Spinal Cord And Root Compression

Techniques

Biopsy - needle biopsy of a paraspinous mass or trochar biopsy of infiltrated bone

Surgical decompression for tumour involving the vertebral body or the pedicle—

posterolateral approach (costo-transversectomy):

/ Several ribs are resected along with the transverse processes.

anterior transthoracic decompression: Provides excellent exposure of the vertebral bodies, but requires the more extensive procedure of a thoracotomy. Usually reserved for patients with the best outcome e.g.--

breast carcinoma.

for tumour lying posterior to the cord or only involving the lamina and spinous processes-

Collapsed vertebral ] body removed

SUGGESTED SCHEME OF MANAGEMENT

Collapsed vertebral ] body removed for tumour involving the vertebral body or the pedicle—

for tumour lying posterior to the cord or only involving the lamina and spinous processes-

Acrylic block inserted and secured with k-wires or with a metal plate laminectomy: Removal of the lamina and spinal processes.

Acrylic block inserted and secured with k-wires or with a metal plate laminectomy: Removal of the lamina and spinal processes.

Prognosis: Outcome depends on the nature of the primary tumour. Mean survival after surgery and radiotherapy ranges from 6 months for lung carcinoma to 45 months for prostatic and thyroid carcinoma.

MYELOMA

This malignant condition usually affects older age groups. It is often multifocal, involving the vertebral bodies, pelvis, ribs and skull, but solitary tumours may occur ('plasmacytoma'). Spinal cord compression occurs in 15% of patients with myeloma and rarely without vertebral body involvement due to intradural deposits. If suspect, look for characteristic changes in the plasma immunoglobulins and for Bence-Jones protein in the urine. An isotope bone scan may be less informative than a radiological skeletal survey. Bone marrow shows infiltration of plasma cells. Serum calcium levels may be high.

Management is as for metastatic tumour with additional chemotherapy. The prognosis is variable but patients may survive many years with a solitary plasmacytoma.

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