European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Spinal intradural extramedullary (IDEM) schwannoma diagnosed by magnetic resonance (MR) imaging is sometimes detected incidentally. Because the natural history of spinal IDEM schwannoma has not been established well, questions remain regarding whether small and asymptomatic tumour has to be removed. We aimed to assess the natural history of spinal schwannoma diagnosed by MR imaging using an accurate and reliable method. ⋯ Spinal probable IDEM schwannoma grew 5.45% of the tumour volume annually and can be divided into growing and stable tumours. The tumour that grows≥2.5% of volume per year needs a careful inspection because it may be not benign schwannoma and keep growing continuously.
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Age-related loss of functional muscle mass is associated with reduced functional ability and life expectancy. In disseminated cancer, age-related muscle loss may be exacerbated by cachexia and poor nutritional intake, increasing functional decline, morbidity and accelerate death. Patients with spinal metastases frequently present for decompressive surgery with decision to operate based upon functional assessment. A subjective assessment of physical performance has, however, been shown to be a poor indicator of life expectancy in these patients. We aimed to develop an objective measure based upon lean muscle mass to aid decision making, in these individuals, by investigating the association between muscle mass and 1-year survival. ⋯ Death within 1 year in individuals with spinal metastases is related to lean muscle mass at presentation. Assessment of lean muscle mass may inform decision to operate in patients with spinal metastases.
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Although surgeries have been performed for the treatment of lumbar disc herniation (LDH) or lumbar spinal stenosis (LSS), not all patients who undergo surgery are satisfied with the outcome. Electrodiagnostic study (EDX) can assess the physiological functions of nerve roots with higher specificity and relate better with clinical manifestations. The purpose of this study was to examine how EDX can predict surgical outcomes in patients with LDH and LSS and to compare the predicted values of EDX with other clinical factors and MRI findings. ⋯ EDX detected functional abnormalities of nerve roots that did not show clinical manifestation and did not appear compressed on MRI. These abnormalities are important predictive factors for surgical outcomes in patients with LDH or LSS. Therefore, pre-operative EDX is a clinically useful method to predict surgical prognosis.
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Clinical treatment of spinal metastasis is gaining in complexity while the underlying biology remains unknown. Insufficient biological understanding is due to a lack of suitable experimental animal models. Intercellular adhesion molecule-1 (ICAM1) has been implicated in metastasis formation. Its role in spinal metastasis remains unclear. It was the aim to generate a reliable spinal metastasis model in mice and to investigate metastasis formation under ICAM1 depletion. ⋯ Applying a reliable animal model for spinal metastasis, ICAM1 depletion reduces spinal metastasis formation due to an organ-unspecific reduction of metastasis development.
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Surgical decompression for lumbar spinal stenosis (LSS) has been associated with poorer outcomes in patients with pronounced low back pain (LBP) as compared to patients with predominant leg pain. This cross registry study assessed potential benefits of the interlaminar coflex® device as an add-on to bony decompression alone. ⋯ In the short-term, lumbar decompression with coflex® compared with decompression alone in patients with LSS and pronounced LBP at baseline is a safe and effective treatment option that appears beneficial regarding clinical and functional outcomes. However, residual confounding of non-measured covariables may have partially influenced our findings. Also, despite careful inclusion and exclusion of cases the cross registry approach introduces a potential for selection bias that we could not totally control for and that makes additional studies necessary.