The Management of Spinal Epidural Metastases

Brihaye, J; Ectors, P; Lemort, Marc; Houtte, Paul Van

doi:10.1007/978-3-7091-6954-4_4

Cited by 92 publications

(31 citation statements)

References 137 publications

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“…www.ksmrm.org JKSMRM 17(1) : [8][9][10][11][12][13][14][15][16][17][18]2013 the extraosseous soft tissue component of a neoplasm from the normal paraspinal soft tissue and neural structures (10)(11)(12). Therefore, understanding the characteristic MRI findings of spinal metastases from various primary tumors would be useful for both accurate diagnosis of spinal metastasis and identification of the origin of the primary cancer.…”

Section: Introductionmentioning

confidence: 99%

Characteristic MRI Findings of Spinal Metastases from Various Primary Cancers: Retrospective Study of Pathologically-Confirmed Cases

Lee

Kim

et al. 2013

J Korean Soc Magn Reson Med

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Purpose : The purpose of this study was to find and categorize the various magnetic resonance imaging (MRI) findings of spinal metastases that correlate with the type of primary cancer. Materials and Methods:We retrospectively reviewed gadolinium-enhanced magnetic resonance images of 30 patients with 169 spinal metastatic lesions from lung cancer (n = 56), breast cancer (n = 29), colorectal cancer (n = 20), hepatocellular carcinoma (HCC) (n = 17), and stomach cancer (n = 47). The size, location, extent of invasion, signal intensity, margin, enhancement pattern, and osteoblastic or osteolytic characteristics of each metastatic tumor were analyzed. Results:The metastatic lesions from HCC were larger than those from the other primary tumors (P < 0.05) except for colorectal cancer (P = 0.268). Well-defined metastatic tumor margins were more frequently seen in lung cancer and breast cancer (P < 0.01). All but HCC showed a tendency to invade the vertebral body rather than the posterior elements (P < 0.02). Colorectal cancer and HCC showed a tendency toward extraosseous invasion without statistical significance. HCC showed a characteristic enhancement pattern of 'worms-in-a-bag'. Rim enhancement with a sclerotic center was only seen in spinal metastases from stomach cancer. Conclusion:Despite many overlapping imaging features, spinal metastases of various primary tumors display some characteristic MRI findings that can help identify the primary cancer.

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Section: Introductionmentioning

confidence: 99%

Characteristic MRI Findings of Spinal Metastases from Various Primary Cancers: Retrospective Study of Pathologically-Confirmed Cases

Lee

Kim

et al. 2013

J Korean Soc Magn Reson Med

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“…7% . Pain relief was apparent in 38 of 41 patients (92.7%), and mOlor improvement was manifest Kcy words: Metastatic spinal tumor -A nterior decompression -Prosthetic replacement -Implant dislocation Due 10 improved oncolo gical care and increased surviva l rate of many malignant lumors, the surgeon is confronted with a risi ng number of metastases of (he spine [1 2, 15J lending to ca use instability, deformity, pathological fracture , or a neurological deficit with progress o f the metastatic growth [11 , 15-[ 71. According to (he metastatic spread via the vertebra l venous plexus [1], involvement of the vertebral body represcnt s the major region of metastatic manifestatio n cf the spine (70%-80%) [J I], while the posterior spinal elemcnts or pericordal metastases make up onl y a mjnor part of metastatic tumor occurrence (up [ 0 20% ) [3,23].…”

Section: L\1ots-ch!s: Metastase Rachdiennc -Decompression Ante Rieurementioning

confidence: 99%

Spinal stabilization for patients with metastatic lesions of the spine using a titanium spacer

Hertlein¹,

Mittlmeier²,

Piltz³

et al. 1992

Eur Spine J

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Stabilisation rachidicnnc utilisant un " spacer" eil titane chc7. les palients porteurs de lesions mClastatiqucs dc la eolOllllC vertebrale ResumC. La decompressio n anterieure a ete realiscc chez 41 patienls porteurs de metastases du corps vertebral. Les complications neurologiqucs Claient patentes chez 36 patients el latentes chez 5 d'entre eux. On a urilisc poUT la reconstruction un cylindrc dc litane, mis eil place aprcs la corporectomie cl rCllfo rce par une pl aque anlerieure. L'implant cn tilane peul eire faeil ement adapte a la longueur necessaire sans necessiter de materiel supplemenlaire el onereux. L' implant eSl rempli de PMMA avant sa mise en place, ce qui facilit e la transfixation necessaire au verrouil1age de la rotalion. La mortalite a 30 jou rs est de 9.7%. La douleur a disparu dans 38 cas sur 4 1 (92.7%), I'amelioration motricc a ete manifeste dans 31 cas sur 35 (88.6%) , 6 patients ne presentaienl aueun symptome neu rologique ni avant ni aprcs l'operalion. Une degradation neurologique n' a ete relevee que dans I cas (2.4%). L'efficacite du geste chirurgical a eie mai ntenue jusqu'au deres des patients. Bien que la recidi ve tumorale a un autre niveau rachidien ait conduit a une chirurgie iterative chez 5 patients, aucun deplacement d 'implant n'est survenu durant la periode d'obscrv3 1io n (recul maximum 44 mais), ccla temoignant du caracterc mecaniquement fa ible el su r du procede ulilise. l\1ots-ch!s: Metastase rachdiennc -Decompression ante rieure -Prothese vcn ebrale -Deplacemen t d 'implant SUlllmary. A nterior decomp ression in spinal metastases of the corporal type with impcnding (n = 5) or presenl (n = 36) neurological complications was performed in 41 paticnts. For rcconstruction , a ti lanium cylinde r was inserted aft er spondylectom y and augmented with an anterior plate. Tb e titanium implant can casily be adj usted {O the Icngl h necdcd witbout neccssitating expensive additio nal equipment. O utsidc the patient the implant is filled with polymclhylmclacrylatc, facilitatiog pla lc transfixation for rotatio nal locking. There was a 30-day morl ality of 9. 7% . Pain relief was apparent in 38 of 41 patients (92.7%), and mOlor improvement was manifestCorrespondence 10: H . Hcnlein in 31 of 35 cases (88.6%). Si. x patients did no t present with any neurological symptoms pre-o r postoperati vely. Neurological deterioration was rcgistered in o nl y 1 case (2.4%) . Surgical efficacy was maintained unlil the death of the patients. Tbough tumor reeurrence at a different spinal level led to consecurive surgery in 5 patients, no implant dislocation occurred during the observation period (maximum 44 momhs), characteriz.ing the procedure as a mechanically reliable and safe technique.Kcy words: Metastatic spinal tumor -A nterior decompression -Prosthetic replacement -Implant dislocation Due 10 improved oncolo gical care and increased surviva l rate of many malignant lumors, the surgeon is confronted with a risi ng number of metastases of (he spine [1 2, 15J lending to ca use instability, defor...

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“…Nearly 10% of patients with spinal metastases develop neurologic compromise such as intense pain, sensory loss, weakness, and sphincter dysfunction as a result of either pathologic fractures of the vertebral bodies or direct extension of a tumor mass from the vertebral body directly within the spinal cord and/or the nerve roots [5,21]. The treatment of spinal metastasis is typically multidisciplinary, including chemotherapy, radiation, and surgery.…”

Section: Introductionmentioning

confidence: 99%

Patients With Cervical Metastasis and Neoplastic Pachymeningitis are Less Likely to Improve Neurologically After Surgery

Denaro

Martino

Papalia

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Although many patients with cervical spine metastases are treated surgically, it is unknown whether certain subsets achieve better pain relief and improvement of neurologic function. Questions/purposes(1) Does tumor removal with reconstruction improve the neurologic status? (2) Is any subset of patients more likely to have neurological recovery from palliative surgery? (3) What is the rate of surgeryrelated complications? Patients and MethodsWe retrospectively reviewed 46 patients who had palliative surgery for metastatic solid tumor metastases of the subaxial cervical spine. Indications were neurologic deficits, life expectancy longer than 6 months, and a Karnofsky Performance Score of 50 to 70. Surgery consisted of anterior tumor removal and reconstruction with titanium mesh cages and/or tricortical iliac crest allograft plus plate fixation or of a combined procedure with adjunctive posterior decompression and stabilization with lateral mass screw fixation. Postoperatively, neurologic Frankel score grade, Karnofsky Performance Score, and complications were recorded.

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The Management of Spinal Epidural Metastases

Cited by 92 publications

References 137 publications

Characteristic MRI Findings of Spinal Metastases from Various Primary Cancers: Retrospective Study of Pathologically-Confirmed Cases

Characteristic MRI Findings of Spinal Metastases from Various Primary Cancers: Retrospective Study of Pathologically-Confirmed Cases

Spinal stabilization for patients with metastatic lesions of the spine using a titanium spacer

Patients With Cervical Metastasis and Neoplastic Pachymeningitis are Less Likely to Improve Neurologically After Surgery

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