scholarly journals Multidisciplinary treatment system for bone metastases for early diagnosis, treatment and prevention of malignant spinal cord compression

2020 ◽  
Author(s):  
Eiji Nakata ◽  
Shinsuke Sugihara ◽  
Yoshifumi Sugawara ◽  
Ryuichi Nakahara ◽  
Takayuki Furumatsu ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Early Diagnosis ◽  
Bone Metastases ◽  
Spinal Cord Compression ◽  
Multidisciplinary Treatment ◽  
Cord Compression ◽  
Treatment System ◽  
Treatment And Prevention

Four cases of spinal cord compression: The need for early diagnosis

1985 ◽  
Vol 71 (2) ◽  
pp. 92-95
Author(s):  
R. K. Bradley ◽  
S. H. Murch
Keyword(s):  
Spinal Cord ◽  
Early Diagnosis ◽  
Clinical Diagnosis ◽  
Spinal Cord Compression ◽  
Cauda Equina ◽  
Cord Compression ◽  
Symptoms And Signs

SummaryFour cases of spinal cord compression, with symptoms and signs evolving over several years or as quickly as two days, are presented. The symptoms and signs of extrinsic cord compression are described and briefly contrasted with those of intrinsic cord or cauda equina lesions. The need for early clinical diagnosis is emphasised.

Symptomatic Atlantoaxial Dislocation in Down Syndrome

PEDIATRICS ◽  
1982 ◽  
Vol 69 (5) ◽  
pp. 568-571
Author(s):  
Stefan Hreidarsson ◽  
Gary Magram ◽  
Harvey Singer
Keyword(s):  
Spinal Cord ◽  
Down Syndrome ◽  
Early Diagnosis ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Atlantoaxial Dislocation

Spinal cord compression secondary to atlantoaxial dislocation in Down syndrome is relatively uncommon. This case emphasizes the importance of early diagnosis and appropriate radiologic procedures.

Analysis of a neurosurgical directed acute spinal cord compression pathway at Michigan Medicine, a tertiary referral hospital.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18285-e18285
Author(s):  
John C. Krauss ◽  
Daniel Klarr
Keyword(s):  
Decision Making ◽  
Spinal Cord ◽  
Bone Metastases ◽  
Spinal Cord Compression ◽  
Radiation Oncology ◽  
Medical Oncology ◽  
Cord Compression ◽  
Imaging Protocol ◽  
Presenting Symptoms ◽  
Previous Diagnosis

e18285 Background: Spinal cord compression (SCC) is considered an oncologic emergency that is likely to severely impair patients’ quality of life if immediate action is not taken. Clinicians need a high suspicion to diagnose SCC, as the presenting symptoms are variable and nonspecific. To expedite the diagnosis and treatment of SCC, we instituted an emergent spine MRI imaging pathway that was led by the neurosurgeons and involved close collaboration with medical oncology and radiation oncology. Methods: The charts of all patients from July 2015 to June 2018 who underwent the “MR Spine Cord Compression Acute” imaging pathway at Michigan Medicine were reviewed. Electronic time stamps provided the time of the initial order, the time to scan completion, the time to scan reading, and the time to definitive intervention. The charts were reviewed for the initial neurosurgical physical exam, a presentation consistent with recent trauma, a previous diagnosis of malignancy, and a previous diagnosis of bone metastases. The type and timing of therapy, and survival following the imaging protocol were assessed. Results: 319 unique MRI exams were done over the three-year span, 155 of the patients had cancer, and 75 patients had SCC. The time from ordering of exam to performance is 2.91 hours (0 to 25.45), from performance to read 8.31 hours (0 to 75.25 hours). Time from MRI to intervention was 63.14 hours (0 to 432 hours) based on complex decision making around surgical vs. radiation vs. medical therapy. For the majority of patients who were diagnosed with SCC, the cause was secondary to tumor growth from contiguous spinal metastasis, and most had previously identified bone metastases. Degenerative disc extrusion was the most common cause of benign SCC. Conclusions: A neurosurgical directed standard imaging protocol is effective at rapidly diagnosing SCC. Malignant SCC is predominately treated surgically, but complex multi-disciplinary patient centered decision-making involving neurosurgery, radiation oncology, and medical oncology is frequently necessary to arrive at the appropriate treatment.

scholarly journals Metastatic Spinal Cord Compression Secondary to Liver Cancer

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Daniel Gams Massi ◽  
Japhari Nyassinde ◽  
Ngor Side Diagne ◽  
Ramy Abdennaji ◽  
Kamadore Toure ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Liver Cancer ◽  
Spinal Cord Compression ◽  
Hepatitis B Surface Antigen ◽  
Multidisciplinary Treatment ◽  
Cord Compression ◽  
Metastatic Spinal Cord Compression ◽  
Diagnosis And Treatment ◽  
Medical Emergency ◽  
The Right

Metastatic spinal cord compression (MSCC) is a medical emergency that requires rapid diagnosis and treatment to reduce pain, to preserve neurological functioning, and to prolong survival. The diagnosis of liver cancer is often neglected in the differential diagnosis of MSCC. Treatment is usually palliative and evolution is often fatal. This is a case report of a 28-year-old patient living in Mauritania hospitalized in November 2014 at the neurology department of Fann national teaching hospital in Dakar, for the management of a chronic dorsal spinal cord compression. The radiological and laboratory investigations done revealed the metastatic compression originating from a liver cancer with elevated alpha-fetoprotein and aspartate transaminase, positive hepatitis B surface antigen, and multiple metastasis in the lungs, mediastinum, ribs, iliac, and peritoneum. The hip joint X-ray showed a spontaneous fracture of the right femoral neck. The multidisciplinary treatment was palliative and the evolution was fatal within the month of hospitalization. Earlier diagnosis and treatment of MSCC may not have saved the life of the patient but may have prevented much suffering and would likely have prolonged the life of a young man.

scholarly journals Metastatic small cell neuroendocrine tumor with spinal cord compression – Understanding a rare entity

2020 ◽  
Vol 11 ◽  
pp. 185
Author(s):  
Shailesh Hadgaonkar ◽  
Amogh Zawar ◽  
Anoop Patel ◽  
Ajay Kothari ◽  
Ashok Shyam ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Early Diagnosis ◽  
Spinal Cord Compression ◽  
Surgical Intervention ◽  
Treatment Plan ◽  
Cord Compression ◽  
Small Cell ◽  
Lower Limbs ◽  
Rare Entity

Background: Metastatic spinal cord compression with carcinoid tumor as primary is a rare entity with its own diagnostic dilemmas and surgical challenges. Most of these neuroendocrine tumors arise from the gastrointestinal tract or lungs with metastasis to spine in <2% cases. Early diagnosis in an orderly manner is of significance as most of it is delayed due to slowly developing symptoms. Furthermore, prompt management has been an important factor as morbidity and mortality are high in such cases and surgical intervention if needed, which can be a challenge due to disturbed alignment, complex regional anatomy, and careful handling of spinal cord. Case Description: The authors describe a case report on similar lines of a middle aged gentleman presenting with low back pain and weakness in both lower limbs which on further investigations revealed a pathological fracture causing spinal cord compression due to metastasis from small cell carcinoma in the lungs, managed with surgical intervention, and subsequently with radiotherapy. Conclusion: Secondary metastatic deposits in the lumbar vertebrae due to carcinoid tumors in the lungs are a rare entity and can be difficult to diagnose and manage further. However, it should be included in the list of differential diagnosis. The case report emphasizes on using investigative modalities such as PET-CT scan to aid an early diagnosis and plan further treatment plan as early as possible to offer a better quality of life to the patients.

American Society of Clinical Oncology Guideline on the Role of Bisphosphonates in Breast Cancer

2000 ◽  
Vol 18 (6) ◽  
pp. 1378-1391 ◽  
Author(s):  
Bruce E. Hillner ◽  
James N. Ingle ◽  
James R. Berenson ◽  
Nora A. Janjan ◽  
Kathy S. Albain ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Spinal Cord ◽  
Bone Metastases ◽  
Clinical Oncology ◽  
Spinal Cord Compression ◽  
Hormonal Therapy ◽  
Cord Compression ◽  
Adjuvant Setting ◽  
American Society ◽  
Substantial Decline

PURPOSE: To determine clinical practice guidelines for the use of bisphosphonates in the prevention and treatment of bone metastases in breast cancer and their role relative to other therapies for this condition. METHODS: An expert multidisciplinary panel reviewed pertinent information from the published literature and meeting abstracts through May 1999. Additional data collected as part of randomized trials and submitted to the United States Food and Drug Administration were also reviewed, and investigators were contacted for more recent information. Values for levels of evidence and grade of recommendation were assigned by expert reviewers and approved by the panel. Expert consensus was used if there were insufficient published data. The panel addressed which patients to treat and when in their course of disease, specific drug delivery issues, duration of therapy, management of bony metastases with other therapies, and the public policy implications. The guideline underwent external review by selected physicians, members of the American Society of Clinical Oncology (ASCO) Health Services Research Committee, and the ASCO Board of Directors. RESULTS: Bisphosphonates have not had an impact on the most reliable cancer end point: overall survival. The benefits have been reductions in skeletal complications, ie, pathologic fractures, surgery for fracture or impending fracture, radiation, spinal cord compression, and hypercalcemia. Intravenous (IV) pamidronate 90 mg delivered over 1 to 2 hours every 3 to 4 weeks is recommended in patients with metastatic breast cancer who have imaging evidence of lytic destruction of bone and who are concurrently receiving systemic therapy with hormonal therapy or chemotherapy. For women with only an abnormal bone scan but without bony destruction by imaging studies or localized pain, there is insufficient evidence to suggest starting bisphosphonates. Starting bisphosphonates in patients without evidence of bony metastasis, even in the presence of other extraskeletal metastases, is not recommended. Studies of bisphosphonates in the adjuvant setting have yielded inconsistent results. Starting bisphosphonates in patients at any stage of their nonosseous disease, outside of clinical trials, despite a high risk for future bone metastasis, is currently not recommended. Oral bisphosphonates are one of several options which can be used for preservation of bone density in premenopausal patients with treatment-induced menopause. The panel suggests that, once initiated, IV bisphosphonates be continued until evidence of substantial decline in a patient’s general performance status. The panel stresses that clinical judgment must guide what is a substantial decline. There is no evidence addressing the consequences of stopping bisphosphonates after one or more adverse skeletal events. Symptoms in the spine, pelvis, or femur require careful evaluation for spinal cord compression and pathologic fracture before bisphosphonate use and if symptoms recur, persist, or worsen during therapy. The panel recommends that current standards of care for cancer pain, analgesics and local radiation therapy, not be displaced by bisphosphonates. IV pamidronate is recommended in women with pain caused by osteolytic metastasis to relieve pain when used concurrently with systemic chemotherapy and/or hormonal therapy, since it was associated with a modest pain control benefit in controlled trials. CONCLUSION: Bisphosphonates provide a meaningful supportive but not life-prolonging benefit to many patients with bone metastases from cancer. Further research is warranted to identify clinical predictors of when to start and stop therapy, to integrate their use with other treatments for bone metastases, to identify their role in the adjuvant setting in preventing bone metastases, and to better determine their cost-benefit consequences.

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