Chronic spinal cord compression associated with intervertebral disc degeneration in SPARC-null mice

Chronic spinal cord compression(CSCC)is induced by disc herniation and other reasons,leading to movement and sensation dysfunction,with a serious impact on quality of life.Spontaneous disc herniation rarely occurs in rodents,and therefore establishing a chronic spinal cord compression(CSCC)animal model is of crucial importance to explore the pathogenesis and treatment of CSCC.The absence of secreted protein,acidic,and rich in cysteine(SPARC)leads to spontaneous intervertebral disc degeneration in mice,which resembles human disc degeneration.In this study,we evaluated whether SPARC-null mice may serve as an animal model for CSCC.We performed rod rotation test,pain threshold test,gait analysis,and Basso Mouse Scale score.Our results showed that the motor function of SPARC-null mice was weakened,and magnetic resonance images revealed compression at different spinal cord levels,particularly in the lumbar segments.Immunofluorescence staining and western blot assay showed that the absence of SPARC induced apoptosis of neurons and oligodendrocytes,activation of microglia/macrophages with M1/M2 phenotype and astrocytes with A1/A2 phenotype;it also activated the expression of the NOD-like receptor protein 3 inflammasome and inhibited brain-derived neurotrophic factor/tyrosine kinase B signaling pathway.Notably,these findings are characteristics of CSCC.Therefore,we propose that SPARC-null mice may be an animal model for studying CSCC caused by disc herniation.

Cellular apoptosis and Caspase-12 expression in a rat model of progressive spinal cord compression

BACKGROUND： Studies have demonstrated that the mechanisms underlying cellular apoptosis signal transduction focus on two pathways： intracellular mitochondria and extracellular death receptor. The current evidence supports that signal transduction of cellular apoptosis also includes endoplasmic reticulum stress signal transduction. OBJECTIVE： To observe Caspase-12 expression and cellular apoptosis following ischemia in rats with progressive spinal cord compression, and to verify the influence of endoplasmic reticulum stress on the apoptosis induced by spinal cord injury. DESIGN, TIME AND SETTING： A randomized, controlled, animal trial was performed at the Institute of Neuroscience in Chongqing Medical University between January and October in 2006. MATERIALS： Immunohistochemical kit, diaminobenzidine, and TUNEL kit were purchased from Beijing Zhongshan Biotechnology, China; rabbit anti-rat Caspase-12 monoclonal antibody was provided by Santa Cruz, USA. METHODS： Sixty Wistar rats, aged 3-4 months, were randomly assigned to a model group （n = 50）, which underwent spinal cord compression in the L1 segment following L1 laminectomy and articular process excision to establish a model of progressive spinal cord compression, and a sham-surgery group （n = 10）, which underwent only laminectomy. Starting with the first day after surgery, the rats were locally anesthetized, the skin was opened, and the screw was rotated by 1/4 of a cycle, twice weekly. MAIN OUTCOME MEASURES： At 3, 7, 14, 21, and 28 days after surgery, rats from each group were anesthetized, and the spinal cords were resected. Pathological changes following spinal cord compression were determined using hematoxylin-eosin staining, Nissl dye, and transmission electron microscopy. The TUNEL method was used to observe neuronal apoptosis in the compressed spinal cord segments. Immunohistochemistry and Western blot were utilized to detect Caspase-12 expression in the compressed segments. RESULTS： Cellular swelling, neural degeneration, and altered endoplasmic reticulum structures were observed at 3 days following compression. Symptoms became gradually aggravated with increasing compression time. Compared with the sham-surgery group, the number of apoptotic neurons was remarkably increased in compressed segments of the model group （P 〈 0.05）, and Caspase-12 expression was also shown to increase （P 〈 0.05）. CONCLUSION： Neuronal apoptosis was a predominant pathological factor resulting in secondary spinal cord injury during progressive spinal cord compression, and Caspase-12 was shown to be possibly involved in neuronal apoptosis induced by progressive spinal cord compression.

Spinal cord compression secondary to bone metastases from hepatocellular carcinoma

Bone metastases are rare in primary hepatocellular carcinoma （HCC）. Spinal cord compression （SCC） due to bone metastases occur commonly in patients with lung and breast carcinomas, and metastatic HCC is an unusual cause of SCC. Spinal cord compression is an oncologic emergency and treatment delays can lead to irreversible consequences. Thus, the awareness that SCC could be a potential complication of bone metastases due to HCC is of significance in initiation of early treatment that can improve the quality of life and survival of the patients, if diagnosed earlier. This paper describes four cases of primary HCC with varied manifestations of SCC due to bone metastases. The first patient presented primarily with the symptoms of bone pains corresponding to the bone metastases sites rather than symptoms of associated hepatic pathology and eventually developed SCC. The second patient, diagnosed as having HCC, developed extradural SCC leading to paraplegia during the course of illness, for which he underwent emergency laminectomy with posterior fixation. The third patient developed SCC soon after the primary diagnosis and had to undergo emergency laminectomy. Post laminectomy he had good neurological recovery. The Fourth patient presented primarily with radicular pains rather than frank paraplegia as the first manifestation of SCC.

Comparison of the postoperative pain change and spinal stenosis rate between percutaneous vertebroplasty combined with radiofrequency ablation and with ^(125)I particle implantation in the treatment of metastatic spinal cord compression:A retrospective st

Background context:Metastatic spinal cord compression(MSCC)seriously affects the survival rate.Objective:The therapeutic effects of two treatment strategies for MSCC:percutaneous vertebroplasty(PVP)combined with radiofrequency ablation(RFA)and PVP combined with^(125)I particle implantation,were compared.Study design:Retrospective study.Patient sample:40 patients with MSCC were divided into two groups:19 cases in the RFA group and 21 cases in the^(125)I group.Method:All patients were accessed to determine the differences in pain,which was evaluated using the visual analog scale(VAS)at 1 week,1 month,and 3 months after the operation,and spinal stenosis rates(SSRs),which were measured at 1 and 3 months after the operation,between the two groups.Results:The VAS scores and SSRs at baseline were comparable between the RFA group and the^(125)I group(7.19±2.07 vs 7.42±1.95,37.7%±11.2%vs 41.1%±11.4%).The VAS scores and SSRs at 1 month and 3 months after the operation were significantly reduced in both groups,compared with those at baseline.The VAS scores and SSRs in the^(125)I group were lower than those in the RFA group at 3 months after the operation(1.09±0.97 vs 1.75±1.06 p=0.048 and 12.3%±6.4%vs 18.1%±10.1%p=0.034),while the VAS scores at1 week after the operation in the RFA group were lower than those in the^(125)I group(4.39±1.34 vs 5.05±1.82 p=0.049).Conclusion:PVP combined with RFA has a slight advantage in relieving pain in the short term,while PVP combined with^(125)I particle implantation may have a better effect in the relieving pain and decreasing the SSRs at 3 months after the operation.

Intravascular papillary endothelial hyperplasia as a rare cause of cervicothoracic spinal cord compression:A case report

BACKGROUND Intravascular papillary endothelial hyperplasia(IPEH)is a rare benign reactive vascular lesion that grows into an expansile compressing mass.It most commonly involves the skin and subcutaneous tissue.Spinal involvement is rare,with only 11 reported cases in the literature.We report,to our knowledge,the first case of IPEH in the cervicothoracic spinal canal and present a literature review.CASE SUMMARY A 27-year-old man presented with acute-onset neck pain,numbness,and weakness in his extremities.Magnetic resonance imaging showed an epidural mass in the cervicothoracic(C6-T1)spinal canal and vertebral hemangioma(VH)involving the C7 vertebral body.C6-T1 Laminectomy and radical excision of the mass were performed.Histopathological examinations revealed papillary proliferation of vascular endothelial cells with thrombus formation,and an IPEH diagnosis was made.By his 6-mo follow-up appointment,his symptoms were relieved without recurrence.The possible pathogenesis,clinical and imaging features,differential diagnosis,and management of IPEH were reviewed.CONCLUSION We report,to our knowledge,the first case of IPEH in the cervicothoracic spinal canal,treated via complete resection,and showing a favorable outcome.We found a causal relationship between spinal IPEH and VH;this partly explains the mechanism of IPEH.

Granulocytic sarcoma with long spinal cord compression:A case report

BACKGROUND As an extramedullary form of proliferating myeloblasts,granulocytic sarcoma(GS)is common in patients with acute myeloid leukemia.GS in the central nervous system is rare,and an intraspinal space-occupying lesion caused by GS is even rarer.Surgical decompression is often necessary to remove the intraspinal space-occupying lesion.To the best of our knowledge,we report,for the first time a case of GS that caused extensive compression in the spinal canal without surgical decompression treatment.CASE SUMMARY A 15-year-old male suddenly developed numbness and weakness in his lower limbs for 10 d,which affected his walking ability.Acute myeloid leukemia was later diagnosed in the Department of Hematology.Magnetic resonance imaging revealed that multiple segmental space-occupying lesions were causing severe spinal cord compression in the thoracic spinal canal.As a result,the patient received routine chemotherapy before surgery.Interestingly,the intraspinal space-occupying lesions completely diminished on magnetic resonance imaging after a course of chemotherapy,and the sensation and strength in his lower limbs markedly recovered.CONCLUSION An intraspinal space-occupying lesion could be the first symptom of acute myeloid leukemia,causing spinal nerve compression without any other symptoms.Following standard chemotherapy,spinal canal compression can be quickly relieved,and the spinal cord and nerve function restored,avoiding emergency surgery.

Single-versus multi-fraction radiation treatment for metastatic spinal cord compression:functional outcome study

Objective:The optimal treatment of patients with metastatic spinal cord compression(MSCC) is still being debated.This randomized trial was planned to compare the functional outcome and its related prognostic factors,toxicity and in-field recurrence of the three schedules of radiotherapy.Methods:Two hundred and eighty five patients enrolled in the study of which 95 received 1 × 8 Gy,100 received 10 x 3 Gy and 90 received the radiation treatment of 20 × 2 Gy.Irradiation was performed with 6-10 Mv linear accelerators or cobalt-60 units by single posterior field or parallel opposed fields according to depth of irradiation spines.Premedication with dexamethasone was started from the first day of clinico-radiologic diagnosis till 4-5 days after the end of radiotherapy(RT) then tapered off during 10 days.Potential prognostic factors were evaluated with respect to functional outcome.Results:All groups were balanced for patient's characteristics and potential prognostic factors.No statistically significant difference was observed between the 3 groups as regard functional outcome and toxicity while single fraction was associated with higher in-field recurrences(22.8%) with statistically significant difference between the 3 groups(P = 0.01).Functional outcome was significantly better with younger age(≤ 60 y),Eastern Cooperative Oncology Group performance status(ECOG-PS) of 1-2,involved vertebra of 1-2,favorable tumor type,absence of visceral or other bone metastasis,decreased time of developing motor deficit before radiotherapy,long interval between cancer diagnosis to metastatic spinal cord compression,and normal ambulatory status.Conclusion:The three schedules provided similar functional outcome.Single-radiation dose was associated with higher in-field recurrence.To minimize treatment time and costs,the dose of 1 × 8 Gy is recommended for patients with poor predicated survival and 10 × 3 Gy for other patients.

Spinal Cord Compression Caused by Multifocal Histoplasmosis Treated Conservatively: Case Report and Literature Review

We present the case of a 39-year-old patient admitted for a slow thoracic spinal cord compression syndrome associated with lumbar rachialgia. CT scan and MRI of the thoracic spine showed lysis of T4, T5, T6 and T7 vertebrae, an epiduritis and paravertebral abscesses. CT scan of the lumbar spine demonstrated osteolysis of the left iliac wing with skin invasion. This lesion infiltrated the sacrum and the body of L5. The iliac lesion was biopsied and the analysis revealed a granulomatous osteitis caused by Histoplasma duboisii. The treatment consisted of ketoconazole 400 mg daily for six months. Spinal decompressive surgery was not performed. Following antifungal treatment the patient had satisfying clinical and radiological outcome. After three years’ follow-up, the clinical course was uneventful. The patient had neither symptoms of spinal cord compression nor signs of further localizations.

A progressive compression model of thoracic spinal cord injury in mice： function assessment and pathological changes in spinal cord

Non-traumatic injury accounts for approximately half of clinical spinal cord injury, including chronic spinal cord compression. However, previous rodent spinal cord compression models are mainly designed for rats, few are available for mice. Our aim is to develop a thoracic progressive compression mice model of spinal cord injury. In this study, adult wild-type C57BL/6 mice were divided into two groups： in the surgery group, a screw was inserted at T9 lamina to compress the spinal cord, and the compression was increased by turning it further into the canal（0.2 mm） post-surgery every 2 weeks up to 8 weeks. In the control group, a hole was drilled into the lamina without inserting a screw. The results showed that Basso Mouse Scale scores were lower and gait worsened. In addition, the degree of hindlimb dysfunction in mice was consistent with the degree of spinal cord compression. The number of motor neurons in the anterior horn of the spinal cord was reduced in all groups of mice, whereas astrocytes and microglia were gradually activated and proliferated. In conclusion, this progressive compression of thoracic spinal cord injury in mice is a preferable model for chronic progressive spinal cord compression injury.

Thoracic cord compression caused by contiguous multilevel ossification of ligamentum flavum in Chinese patients

Objective： To explore the epidemiology, clinical presentation, radiology and surgical treatment outcome in Chinese patients with myelopathy caused by contiguous multilevel ossification of ligamentum flavum. Methods. Medical notes and imaging data of 18 Chinese patients （14 males and 4 females, aged 43-72 years, mean： 57 years ） with myelopathy caused by contiguous multilevel ossification of ligamentum flavum were studied retrospectively in this article. The diagnosis was based on clinical examination, X-ray films, computerized tomography （CT） and magnetic resonance imaging （MRI） scanning results and pathological results. Sixteen patients were treated by laminectomy and two by laminoplasty, The average follow-up duration was 34 months （range, 28-49 months ）. The outcome was evaluated by Japanese Orthopaedics Association （JOA） Score. Results： The average time for occurring clinical symptoms was 7.5 months （range, 2 days-16 months）. All the 18 cases presented with clinical evidences of chronic and progressive thoracic spinal cord compression, which included bilateral leg weakness, spastic gait, numbness in lower limbs, paresthesia in terminal and perineum, and urinary incontinence. Neurological examination revealed severe spastic paraparesis, absence of abdominal reflexes, and reduction of the sensory function below the compression level. The mean JOA score before operation was 3. 6 （range, 0-6 ）. MRI and CT scans of the thoracic spine confirmed the presence of contiguous multilevel ossification of the ligamentum flavum. The mean recovery rate after surgery in terms of JOA score was 66.3 % （ range, 33.3 %- 100% ）, with a mean final JOA score of 8. 3. Thoracic decompression laminectomy or laminoplasty could result in a good postoperative outcome. Conclusions ： Contiguous multilevel ossification of the ligamentum flavum is not a common cause of myelopathy in Chinese population and should be treated as early as possible. MRI and CT scan examinations may diagnose the presence of thoracic ossification of ligamentum flavum （OLF）. Posterior decompression, especially with en bloc dissection of the laminae, can obtain satisfactory results.

The ferroptosis activity is associated with neurological recovery following chronic compressive spinal cord injury

Chronic compressive spinal cord injury in compressive cervical myelopathy conditions can lead to rapid neurological deterioration in the early phase,followed by partial self-recovery,and ultimately an equilibrium state of neurological dysfunction.Ferroptosis is a crucial pathological process in many neurodegenerative diseases;however,its role in chro nic compressive spinal cord injury remains unclear.In this study,we established a chronic compressive spinal cord injury rat model,which displayed its most severe behavioral and electrophysiological dysfunction at 4 wee ks and partial recovery at 8 weeks after compression.Bulk RNA sequencing data identified enriched functional pathways,including ferroptosis,presynapse,and postsynaptic membrane activity at both 4 and 8 wee ks following chro nic compressive spinal co rd injury.Tra nsmission electron microscopy and malondialdehyde quantification assay confirmed that ferroptosis activity peaked at 4 weeks and was attenuated at 8 weeks after chronic compression.Ferro ptosis activity was negatively correlated with behavioral score.Immunofluorescence,quantitative polymerase chain reaction,and western blotting showed that expression of the anti-ferroptosis molecules,glutathione peroxidase 4(GPX4) and MAF BZIP transcription factor G(MafG),in neuro ns was suppressed at 4 weeks and upregulated at 8 weeks following spinal co rd compression.There was a positive correlation between the expression of these two molecules,suggesting that they may work together to contribute to functional recovery following chronic compressive spinal cord injury.In conclusion,our study determined the genome-wide expression profile and fe rroptosis activity of a consistently compressed spinal cord at different time points.The results showed that anti-fe rroptosis genes,specifically GPX4 and MafG,may be involved in spontaneous neurological recovery at 8 weeks of chronic compressive spinal cord injury.These findings contribute to a better understanding of the mechanisms underlying chronic compressive spinal cord injury and may help identify new therapeutic targets for compressive cervical myelopathy.

Primary spinal epidural non-Hodgkin’s lymphoma presentedwith spinal cord compression syndrome

The spinal epidural space is an uncommon presenting site in primary non-Hodgkin’s lymphomas,especially for children.A boy suffered spinal cord compression syndrome caused by primary spinal epidural non-Hodgkin’s lymphoma.Thoracolumbar magnetic reso-nance imaging(MRI)demonstrated an intraspinal mass.An operation was performed with gross total tumor removal.Histological examination revealed a non-Hodgkin’s B-cell lymphoma.Bone marrow aspiration was negative for lymphoma involvement.No other therapies(chemotherapy and/or radiotherapy)were per-formed according to the parents’opinion.The patient died approximately one year after the operation due to brain metastases.The clinical course and imaging features were discussed with a review of literatures.

Epidural spinal cord compression as initial clinical presentation of an acute myeloid leukaemia: case report and literature review

Epidural localization of myeloid leukaemia is rarely reported.Spinal cord compression as an initial presentation of acute myeloid leukaemia is extremely rare.This is a report of a 17-year-old black boy who presented to emergency department with neurological symptoms of spinal cord compression.Imaging modalities showed multiple soft tissue masses in the epidural space.After surgical treatment,histopathological examination of the epidural mass showed myeloid leukaemia cells infiltration.Literature review on Medline and 'scholar Google' database was done.The characteristics and management of extra-medullary leukaemia are discussed.Granulocytic sarcoma,myeloid sarcoma or chloroma with acute myeloid leukaemia should be considered as part of epidural spinal cord compression.Therefore surgery is indicated on an emergent basis.

A novel mouse model of central cord syndrome

Patients with potential spinal stenosis are susceptible to central cord syndrome induced by blunt trauma.Suitable animal models are helpful for studying the pathogenesis and treatment of such injuries.In this study,we established a mouse model of acute blunt traumatic spinal cord injury by compressing the C6 spinal cord with 5 and 10 g/mm~2 compression weights to simulate cervical central cord syndrome.Behavioral testing confirmed that this model exhibited the characteristics of central cord syndrome because motor function in the front paws was impaired,whereas basic motor and sensory functions of the lower extremities were retained.Hematoxylin-eosin staining showed that the diseased region of the spinal cord in this mouse model was restricted to the gray matter of the central cord,whereas the white matter was rarely affected.Magnetic resonance imaging showed a hypointense signal in the lesion after mild and severe injury.In addition,immunofluorescence staining showed that the degree of nerve tract injury in the spinal cord white matter was mild,and that there was a chronic inflammation reaction.These findings suggest that this mouse model of central cord syndrome can be used as a model for preclinical research,and that gray matter is most vulnerable to injury in central cord syndrome,leading to impaired motor function.

Metastatic Spinal Tumors: Diagnostic Methods, Management and Prognosis at the Yaounde Central Hospital and Yaounde General Hospital

Introduction: Metastatic spinal tumors (MST) refer to secondary involvement of the vertebral column by hematogenously-disseminated metastatic cells. They could affect either the bony structures or the spinal cords. Mechanical instability and neurologic deficits resulting from spinal cord compression are the most common manifestations. Surgical intervention remains the most effective treatment for about 20% of patients who present with spinal cord compression. The prognosis is relatively poor. This work has as objectives to describe: the diagnostic tools, the different modalities of management and the prognostic elements of spine metastasis. Methodology: We conducted an ambispective cross-sectional descriptive study;with retrospective data collection from January 2015 to December 2021 and prospective collection from January to April 2022 in the “Neurosurgery” unit of the Yaounde Central Hospital and the “Oncology and Neurosurgery” units of Yaounde General Hospital. Result: We included 101 patients. The M/F sex ratio was 1.66. The average age of the participants was 56.44 years (±14.19 SD) with a median of 58 years. Metastatic spinal tumors were discovered in 61.39% of patients with a previously known primary tumor and 21.78% of patients had newly discovered tumors. The neurologic examination revealed a vertebral syndrome in 79.21% of cases, radicular syndrome in 60.40% and sub-lesional syndrome in 59.89%. Sensory disorders accounted for 39.60% and sphincter disorders accounted for 34.65%. According to the degree of severity, the lesions were classified as Frankel E (37.62%) followed by Frankel D (21.78%). Metastatic lesions were mostly found at the thoracic vertebrae (68.25%) and lumbar vertebrae (22.22%). The most represented primary tumors were: prostate tumors (41.58%) and breast tumors (23.76%);followed by malignant hemopathies (15.84%). Computed-tomography scan (CT-scan) was the most frequent diagnostic imaging technique used (71.28%). Analgesic treatment mostly involved level II analgesia (64.36%). High dose steroid therapy (greater than 80mg/24h) was used in more than half of the patients. Radiation therapy was performed in 24.75% of the patients, chemotherapy in 55.44% and specific surgical interventions performed in 20.79%. The most frequent surgical indication was complete motor deficit according to the Frankel classification (47.21%). One patient in four (23.76%) experienced improvement in functional prognosis with increased muscle strength after a period of 2 weeks to 5 months of treatment. About 1 in 10 patients (8.8%) rather had worsening of their neurologic status. We observed that there was a correlation between spine surgery and improvement in muscle strength (P-value less than 0.05). Patients (12) who had better recovery or preserved gait were those with partial compression (P-value = 0.0143). Four out of five patients (81.18%) of our series had an estimated survival of less than one year according to the Tokuhashi score. Conclusion: MSTs are frequent in our context. Most patients sought consultation late after the first symptoms appeared (principally back pain). The clinical examination revealed a high proportion of patients with spinal cord compression syndrome. Medical treatment was first-line for the management of pain and most patients who underwent surgical treatment had complete neurologic deficits. The functional prognosis was found to be improved by surgery and the vital prognosis depended on the Tokuhashi score, with better accuracy when the prediction is more than 12 months.

Establishment and validation of standardized animal models of spinal cord injury by normal external force-caused fracture dislocation

The duplication of animal models plays a key role in spinal cord injury research; however, there has been limited study into normal, external force-derived fracture dislocation. This study adopted experimental devices, designed in-house, to construct standardized ventral and dorsal spinal cord injury animal models of 6 g and 17 g falling from a height of 2, 4, and 10 cm, and 15, 30 or 50 g transversal compression on the spinal cord. The results showed that gradual increases in the degree of histopathological injury led to decreased Tarlov and Basso, Beattie and Bresnahan scores for the behavioral test, and increased Ashworth scores for the hind limb. Furthermore, there was a gradual decline in the slope test in the rats with dorsal spinal cord injury that correlated to increases in the falling substance weight or falling height. Similar alterations were observed in the ventral spinal cord injured rats, proportional to the increase in compression weight. Our experimental findings indicate that the standardized experimental rat models of dorsal and ventral spinal cord injury are stable, reliable and reproducible.

Does diffusion tensor data reflect pathological changes in the spinal cord with chronic injury?

Magnetic resonance diffusion tensor imaging has been shown to quantitatively measure the early pathological changes in chronic cervical spondylotic myelopathy. In this study, a novel spongy poly- urethane material was implanted in the rat C^-s epidural space to establish a rat model of chronic cervical spondylotic myelopathy. Diffusion tensor data were used to predict pathological changes. Results revealed that the fractional anisotropy value gradually decreased at 4, 24, and 72 hours and 1 week after injury in rat spinal cord, showing a time-dependent manner. Average diffusion coeffi- cient increased at 72 hours and 1 week after implantation. Hematoxylin-eosin staining and Luxol-fast-blue staining exhibited that the number of neurons in the anterior horn of the spinal cord gray matter and the nerve fiber density of the white matter gradually reduced with prolonged com- pression time. Neuronal loss was most significant at 1 week after injury. Results verified that the fractional anisotropy value and average diffusion coefficient reflected the degree of pathological change in the site of compression in rat models at various time points after chronic spinal cord compression injury, which potentially has a reference value in the early diagnosis of chronic cervical spondylotic myelopathy.

MRI Contribution in the Diagnosis of Non-Traumatic Medular Compressions at the Mali Hospital of about 179 Cases

Slow spinal compressions are due to the development of an expansive process in the spinal canal. It is a very common pathology, the diagnosis of which is mainly clinical. However, magnetic resonance imaging occupies an essential place in the site diagnosis and etiological research in the management. Non-traumatic spinal cord compression is a diagnostic and therapeutic emergency, requiring early and appropriate management. MRI is the benchmark imaging examination for this pathology. No similar previous MRI study in Mali. We undertook this work with the aim to determine the place of MRI in the diagnosis of spinal cord compressions in Mali hospital. Method and Patients: This was a descriptive retrospective study, carried out at the hospital’s medical imaging department from January 1, 2017 to December 31, 2018 (02 years). It involved all patients, regardless of sex and age, sent for an MRI examination of the spine, and in whom spinal cord compression was diagnosed. We used a 0.35T low-field MRI machine with solid-state antennas. Results: We collected 179 cases of spinal cord compression MRI out of 585 spinal MRI performed, (frequency of 30.59%). The average age was 53.5 years with a male predominance (sex ratio 3.7). Motor disorders were the most common reason for examination (41%). We used the T1 T2 sagittal and T2 axial sequences. IV injection of gadolinium was performed in 48% of patients. The topographic lesions were: cervical (54.7%), thoracic (31.3%) and several segments (9.5%). The lesions concerned the compartments: extradural (79.3%), intradural (4.5%), and intramedullary (16.2%). The processes were degenerative (57.5%). tumorous (29.6%), infectious (12.3%) and vascular (0.6%). Conclusion: MRI is the benchmark imaging test for the management of non-traumatic spinal cord injury. Myelo-CT can be an alternative in the absence or in case of MRI contraindication.

Palliative external-beam radiotherapy for bone metastases from hepatocellular carcinoma

The incidence of bone metastases(BMs)from hepatocellular carcinoma(HCC)is relatively low compared to those of other cancers,but it has increased recently,especially in Asian countries.Typically,BMs from HCC appear radiologically as osteolytic,destructive,and expansive components with large,bulky soft-tissue masses.These soft-tissue masses are unique to bone metastases from HCC and often replace the normal bone matrix and exhibit expansive growth.They often compress the peripheral nerves,spinal cord,or cranial nerves,causing not only bone pain but also neuropathic pain and neurological symptoms.In patients with spinal BMs,the consequent metastatic spinal cord compression(MSCC)causes paralysis.Skull base metastases(SBMs)with cranial nerve involvement can cause neurological symptoms.Therefore,patients with bony lesions often suffer from pain or neurological symptoms that have a severe,adverse effect on the quality of life.External-beam radiotherapy(EBRT)can effectively relieve bone pain and neurological symptoms caused by BMs.However,EBRT is not yet widely used for the palliative management of BMs from HCC because of the limited number of relevant studies.Furthermore,the optimal dosing schedule remains unclear,despite clinical evidence to support single-fraction ra-diation schedules for primary cancers.In this review,we outline data describing palliative EBRT for BMs from HCC in the context of(1)bone pain;(2)MSCC;and(3)SBMs.

Traditional Chinese medicine manipulative reduction combined with percutaneous vertebroplasty for treating type Ⅲ Kummell's disease: A case report

BACKGROUND A patient with type Ⅲ Kummell’s disease had a ruptured posterior cortex of the fractured vertebral body, which caused spinal cord compression. An open surgery was considered the best choice of operation. However, the patient and her family refused open surgery and instead demanded a minimally invasive surgical treatment such as percutaneous vertebroplasty(PVP). After preoperative discussion, we finally adopted the novel therapy of traditional Chinese medicine manipulative reduction(TCMMR) combined with PVP.CASE SUMMARY A patient with type Ⅲ Kummell’s disease exhibiting bone block-induced spinal cord compression was admitted to our hospital. She suffered from a variety of medical disorders but refused open surgery, and instead asked for PVP surgery. TCMMR, in parallel with PVP, was used to restore the height of the compressed vertebral body and reduce the symptoms of spinal cord compression by the bone block in order to strengthen the vertebral body and prevent further collapse. The surgery was very successful. The height of the compressed vertebra was restored, and the symptom of spinal cord compression by bone block was reduced successfully via TCMMR. The fractured vertebra was solidified by the PVP. The pain visual analog score declined from preoperative 7 scores to postoperative 2 scores, and the Frankel spinal cord scale increased from preoperative D degree to postoperative E degree.CONCLUSION The new method has advantages in treating patients with type Ⅲ Kummell’s disease who cannot be treated with open surgery.