Vértebras Torácicas
20.
Clin J Pain ; 35(1): 7-17, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30222611

RESUMO

OBJECTIVES: Assessment of neuropathic pain in chronic low back syndromes is important. However, there is currently no gold standard for its diagnosis. The aim of this observational cross-sectional study was to assess the neuropathic component of pain in various chronic low back pain syndromes using a range of diagnostic tests. MATERIALS AND METHODS: Included in this study were 63 patients with chronic axial low back pain (ALBP), 48 patients with chronic radicular syndromes (CRS) comprising 23 with discogenic compression (CDRS) and 25 with lumbar spinal stenosis (LSS), and 74 controls. PainDETECT questionnaire (PDQ), quantitative sensory testing (QST), and skin biopsy with evaluation of intraepidermal nerve fiber density (IENFD) were used to assess the neuropathic pain component. RESULTS: Positive PDQ (≥19) was obtained more frequently in patients with CDRS and LSS (26.1% and 12.0%, respectively) compared with patients with ALBP (1.6%, P<0.001). The proportion of patients with sensory loss confirmed by QST was lowest in the ALBP subgroup (23.8%) compared with CDRS (47.8%), and LSS (68.0%) subgroups (P<0.001). A reduction in IENFD was disclosed in a proportion of up to 52.0% of affected roots in patients with CRS. DISCUSSION: Neuropathic pain is quite frequent in CRS, and QST reveals sensory loss as a frequent abnormality in patients with CRS. Using a cut-off value of 19, PDQ identified a neuropathic component in a relatively low proportion of patients with CRS. CRS may be associated with a reduction in IENFD.


Assuntos
Dor Lombar/diagnóstico , Neuralgia/diagnóstico , Adulto , Idoso , Biópsia , Estudos Transversais , Feminino , Humanos , Dor Lombar/complicações , Dor Lombar/patologia , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Neuralgia/complicações , Neuralgia/patologia , Exame Neurológico , Medição da Dor , Radiculopatia/etiologia , Radiculopatia/patologia , Transtornos das Sensações/diagnóstico , Transtornos das Sensações/etiologia , Pele/patologia , Compressão da Medula Espinal/complicações , Raízes Nervosas Espinhais/patologia , Estenose Espinal/complicações , Adulto Jovem
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