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To report efficacy and safety of percutaneous electrochemotherapy (ECT) in patients with radiotherapy-resistant metastatic epidural spinal cord compression (MESCC). This retrospective study analyzed all consecutive patients treated with bleomycin-based ECT between February-2020 and September-2022 in a single tertiary referral cancer center. Changes in pain were evaluated with the Numerical Rating Score (NRS), in neurological deficit with the Neurological Deficit Scale, and changes in epidural spinal cord compression were evaluated with the epidural spinal cord compression scale (ESCCS) using an MRI. Forty consecutive solid tumour patients with previously radiated MESCC and no effective systemic treatment options were eligible. With a median follow-up of 5.1 months [1–19.1], toxicities were temporary acute radicular pain (25%), prolonged radicular hypoesthesia (10%), and paraplegia (7.5%). At 1 month, pain was significantly improved over baseline (median NRS: 1.0 [0–8] versus 7.0 [1.0–10], P <.001) and neurological benefits were considered as marked (28%), moderate (28%), stable (38%), or worse (8%). Three-month follow-up (21 patients) confirmed improved over baseline (median NRS: 2.0 [0–8] versus 6.0 [1.0–10], P <.001) and neurological benefits were considered as marked (38%), moderate (19%), stable (33.5%), and worse (9.5%). One-month post-treatment MRI (35 patients) demonstrated complete response in 46% of patients by ESCCS, partial response in 31%, stable disease in 23%, and no patients with progressive disease. Three-month post-treatment MRI (21 patients) demonstrated complete response in 28.5%, partial response in 38%, stable disease in 24%, and progressive disease in 9.5%. This study provides the first evidence that ECT can rescue radiotherapy-resistant MESCC. • Radiotherapy-resistant metastatic spinal cord compression is an unmet medical need. • Electrochemotherapy (ECT) improves neurological in this advanced cancer setting. • ECT also results in significant pain decrease at 1-month and 3-months. • At MRI, 77% of patients had an objective response at 1 month and 66.5% at 3 months. • Complications were overall minor, with the exception of paraplegia in 7.5% of patients. [ABSTRACT FROM AUTHOR]

Background Context: Surgical decompression and stabilization followed by radiosurgery represents an effective method for local tumor control and neurologic preservation for patients with metastatic epidural spinal cord compression (MESCC). We have previously demonstrated improvement in health-related quality of life (HrQOL) after this combined modality treatment ("hybrid therapy").Purpose: The current analysis focuses on delineation of patient-specific prognostic factors predictive of HrQOL change after combined surgery-stereotactic radiosurgery (SRS) treatment of MESCC.Study Design: This is a prospective, single-center, cohort study.Patient Sample: One hundred and eleven patients with MESCC who underwent separation surgery followed by SRS were included.Outcome Measures: Prognostic factors associated with improved patient-reported outcome (PRO) measures.Methods: Patient-reported outcome tools, that is, Brief Pain Inventory (BPI) and MD Anderson Symptom Inventory-Spine Tumor (MDASI-SP), both validated in the cancer population, were prospectively collected. Numeric prognostic factors were correlated with PRO measures using the Spearman rank correlation coefficient. Categorical prognostic factors were correlated with PRO measures using the Wilcoxon two-sample test (for two categories) or the Kruskal-Wallis test (for three or more categories). All statistical tests were two-sided with a level of significance <.05 for correlation of prognostic factors with PRO constructs and a level of significance <.0014 for correlation of prognostic factors with PRO items. Statistical analyses were done in SAS (version 9.4, Cary, NC, USA).Results: One hundred and eleven patients were included in this analysis. Patients with lower preoperative Medical Research Council (MRC) motor scores experienced a greater decrease in symptom interference (BPI interference construct (p=.03) and individual functional measures including general activity (p=.001), walking (p=.001), and normal work (p=.006)). Lumbar location was associated with better outcomes than cervical or thoracic as noted on the BPI pain experience construct (p=.03) and MDASI-SP interference (p=.01) and core symptom (p=.002) constructs. Patients with American Spinal Injury Association (ASIA) scores of C or D benefit more than those with ASIA E on BPI interference construct (p=.04). Patients with higher Eastern Cooperative Oncology Group (ECOG) scores at presentation benefit more than those with low ECOG scores on MDASI-SP interference construct (p=.03). Women benefit more than men on BPI interference (p=.03) and pain experience (p=.04) constructs. Patients with prior spinal surgery at the current level of interest benefit less than those who are naïve surgical patients in MDASI-SP interference construct (p=.04).Conclusions: Delineation of patient characteristics associated with HrQOL improvement provides crucial information for patient selection, patient education, and setting treatment expectations. For patients with MESCC treated with hybrid therapy using surgery and radiosurgery, the presence of neurologic deficits and diminished performance status, lumbar tumor level, and female gender were associated with greater PRO improvement. [ABSTRACT FROM AUTHOR]

Background and Context: Metastatic epidural spinal cord compression (MESCC) is a disabling consequence of disease progression. Surgery can restore or preserve physical function, improving access to treatments that increase duration of survival; however, advanced patient age may deter oncologists and surgeons from considering surgical management.Purpose: Evaluate the duration of ambulation and survival in elderly patients following surgical decompression of MESCC.Study Design/setting: Retrospective file review of a prospective database, under institutional review board (IRB) waiver of informed consent, of consecutive patients treated in an academic tertiary care medical center from August 2008 to March 2015.Patient Sample: Patients ≥65 years presenting neurological and/or radiological signs of cord compression because of metastatic disease, who underwent surgical decompression.Outcome Measures: Duration of ambulation and survival.Methods: Patients underwent urgent multidisciplinary evaluation and surgery. Ambulation and survival were compared with age, pre-, and postoperative neurological (American Spinal Injury Association [ASIA] Impairment Scale [AIS]) and performance status (Karnofsky Performance Status [KPS]), and Tokuhashi Score using Kruskal-Wallis and Wilcoxon signed rank tests, Pearson correlation coefficient, Cox regression model, log-rank analysis, and Kaplan-Meier analysis.Results: Forty patients were included (21 male, 54%; mean age 74 years, range 65-87). Surgery was performed a mean 3.8 days after onset of motor symptoms. Mean duration of ambulation and survival were 474 (range 0-1662) and 525 days (range 11-1662), respectively; 53% of patients (21 of 40) survived and 43% (17 of 40) retained ambulation for ≥1 year. There was no significant relationship between survival and ambulation for patients aged 65-69, 70-79, or 80-89 years, although Kaplan-Meier analysis suggested stratification. There was a significant relationship between duration of ambulation and pre- and postoperative AIS (p=.0342, p=.0358, respectively) and postoperative KPS (p=.0221). Tokuhashi score was not significantly related to duration of survival or ambulation, and greatly underestimated life expectancy in 22 of 37 (59%) patients with scores 0-11.Conclusions: Decompressive surgery led to marked improvement in neurological function and performance status. More than 50% of patients survived for >1 year, some for 3 years or more after surgery. [ABSTRACT FROM AUTHOR]

Background Context: Bioresorbable calcium phosphate cement (CPC) may be suitable for vertebroplasty/kyphoplasty of osteoporotic vertebral fractures. However, additional targeted delivery of osteoinductive bone morphogenetic proteins (BMPs) in the CPC may be required to counteract the augmented local bone catabolism and support complete bone regeneration.Purpose: This study aimed at testing an injectable, poly (l-lactide-co-glycolide) acid (PLGA) fiber-reinforced, brushite-forming cement (CPC) containing low-dose bone morphogenetic protein BMP-2 in a sheep lumbar osteopenia model.Study Design/ Setting: This is a prospective experimental animal study.Methods: Bone defects (diameter 5 mm) were generated in aged, osteopenic female sheep and filled with fiber-reinforced CPC alone (L4; CPC+fibers) or with CPC containing different dosages of BMP-2 (L5; CPC+fibers+BMP-2; 1, 5, 100, and 500 µg BMP-2; n=5 or 6 each). The results were compared with those of untouched controls (L1). Three and 9 months after the operation, structural and functional effects of the CPC (±BMP-2) were analyzed ex vivo by measuring (1) bone mineral density (BMD); (2) bone structure, that is, bone volume/total volume (assessed by micro-computed tomography [micro-CT] and histomorphometry), trabecular thickness, and trabecular number; (3) bone formation, that is, osteoid volume/bone volume, osteoid surface/bone surface, osteoid thickness, mineralizing surface/bone surface, mineral apposition rate, and bone formation rate/bone surface; (4) bone resorption, that is, eroded surface/bone surface; and (5) compressive strength.Results: Compared with untouched controls (L1), CPC+fibers (L4) and/or CPC+fibers+BMP-2 (L5) significantly improved all parameters of bone formation, bone resorption, and bone structure. These effects were observed at 3 and 9 months, but were less pronounced for some parameters at 9 months. Compared with CPC without BMP-2, additional significant effects of BMP-2 were demonstrated for bone structure (bone volume/total volume, trabecular thickness, trabecular number) and formation (osteoid surface/bone surface and mineralizing surface/bone surface), as well as for the compressive strength. The BMP-2 effects on bone formation at 3 and 9 months were dose-dependent, with 5-100 µg as the optimal dosage.Conclusions: BMP-2 significantly enhanced the bone formation induced by a PLGA fiber-reinforced CPC in sheep lumbar osteopenia. A single local dose as low as ≤100 µg BMP-2 was sufficient to augment middle to long-term bone formation. The novel CPC+BMP-2 may thus represent an alternative to the bioinert, supraphysiologically stiff polymethylmethacrylate cement presently used to treat osteoporotic vertebral fractures by vertebroplasty/kyphoplasty. [ABSTRACT FROM AUTHOR]

Objective Spinal arachnoid webs are a rare variant of spinal arachnoid cysts where 1 or multiple focal membranes of arachnoid tissue obstruct the subarachnoid space. Only 11 prior cases of arachnoid webs have been reported in the literature. We present a series of 3 consecutive cases of arachnoid webs from our institution and review the literature on this rare condition to provide recommendations for its management. Methods Retrospective chart review was performed for 3 consecutive cases of intradural arachnoid webs causing spinal cord compression at our institution, with inconclusive preoperative imaging, treatment with surgical decompression, and resection. There were no external sources of funding. Results Our cases occurred dorsally in the thoracic spine and were associated with syringomyelia. Preoperative magnetic resonance imaging, computed tomography myelography, and cine magnetic resonance imaging were inconclusive, and the definitive diagnosis was made with intraoperative ultrasound. Patients underwent laminectomies and resection of arachnoid webs. Unique from prior reports of arachnoid webs, the webs in the present cases were composed of multiple septated longitudinal membranes rather than a transverse band. All patients had improvement of presenting symptoms postoperatively. Conclusions Intradural arachnoid webs causing spinal cord compression are rare. Preoperative imaging may be inconclusive. Because of the septated longitudinal nature of the visualized membranes, we propose a 1-way valve mechanism of cerebrospinal fluid obstruction causing gradual cord compression and resultant syringomyelia. [ABSTRACT FROM AUTHOR]

Metastatic spinal cord compression (MSCC) is compression of the spinal cord or caudal equina as a result of the progression of metastatic lesions within the vicinity of the spinal cord. The consequences are very severe with loss of neurological function and severe pain. The standard treatment is surgical intervention followed by radiotherapy or radiotherapy alone in rising life expectancy of cancer patients, prevention of irreversible neurological injury, pain treatment, maintain patients' mobility, function and independence. In RO clinics Interprofessional collaborative practice (IPC) becomes essential in rising life expectancy of cancer patients. Although Interprofessional education (IPE) has been recognized to improve health care delivery and patient outcomes yet IPE and IPCP data in RO of MSCC) are lack and limited. This qualitative study primarily aimed to appraisal of IP practice in radiation oncology of MSCC. A Survey was conducted from July2021 to April 2022 with radiation oncologists professions across two radiation oncology clinics affiliated in Dar –Es salaam. On appointment Interviews were recorded, de-identified, and transcribed verbatim. Resulting transcripts were analyzed using thematic analysis. Seventy interviews were performed with radiation oncologist's professions. Following thematic analysis 4 themes were identified: (1) challenges associated with management of the radiation oncology clinic to the patients with highly needs, (2) potential impact IP in MSCC as special cases (3) current situation of IPE in radiation oncology settings and (4) creating an IPE initiatives in radiation oncology. This study hypothesized that misunderstanding professionals' roles can lead to communication breakdown and less efficient IN RO clinics. This study suggests Well-structured IPE Exposure for radiation oncologists professions can be an opportunities to professions working in palliative care environment. [ABSTRACT FROM AUTHOR]

Kyphoplasty is a minimally invasive spine surgical procedure performed to stabilize and treat the pain caused by a spine compression fracture. Complications are rare with kyphoplasty and include cement extrusion into the vertebral canal leading to spinal cord or nerve root compression. Herein, the authors present a case of a 72-year-old woman who presented with symptoms of a right L2 radiculopathy after a kyphoplasty procedure. Computed tomography imaging showed leakage of the kyphoplasty cement into the neural foramen above and medial to the right L2 pedicle. A transforaminal endoscopic surgical approach was used to remove the cement and decompress the L2 nerve. The patient's postoperative clinical course was uneventful. Clinicians should be aware that for the treatment of complications to vertebroplasty and kyphoplasty procedures, minimally invasive transforaminal endoscopic surgery is one option to avoid the destabilizing effects of laminectomy and facetectomy. [ABSTRACT FROM AUTHOR]

Background Context: A number of studies have reported favorable surgical results for metastatic spinal tumors from various solid tumors. However, there are few data available on metastatic spinal cord compression (MSCC) from lung cancer despite its considerable frequency.Purpose: The study aims to present the functional outcomes, survival time, and complications after surgical treatment for MSCC from non-small cell lung cancer (NSCLC).Study Design/setting: This is a longitudinal observational study.Patient Sample: The study includes 50 patients who had neurologic deficit and underwent surgical treatment for MSCC from NSCLC.Outcome Measures: The Eastern Cooperative Oncology Group performance status (ECOG-PS), ambulatory status, overall survival, factors associated with survival time, and perioperative complications were analyzed.Methods: The postoperative changes of ECOG-PS and ambulatory status were assessed. The factors affecting postoperative ambulatory status were evaluated using logistic regression analysis. Survival time was calculated using the Kaplan-Meier method. To identify the prognostic factors, log-rank test and Cox hazards regression model were used for univariate and multivariate analyses, respectively. Major complications within postoperative 30 days and mortality rate were recorded.Results: The study cohort consisted of 27 males and 23 females with a mean age of 58.0±11.3 years at the time of surgery. An ECOG-PS improvement by at least one grade was observed in 33 of 50 cases (66.0%). Among 39 patients who were not ambulatory before surgery, 23 patients (59.0%) regained ambulatory ability after surgery. Patients who were preoperatively ambulant and those who underwent surgery within 72 hours from neurologic deficit had an increased chance of postoperative ambulation. The median for overall survival after surgery was 5.2 months. Five prognostic factors were identified on univariate analysis: time from neurologic deficit, responsiveness to preoperative chemotherapy, postoperative chemotherapy, postoperative ECOG-PS, and postoperative ambulatory status. Multivariate analysis revealed that time to neurologic deficit (risk ratio [RR]: 2.28, p=.023), postoperative chemotherapy (RR: 6.58, p<.001), and postoperative ECOG-PS (RR: 2.73, p=.040) were independent prognostic factors of survival time. Major complications developed in 34.0% of patients (17 of 50), and the 30-day mortality rate was 10.0% (5 of 50).Conclusions: Functional improvements were observed through surgical treatment even with relatively high complication rates for MSCC from NSCLC. Earlier surgical treatment could act as an adjuvant therapy for prolonging survival by improving functional status. [ABSTRACT FROM AUTHOR]

Background: Although hormonal therapy is effective for treatment of prostate cancer, its effect in the treatment of metastatic spinal cord compression (MSCC) has not been established. The objective of this study was to clarify the efficacy of conservative treatment of MSCC-induced paralysis resulting from prostate cancer for patients without a previous treatment history. Methods: We reviewed data from 38 patients with MSCC-induced paralysis from newly diagnosed prostate cancer who presented to our service between 1984 and 2010. Conservative treatment consisted of hormonal therapy with external radiation therapy (ERT). Patient demographic data, treatment details, involved spine MRI images, complications, and the course of neurologic recovery were investigated. Results: Twenty-five patients were treated conservatively. Mean follow-up period was 36.8 months. Sixteen patients (two with Frankel B, 14 with Frankel C) were unable to walk at initial presentation. After initiating conservative treatment, 75 % (12 of 16) of these patients regained the ability to walk within 1 month, 88 % (14 in 16) did so within 3 months, and all non-ambulatory patients did so within 6 months. No one had morbid complications. Four patients who did not regain the ability to walk at 1 month were found to have progressed to paraplegia rapidly, and tended to have severe compression as visualized on MRI, with a delay in the start of treatment in comparison with those who did so within 1 month (21.0 vs. 7.8 days). Conclusions: Hormonal therapy associated with ERT is an important option for treatment of MSCC resulting from newly diagnosed prostate cancer. [ABSTRACT FROM AUTHOR]

Abstract: Background context: Primary non-Hodgkin lymphoma of the spine (PNHLS) with spinal cord compression is an extremely rare disease in clinical practice. The optimal treatment options for this disease have been controversial and pose a challenge for the clinicians. Purpose: To provide some useful insight into the treatments, outcomes, and prognostic factors of PNHLS. Study design: Retrospective analysis. Patient sample: The authors collected 40 patients’ data with primary non-Hodgkin lymphoma at the mobile spine, and these patients presented with spinal cord compression as a first symptom between 1998 and 2010. Outcome measures: The posttreatment neurologic status, general status, local recurrence, and survival were noted according to the telephone calls, letters, or follow-up visits in the outpatient department. Methods: Multidisciplinary treatments, including surgical intervention, chemotherapy, and radiotherapy, were performed in this series. Follow-ups regarding treatment outcomes, local recurrence, and survival rates were carried out and analyzed. The prognostic factors including age, neurologic status, general status, vertebrae involvement, and treatment outcomes were determined. Results: The median age of the patients was 52 years (range, 13–79 years). After treatments, 30 patients (75%) reached a complete remission (CR). The 5-year overall survival (OS) of all patients was 72.9%. Patients who were younger than 60 years, with single vertebra involvement, or had CR after treatment had higher 5-year OS (p<.05). In multivariate analysis, CR after treatment and involvement of a single vertebra were identified as favorable prognostic factors for OS. Conclusions: Patients with PNHLS with neurologic compression had distinct clinical features. Regarding treatment, the authors emphasized the importance of multidisciplinary management and the optimal operating juncture. Patients with excellent response to the treatment and single vertebra involvement had better survival. [Copyright &y& Elsevier]

Purpose: To update the 2005 Cancer Care Ontario practice guidelines for the diagnosis and treatment of adult patients with a suspected or confirmed diagnosis of extradural malignant spinal cord compression (MESCC). Methods: A review and analysis of data published from January 2004 to May 2011. The systematic literature review included published randomized control trials (RCTs), systematic reviews, meta-analyses, and prospective/retrospective studies. Results: An RCT of radiation therapy (RT) with or without decompressive surgery showed improvements in pain, ambulatory ability, urinary continence, duration of continence, functional status, and overall survival. Two RCTs of RT (30 Gy in eight fractions vs. 16 Gy in two fractions; 16 Gy in two fractions vs. 8 Gy in one fraction) in patients with a poor prognosis showed no difference in ambulation, duration of ambulation, bladder function, pain response, in-field failure, and overall survival. Retrospective multicenter studies reported that protracted RT schedules in nonsurgical patients with a good prognosis improved local control but had no effect on functional or survival outcomes. Conclusions: If not medically contraindicated, steroids are recommended for any patient with neurologic deficits suspected or confirmed to have MESCC. Surgery should be considered for patients with a good prognosis who are medically and surgically operable. RT should be given to nonsurgical patients. For those with a poor prognosis, a single fraction of 8 Gy should be given; for those with a good prognosis, 30 Gy in 10 fractions could be considered. Patients should be followed up clinically and/or radiographically to determine whether a local relapse develops. Salvage therapies should be introduced before significant neurologic deficits occur. [Copyright &y& Elsevier]

Purpose: Radiotherapy alone is the most common treatment for metastatic spinal cord compression (MSCC) from relatively radioresistant tumors such as renal cell carcinoma, colorectal cancer, and malignant melanoma. However, the results of the “standard” regimen 30 Gy/10 fractions need to be improved with respect to functional outcome. This study investigated whether a dose escalation beyond 30 Gy can improve treatment outcomes. Methods and Materials: A total of 91 patients receiving 30 Gy/10 fractions were retrospectively compared to 115 patients receiving higher doses (37.5 Gy/15 fractions, 40 Gy/20 fractions) for motor function and local control of MSCC. Ten further potential prognostic factors were evaluated: age, gender, tumor type, performance status, number of involved vertebrae, visceral or other bone metastases, interval from tumor diagnosis to radiotherapy, pretreatment ambulatory status, and time developing motor deficits before radiotherapy. Results: Motor function improved in 18% of patients after 30 Gy and in 22% after higher doses (p = 0.81). On multivariate analysis, functional outcome was associated with visceral metastases (p = 0.030), interval from tumor diagnosis to radiotherapy (p = 0.010), and time developing motor deficits (p < 0.001). The 1-year local control rates were 76% after 30 Gy and 80% after higher doses, respectively (p = 0.64). On multivariate analysis, local control was significantly associated with visceral metastases (p = 0.029) and number of involved vertebrae (p = 0.043). Conclusions: Given the limitations of a retrospective study, escalation of the radiation dose beyond 30 Gy/10 fractions did not significantly improve motor function and local control of MSCC in patients with relatively radioresistant tumors. [ABSTRACT FROM AUTHOR]

The article describes the case of a 56-year-old woman diagnosed with basilar invagination (BI) treated with a novel use of bone cement to aid atlanto-axial distraction. It discusses a technical variation of the technique by which anatomic realignment of the dens with successful decompression and fusion can be obtained and maintained by a single posterior approach only. The reproducibility, safety and efficiency of the approach in the treatment of spinal cord compression due to BI is discussed.

Although outpatient specialty palliative-care clinics improve outcomes, there is no consensus on who should be referred or the optimal timing for referral. In response to this issue, we did a Delphi study to develop consensus on a list of criteria for referral of patients with advanced cancer at secondary or tertiary care hospitals to outpatient palliative care. 60 international experts (26 from North America, 19 from Asia and Australia, and 11 from Europe) on palliative cancer care rated 39 needs-based criteria and 22 time-based criteria in three iterative rounds. Nearly all experts responded in each round. Consensus was defined by an a-priori agreement of 70% or more. Panellists reached consensus on 11 major criteria for referral: severe physical symptoms, severe emotional symptoms, request for hastened death, spiritual or existential crisis, assistance with decision making or care planning, patient request for referral, delirium, spinal cord compression, brain or leptomeningeal metastases, within 3 months of advanced cancer diagnosis for patients with median survival of 1 year or less, and progressive disease despite second-line therapy. Consensus was also reached on 36 minor criteria for specialist palliative-care referral. These criteria, if validated, could provide guidance for identification of patients suitable for outpatient specialty palliative care. [ABSTRACT FROM AUTHOR]

Objective Accurate prediction of surgical outcomes in patients suffering from metastatic epidural spinal cord compression (MESCC) is challenging. This survey aims to obtain expert opinion on which preoperative clinical factors are the most relevant predictors of survival, neurologic, functional, and health-related quality of life (HRQoL). Methods Members of AOSpine International were invited to participate in a 15-question electronic survey. Results from the entire sample and differences across geographic regions and between neurosurgeons and orthopedic surgeons were analyzed. Factors endorsed by over 50% of the respondents were considered key predictors. Results Among AOSpine members, 438 responded. The absence of visceral metastasis ( n = 335; 76.48%) and the site of primary tumor ( n = 228; 52.05%) were identified as important predictors for survival. Frankel/American Spinal Injury Association grade D or E and the ability to walk were common to neurologic ( n = 344; 78.54% and n = 238; 54.34%, respectively); functional ( n = 269; 61.42% and n = 243; 55.48%, respectively); and HRQoL outcomes ( n = 241; 55.02% and n = 242; 55.25%, respectively). While the absence of bowel/bladder/sexual dysfunction was common to neurologic ( n = 260; 59.36%) and HRQoL ( n = 229; 52.28%) outcomes, a high Karnofsky/Eastern Cooperative Oncology Group performance status was common to functional ( n = 237; 54.11%) and HRQoL ( n = 221; 50.46%) outcomes. There was overall consistency across specialities and geographic regions. Conclusions Neurosurgeons and orthopedic surgeons and respondents from different geographic regions generally identified similar preoperative clinical factors as key predictors of survival, neurologic, functional, and HRQoL outcomes in surgical MESCC patients. The results of this survey will inform the development of clinical prediction rules for survival and HRQoL in MESCC patients selected for surgery to maximize their clinical relevance. [ABSTRACT FROM AUTHOR]

Background Context: Multiple myeloma (MM) with spinal involvement may present with spinal cord or cauda equina compression, with or without neurological impairment. This occurs when a soft-tissue myelomatous mass extends into the epidural space (Barron et al., 1959 [1]). The mainstay of management for such lesions in patients with normal neurology is chemotherapy and radiotherapy or radiotherapy alone, but those with neurological compromise require surgical decompression with adjuvant therapy (Patchell et al., 2005 [2]). Infrequently, patients with MM present with spinal cord compression and neurological impairment due to bony encroachment from vertebral translation and kyphosis where significant lytic bone disease has rendered the spine mechanically unstable. The standard management for these patients is surgical decompression and internal fixation.Purpose: This study aimed to report a high-risk myeloma patient with a mechanically unstable spine, acute spinal cord compression, and neurologic deficit that was treated successfully using nonoperative means.Study Design: Case report.Methods: A 37-year-old male patient with MM was referred to our tertiary referral spinal unit with acute bony spinal cord compression and neurological impairment. Computer tomography revealed lytic lesions of T2 and T3 and anterolisthesis of T1 on T2 producing mechanical instability and magnetic resonance imaging confirmed extension of disease into the epidural space and cord compression. This was successfully managed with nonoperative treatment using a brace.Results: Management in a brace restored clinical and radiological stability and normal neurological function.Conclusion: Certain high-risk myeloma patients with a mechanically unstable spine, acute spinal cord compression and neurologic deficit can be treated effectively in an appropriate brace when managed by a tertiary referral spinal unit. [ABSTRACT FROM AUTHOR]

Objective Myeloid sarcoma is a rare extramedullary solid tumor comprised of immature myeloid precursor cells, most commonly associated with acute myelogenous leukemia (AML). We present the case of a patient with a history of Shwachman-Diamond syndrome and AML who presented with myeloid sarcoma causing acute spinal cord compression. Case Description The patient was a 20-year-old man who presented with acute onset weakness and numbness in his lower extremities. Magnetic resonance imaging revealed a thoracic dorsal epidural mass. Despite the history of AML, we elected to forego image-guided biopsy and up-front radiation due to the rapidly progressive nature of his myelopathy. Immediate surgical decompression was performed, but the patient had recurrence of tumor leading to further compression 13 days postoperatively. Subsequently, emergent radiation was performed, leading to resolution of cord compression and local disease control. Conclusions To our knowledge, there are no randomized controlled trials examining the appropriate timing for postoperative radiation. Because most typical neuro-oncologic cases have no need for immediate postoperative radiation, our practice has been to wait 14 days to initiate postoperative radiation to ensure wound healing. One unique feature of our case was the rapid recurrence of symptoms due to tumor progression. Given this observation, we believe that radiation therapy should be considered as soon as possible after confirmatory pathology diagnosis for patients presenting with neurological compromise due to myeloid sarcoma of the spine. [ABSTRACT FROM AUTHOR]

We report a case of thoracic epidural extension of an infected extra-pleural and chest wall haematoma with evidence of spinal cord compression and signs of cauda equina. Emergency spinal cord decompression with laminectomy followed by thoracotomy was performed. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess the accuracy of a virtual consultation (VC) process in determining treatment strategy for patients with malignant epidural spinal cord compression (MESCC). Methods and Materials: A prospective clinical database was maintained for patients with MESCC. A virtual consultation process (involving exchange of key predetermined clinical information and diagnostic imaging) facilitated rapid decision-making between oncologists and spinal surgeons. Diagnostic imaging was reviewed retrospectively (by R.R.) for surgical opinions in all patients. The primary outcome was the accuracy of virtual consultation opinion in predicting the final treatment recommendation. Results: After excluding 20 patients who were referred directly to the spinal surgeon, 125 patients were eligible for virtual consultation. Of the 46 patients who had a VC, surgery was recommended in 28 patients and actually given to 23. A retrospective review revealed that 5/79 patients who did not have a VC would have been considered surgical candidates. The overall accuracy of the virtual consultation process was estimated at 92%. Conclusion: The VC process for MESCC patients provides a reliable means of arriving at a multidisciplinary opinion while minimizing patient transfer. This can potentially shorten treatment decision time and enhance clinical outcomes. [Copyright &y& Elsevier]

Purpose: Despite a previously published randomized trial, controversy exists regarding the benefit of adding surgery to radiotherapy for metastatic spinal cord compression (MSCC). It is thought that patients with MSCC from relatively radioresistant tumors or tumors associated with poor functional outcome after radiotherapy alone may benefit from surgery. This study focuses on these tumors. Methods and Materials: Data from 67 patients receiving surgery plus radiotherapy (S+RT) were matched to 134 patients (1:2) receiving radiotherapy alone (RT). Groups were matched for 10 factors and compared for motor function, ambulatory status, local control, and survival. Additional separate matched-pair analyses were performed for patients receiving direct decompressive surgery plus stabilization of involved vertebrae (DDSS) and patients receiving laminectomy (LE). Results: Improvement of motor function occurred in 22% of patients after S+RT and 16% after RT (p = 0.25). Posttreatment ambulatory rates were 67% and 61%, respectively (p = 0.68). Of nonambulatory patients, 29% and 19% (p = 0.53) regained ambulatory status. One-year local control rates were 85% and 89% (p = 0.87). One-year survival rates were 38% and 24% (p = 0.20). The matched-pair analysis of patients receiving LE showed no significant differences between both therapies. In the matched-pair analysis of patients receiving DDSS, improvement of motor function occurred more often after DDSS+RT than RT (28% vs. 19%, p = 0.024). Posttreatment ambulatory rates were 86% and 67% (p = 0.30); 45% and 18% of patients regained ambulatory status (p = 0.29). Conclusions: Patients with MSCC from an unfavorable primary tumor appeared to benefit from DDSS but not LE when added to radiotherapy in terms of improved functional outcome. [Copyright &y& Elsevier]