Journal of neurosurgery. Spine
-
The prognosis in patients with a distant spinal metastasis from the lung is dismal. The role of radical surgery in such cases has been questioned because of the excessive morbidity, blood loss, and operative time as well as the tumor's extreme malignancy. The purpose of this study was to evaluate the surgical results and the prognosis associated with radical surgery for lung cancer metastasis to the spine in carefully selected patients and to clarify whether there is an indication for radical surgery such as total en bloc spondylectomy (TES) in lung cancer metastasis. ⋯ Total en bloc spondylectomy has been shown to be associated with excessive morbidity, blood loss, and operative time; however, the procedure is becoming less invasive. The authors conclude that TES is appropriate in selected cases with controllable primary lung cancer, localized spinal metastasis, and no visceral metastasis. In such patients, improvement in the prognosis can be expected after TES. However, even in selected cases and with skilled surgical technique, the complication rate remains high. Total en bloc spondylectomy should be performed after a thorough discussion of the risks and benefits.
-
Granulocyte colony-stimulating factor (G-CSF) is a hematopoietic cytokine that induces undifferentiated stem cells from the bone marrow (BM) into the peripheral blood. Stem cell factor (SCF) is also a hematopoietic cytokine that stimulates the differentiation and proliferation of neural stem cells and has neuroprotective effects. In cerebrally infarcted mice, the combination of G-CSF and SCF promotes the differentiation of BM-derived cells into neural cells, stimulates the proliferation of intrinsic neural stem cells, and improves motor function. The object of this study was to investigate the effects of these cytokines on BM stem cells, intrinsic cells, and motor function recovery in spinal cord-injured mice. ⋯ In this study, the combined administration of SCF and G-CSF in traumatic spinal cord injury not only improved motor function, but also induced the accumulation of intrinsic microglia and the active proliferation of intrinsic oligodendrocyte precursor cells.
-
The reported incidence of complications in spine surgery varies widely. Variable study methodologies may open differing avenues for potential bias, and unclear definitions of perioperative complication make analysis of the literature challenging. Although numerous studies have examined the morbidity associated with specific procedures or diagnoses, no prospective analysis has evaluated the impact of preoperative diagnosis on overall early morbidity in spine surgery. To accurately assess perioperative morbidity in patients undergoing spine surgery, a prospective analysis of all patients who underwent spine surgery by the neurosurgical service at a large tertiary care center over a 6-month period was conducted. The correlation between preoperative diagnosis and the incidence of postoperative complications was assessed. ⋯ The incidence of complications found in this prospective analysis is higher than that reported in previous studies. This association may be due to a greater accuracy of record-keeping, absence of recall bias via prospective data collection, high complexity of pathology and surgical approaches, or application of a more liberal definition of what constitutes a complication. Further large-scale prospective studies using clear definitions of complication are necessary to ascertain the true incidence of early postoperative complications in spine surgery.
-
The evolution of imaging techniques, along with highly effective radiation options has changed the way metastatic epidural tumors are treated. While high-grade epidural spinal cord compression (ESCC) frequently serves as an indication for surgical decompression, no consensus exists in the literature about the precise definition of this term. The advancement of the treatment paradigms in patients with metastatic tumors for the spine requires a clear grading scheme of ESCC. The degree of ESCC often serves as a major determinant in the decision to operate or irradiate. The purpose of this study was to determine the reliability and validity of a 6-point, MR imaging-based grading system for ESCC. ⋯ The ESCC scale provides a valid and reliable instrument that may be used to describe the degree of ESCC based on T2-weighted MR images. This scale accounts for recent advances in the treatment of spinal metastases and may be used to provide an ESCC classification scheme for multicenter clinical trial and outcome studies.
-
This is a retrospective long-term outcome study of results after laminectomy for lumbar spinal stenosis in an elderly group of patients. The study was designed to evaluate possible demographic, comorbidity, and clinical prognosticators for pain reduction and functional improvement in this population. Because the assessment of functional outcome in the elderly is complicated by several specific factors, the use of outcome measurement parameters should be revised and refined. Moreover, despite numerous relevant studies, the results of various techniques remain equivocal, particularly among the elderly, which renders the implementation of focused studies necessary. New data could be used to refine patient selection and choice of technique to improve prognosis. ⋯ Considering the methodological issues of such studies, particularly in elderly patients, the authors conclude that the ODI is more sensitive than the VAS score in assessing prognostic value and that patient satisfaction is difficult to prognosticate, underscoring the particularities that this population presents regarding functionality assessment. Considering the prognostic value of preoperative factors, a negative influence of low-back pain and female sex is reported.