RESUMEN
A 54-year-old man presented with a very rare case of radiation-induced intramedullary spinal cord anaplastic astrocytoma, which developed 37 years after radiotherapy for testicular seminoma. The patient presented with weakness and numbness of the left lower extremity that had gradually aggravated for 3 months. Magnetic resonance imaging demonstrated an intramedullary mass lesion with syringomyelia at the T9 to T12 levels. Subtotal removal of the tumor was performed using standard microsurgical technique. Histological examination revealed anaplastic astrocytoma. Although radiotherapy was seriously considered, chemotherapy was employed as adjuvant therapy considering the previous treatment. Although his neurological status improved transiently after surgery, relentless neurological decline occurred and resulted in death 9 months following surgery. Considering that subtotal removal of the tumor and chemotherapy had little influence on the quality of life and the length of survival in our case, cordectomy may be the optimum treatment for patients with radiation-induced spinal intramedullary malignant astrocytoma.
Asunto(s)
Astrocitoma/etiología , Neoplasias Inducidas por Radiación/etiología , Neoplasias Primarias Secundarias/etiología , Seminoma/radioterapia , Neoplasias de la Médula Espinal/etiología , Neoplasias Testiculares/radioterapia , Antineoplásicos/uso terapéutico , Astrocitoma/tratamiento farmacológico , Astrocitoma/cirugía , Quimioterapia Adyuvante , Terapia Combinada , Dacarbazina/análogos & derivados , Dacarbazina/uso terapéutico , Progresión de la Enfermedad , Resultado Fatal , Humanos , Hidrocefalia/etiología , Laminectomía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neoplasias Inducidas por Radiación/tratamiento farmacológico , Neoplasias Inducidas por Radiación/cirugía , Neoplasias Primarias Secundarias/tratamiento farmacológico , Neoplasias Primarias Secundarias/cirugía , Nimustina/uso terapéutico , Compresión de la Médula Espinal/etiología , Neoplasias de la Médula Espinal/tratamiento farmacológico , Neoplasias de la Médula Espinal/cirugía , Siringomielia/etiología , Temozolomida , Vértebras Torácicas , Factores de TiempoRESUMEN
OBJECTIVE: A new, modified technique of cervical open-door laminoplasty with hydroxyapatite implants was developed to enlarge the spinal canal in stable fashion yet preserve the architecture of the cervical spine and surrounding tissues. To assess the efficacy of this technique, a retrospective review of neurological and radiological outcomes after cervical laminoplasty was conducted. METHODS: Clinical charts and cervical x-rays of 151 patients with cervical stenotic myelopathy were reviewed. Patients were treated with the cervical laminoplasty between May 2001 and January 2002. The patient group comprised 69 women and 82 men ranging in age from 30 to 86 years (mean, 63 yr). Neurological outcomes were evaluated according to the Japanese Orthopaedic Association grade. To assess alignment and mobility of the cervical spine, the C2-C7 angle was used. RESULTS: The average Japanese Orthopaedic Association grade was 8.1 +/- 2.5 before surgery and 15.2 +/- 1.5 at 1 year after surgery (P < 0.01). No neurological complications were observed. The average C2-C7 angle at the neutral position increased from 8.3 +/- 11.7 degrees before surgery to 14.9 +/- 11.6 degrees at 1 year after surgery (P < 0.01). The range of motion between C2 and C7 was 36.9 +/- 12.5 degrees and 29.1 +/- 10.8 degrees before and 1 year after surgery, respectively. CONCLUSION: A new modified technique of cervical open-door laminoplasty described herein offers some solutions to the problems associated with conventional techniques of cervical laminoplasty.
Asunto(s)
Vértebras Cervicales/cirugía , Laminectomía , Enfermedades de la Médula Espinal/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Durapatita/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Laminectomía/métodos , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/métodos , Prótesis e Implantes , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
The authors describe a rare case of diaphragmatic paralysis caused by cervical spondylosis. A 64-year-old man presented with dyspnea as well as cervical radicular pain and left-sided upper-extremity motor weakness. Chest radiography revealed elevation of both sides of the diaphragm. All symptoms were ameliorated immediately after cervical laminoplasty, and spirometry revealed improvement of ventilatory function 6 months after surgery. Cervical spondylosis should be considered a factor that can cause respiratory dysfunction.