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Multidisciplinary Approach to Patients With Metastatic Spinal Cord Compression: A Diagnostic Therapeutic Algorithm to Improve the Neurological Outcome.

INTRODUCTION: The morbidity associated with metastatic spinal disease is significant because of spinal cord and/or nerve root compression. The purpose of this paper is to define a diagnostic-therapeutic path for patients with vertebral metastases and from this path to build an algorithm to reduce the devastating consequences of spinal cord compression. MATERIALS AND METHODS: The algorithm is born from the experience of a primary care center. A spine surgeon, an emergency room (ER) physician, a neuroradiologist, a radiation oncologist, and an oncologist form the multidisciplinary team. The ER

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… SCORAD III: Randomized Noninferiority Phase III Trial of Single-Dose Radiotherapy (RT) Compared to Multifraction RT in Patients (Pts) With Metastatic Spinal Canal Compression (SCC) . …

Radiofrequency Ablation in Vertebral Body Metastasis with and without Percutaneous Cement Augmentation: A Systematic Review Addressing the Need for SPINE Stability Evaluation.

Vertebral body metastases (VBM) are one of the most frequent sites of bone metastasis, and their adequate therapeutic management still represents an insidious challenge for both oncologists and surgeons. A possible alternative treatment for VBM is radiofrequency ablation (RFA), a percutaneous technique in which an alternating current is delivered to the tumor lesion producing local heating and consequent necrosis. However, RFA alone could alter the biomechanics and microanatomy of the vertebral body, thus increasing the risk of post-procedure vertebral fractures and spine instability, and inde

Posterior occiput-cervical fixation for metastasis to upper cervical spine.

BACKGROUND: Metastasis to craniocervical area may result in instability manifesting as disabling pain, cranial nerve dysfunction, paralysis, or even death. Stabilization is required to prevent complications. Nonoperative treatment modalities are ineffective in providing stability and adequate pain relief. We present our experience of diagnosis, presentation, and surgical management for metastatic tumors to the upper cervical spine (UCS). METHODS: Single-center single-surgeon database of consecutively operated posterior occiput-cervical fusion for metastasis to UCS was reviewed from 2007 to 20

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… Posterior decompression may be necessary in the presence of significant epidural disease with spinal cord compromise or following spinal canal compromise from marked irreducible bony subluxation. …

The outcome of expandable titanium mesh implants for the treatment of multi-level vertebral compression fractures caused by multiple myeloma.

BACKGROUND: Painful vertebral compression fractures (VCFs) in myeloma patients severely reduce quality of life. Currently, the International Myeloma Working Group (IMWG) and National Institute of Clinical Excellence NICE advocate the use of either balloon kyphoplasty or vertebroplasty in the management of these fractures. METHODS: All patients with VCFs and myeloma who adhered to the IMWG indications for vertebral augmentation were treated with the Osseofix® implant. Visual analogue scores (VAS) and Oswestry disability index (ODI) were taken preoperatively and at least one year following surg

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… The most common complications associated with this technique are PMMA leakage into surrounding tissues – 20%; paravertebral vein embolism – 13%; intradiscal leakage – 8% and PMMA leakage into the spinal canal – 0.8% [ 8 ]. …

Management of Pathological Thoracolumbar Vertebral Fractures in Patients With Multiple Myeloma: Multidisciplinary Recommendations.

STUDY DESIGN: Mutlidisciplinary consensus recommendations for patients suffering from multiple myeloma (MM) involvement of the spinal column by the Spine Section of the German Association of Orthopaedic and Trauma Surgeons. OBJECTIVE: To provide a comprehensive multidisciplinary diagnostic and therapeutic approach and to summarize the current literature on the management of pathological thoracolumbar vertebral fractures in patients with multiple myeloma. METHODS: Multidisciplinary recommendations using a classical consensus process provided by radiation oncologists, medical oncologists, orth

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… Additionally, a total spine MRI is needed to detect small focal lesions and to evaluate soft tissue manifestations and spinal canal involvement. Stability assessment can be achieved using the SINS Score. 12 See als Table 2(a + b) . Table 2. …

Представление результатов анализа диабетических осложнений с головы до ног: всеобъемлющий радиологический обзор.

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Pain and quality of life in patients undergoing radiotherapy for spinal metastatic disease treatment.

BACKGROUND: Radiotherapy is an important tool in the control of pain in patients with spinal metastatic disease. We aimed to evaluate pain and of quality of life of patients with spinal metastatic disease undergoing radiotherapy with supportive treatment. METHODS: The study enrolled 30 patients. From January 2008 to January 2010, patients selection included those treated with a 20 Gy tumour dose in five fractions. Patients completed the visual analogue scale for pain assessment and the SF-36 questionnaire for quality of life assessment. RESULTS: The most frequent primary sites were breast, m

Bruton Tyrosine Kinase в лизах множественных склерозов и 3 модели.

ПАТОфизиология множественного склероза (MS) обусловлена лимфоцитами B, макрофагами и микроглией. Bruton tirosine cinase (BTK) — внутриклеточный фермент внутри этих клеток, который модифицирует их подстрекательские свойства. Таким образом, центральные ингибиторы нервной системы и пенектора BTK могут противодействовать регулированию иммунной дистракции, и это стремление высвечивается с помощью 11 фазы 3 Клинические испытания в MS, чтобы остановить этот фермент. Несмотря на большой интерес, пространственное и временнóе возвышение BTK в повреждениях MS и его моделей не является достаточно точным.М

Functional Outcomes of Surgical Management for Spinal Epidural Masses in an Egyptian Tertiary Hospital.

BACKGROUND: The spinal epidural space, covering the dural sac, is located along the posterior longitudinal ligament anteriorly, the ligamentum flavum and the periosteum of laminae posteriorly, and the pedicles of the spinal column by the intervertebral foramina containing their neural elements laterally. It could be affected variably by different types of diseases, either as primary lesions or as an extension from a disease process in the nearby tissues and organs. AIM: We aimed to present clinically and surgically patients with spinal epidural masses operated in the Neurosurgery Department o

Comprehensive analysis of acute flaccid paralysis with and without myelitis in Taiwanese children.

BACKGROUND: Acute flaccid paralysis (AFP) is a clinical syndrome marked by the sudden onset of muscle weakness or paralysis, requiring immediate medical intervention due to its potential for significant morbidity and mortality. Despite extensive studies on AFP, comparative analyses between cases with myelitis (M-AFP) and non-myelitis (NM-AFP) remain scarce. This study seeks to address this gap by analyzing demographic, clinical, and etiological distinctions between these groups. METHODS: A retrospective study was conducted on 39 pediatric AFP patients diagnosed between 2012 and 2021. Particip

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… It can lead to AFP through various mechanisms, including direct compression of the spinal cord or nerve roots, paraneoplastic syndromes (e.g., opsoclonus-myoclonus syndrome), and infiltration of the spinal canal (Fig.  3 ) [ 29 , 30 ]. …

Balloon kyphoplasty in malignant spinal fractures: a systematic review and meta-analysis.

BACKGROUND: Spinal fractures are a common source of morbidity in cancer patients. Balloon Kyphoplasty (BKP) is a minimally invasive procedure designed to stabilize fractures and correct vertebral deformities. We performed a meta-analysis to determine the efficacy and safety of BKP for spinal fractures in cancer patients. METHODS: We searched several electronic databases up to September 2008 and the reference lists of relevant publications for studies reporting on BKP in patients with spinal fractures secondary to osteolytic metastasis and multiple myeloma. Outcomes sought included pain relief

Cancer metastasis to the bone: Mechanisms and animal models (Review).

The majority of cancer-related deaths result from tumor metastasis, with bone metastasis occurring in almost all types of malignant tumors. Understanding the mechanism by which tumors metastasize to bone is critical for the identification of novel therapeutic targets. A large amount of research has been carried out using animal models, and these models have been crucial in advancing the fundamental understanding of cancer. However, current models are limited; although they can mimic specific stages of the metastatic process, they are not able to replicate the entire process from tumorigenesis

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… Intraosseous injections can be administered to the tibia or spinal canal, and the direct injection of PC14 cells into the spinal canal of mice was found to result in spinal metastases of lung cancer ( 99 ). …

Balloon Kyphoplasty in the Treatment of Neoplastic Spine Lesions: A Systematic Review.

STUDY DESIGN: Systematic review. OBJECTIVES: To assess the efficacy of kyphoplasty in controlling pain and improving quality of life in oncologic patients with metastatic spinal disease and pathologic compression fractures of the spine. METHODS: A literature search through medical database was conducted (using PubMed, EMBASE, Cochrane, and LILACS) for randomized controlled trials comparing balloon kyphoplasty versus the traditional treatment for compression fractures of the spine due to metastatic disease. Two investigators independently assessed all titles and abstracts to select potential

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… Gerszten PC, Monaco EA., 3rd Complete percutaneous treatment of vertebral body tumors causing spinal canal compromise using a transpedicular cavitation, cement augmentation, and radiosurgical technique. Neurosurg Focus. 2009;27:E9. 11. Cruz JP, Sahgal A, Whyne C, Fehlings MG, Smith R. …

Intraoperative radiotherapy combined with spinal stabilization surgery-a novel treatment strategy for spinal metastases based on a first single-center experiences.

INTRODUCTION: Current treatment of spinal metastases (SM) aims on preserving spinal stability, neurological status, and functional status as well as achieving local control. It consists of spinal surgery followed by radiotherapy and/or systemic treatment. Adjuvant therapy usually starts with a delay of a few weeks to prevent wound healing issues. Intraoperative radiotherapy (IORT) has previously been successfully applied during brain tumor, breast and colorectal carcinoma surgery but not in SM, including unstable one, to date. In our case series, we describe the feasibility, morbidity and mort

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… For dose calculation we measure the distance from the needle tip to the spinal canal in our intraoperative CT or 3D fluoroscopy scan with the applicator in place. …

The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis).

BACKGROUND & IMPORTANCE: This patient and public-involved systematic review originally focused on arachnoiditis, a supposedly rare "iatrogenic chronic meningitis" causing permanent neurologic damage and intractable pain. We sought to prove disease existence, causation, symptoms, and inform future directions. After 63 terms for the same pathology were found, the study was renamed Diseases of the Leptomeninges (DLMs). We present results that nullify traditional clinical thinking about DLMs, answer study questions, and create a unified path forward. METHODS: The prospective PRISMA protocol is pu

Primary Bone Tumors of the Spine-Proposal for Treatment Based on a Single Centre Experience.

This study reports a large single-center series of primary bone tumors of the spine (PBTs). We aimed to review the concepts for management, as this kind of tumor represents a very rare entity, and also propose a new treatment algorithm. Retrospective analysis revealed 92 patients receiving surgery for PBTs from 2007 to 2019 at our center. They were analyzed based on surgical management and the course of the disease. A total of 145 surgical procedures were performed (50 cervical, 46 thoracic, 28 lumbar, and 21 sacral). Complete tumor resection was achieved in 65%, of which 22% showed tumor recu

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… MRI showed a tumor of C4 comprising the vertebral body and spinal canal. Preoperative neoadjuvant therapy was not possible because of the developing pareses and neurologic deficits. Therefore, surgery was performed the next day. The surgical procedure comprised corpectomy of C4 and ventral plating. …

Risk factors for pulmonary cement embolism after percutaneous vertebroplasty and radiofrequency ablation for spinal metastases.

ObjectivePulmonary cement embolism is a rare but underestimated complication of vertebroplasty due to the relative lack of study and examination. This study aims to investigate the incidence of pulmonary cement embolism in patients with spinal metastasis who undergo PVP with RFA and to analyze the relative risk factors.MethodsA total of 47 patients were retrospectively included and classified into pulmonary cement embolism (PCE) group and non-pulmonary cement embolism (NPCE) group by comparing pre- and postoperative pulmonary CT scan images. The demographic and clinical information of the pati

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… An animal study found that a layer of dense cord can be formed at the edge of the tumor after RFA, and this biomembrane barrier can prevent bone cement leakage into the spinal canal during PVP ( 26 ). However, there is no related research on PCE in spinal metastatic patients following PVP and RFA. …

Suprascapular nerve peripheral nerve stimulation for malignancy-related pain: A case series.

BackgroundBlockade of the suprascapular nerve is an effective diagnostic tool in the workup and potential treatment of shoulder pain. For chronic shoulder pain, peripheral nerve stimulation has been shown to provide significant, sustained pain relief. However, no literature to date has described peripheral nerve stimulation for the treatment of oncologic shoulder pain.ObjectivesWe describe two cases of chronic oncologic-related shoulder pain that responded to posterior suprascapular peripheral nerve stimulator placement to facilitate future progress and discussion in the fields of peripheral n

Thoracic paravertebral block versus local infiltration anesthesia for percutaneous kyphoplasty to treat osteoporotic vertebral compression fractures combined with intercostal neuralgia: a randomized controlled trial.

BACKGROUND: Percutaneous kyphoplasty (PKP) is an effective treatment for osteoporotic vertebral compression fractures (OVCFs) and provides effective pain relief; however, its efficacy is questionable in patients with thoracic OVCFs combined with intercostal neuralgia (IN). This study aims to compare the efficacy and safety of thoracic paravertebral nerve block (TPVB) and local infiltration (LI) anesthesia for PKP to treat thoracic OVCFs combined with IN. METHODS: Patients with OVCFs combined with IN scheduled to undergo PKP between January 2021 and June 2022 were randomized into the following

Guillain-Barré syndrome in patients with multiple myeloma: three cases report and literature review.

BackgroundMultiple myeloma (MM) with Guillain-Barré syndrome (GBS) is relatively rare, and the specific mechanism is still unclear. The previous infection, surgery, and medication use may have contributed to the occurrence of GBS. The use of bortezomib in patients with MM can easily lead to peripheral neuropathy, which is similar to the symptoms of GBS, making it challenging to diagnose GBS.Cases presentationThree patients with IgA type MM experienced lower limb weakness during treatment. Combined with lumbar puncture, nerve conduction studies, and other tests, the diagnosis was confirmed as G

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… Lumbar MRI showed that the space occupying lesion at 5th thoracic vertebra was locally protruding into the spinal canal and compressing the thoracic spinal cord. In January 2024, she underwent posterior thoracic tumor resection, bone graft fusion, and internal fixation. …