ABSTRACT
El cáncer es en España la segunda causa de muerte en mujeres (22%) y la primera en varones (31%). En este capítulo describimos los tipos más frecuentes de metástasis raquídeas, sus localizaciones más habituales dentro de la columna vertebral, así como su comportamiento clínico. Analizamos también los cuadros neurológicos más comúnmente asociados a las metástasis de columna: compresión radicular, compresión medular, cauda equina y afectación medular.(AU)
Cancer is in Spain the second cause of death in women (22%) and the first in men (31%). In this chapter we describe the most frequent types of spinal metastases, their most frequent locations within the spine, as well as their clinical behavior. We also analyze the neurological conditions most frequently associated with spinal metastases: root compression, spinal cord compression, cauda equina, and spinal cord involvement.(AU)
Subject(s)
Humans , Male , Female , Spine , Spinal Neoplasms/drug therapy , Neoplasm Metastasis , Spinal Cord Compression , Osteoprotegerin , Spain/epidemiology , Traumatology , Orthopedic Procedures , OrthopedicsABSTRACT
El cáncer es en España la segunda causa de muerte en mujeres (22%) y la primera en varones (31%). En este capítulo describimos los tipos más frecuentes de metástasis raquídeas, sus localizaciones más habituales dentro de la columna vertebral, así como su comportamiento clínico. Analizamos también los cuadros neurológicos más comúnmente asociados a las metástasis de columna: compresión radicular, compresión medular, cauda equina y afectación medular.(AU)
Cancer is in Spain the second cause of death in women (22%) and the first in men (31%). In this chapter we describe the most frequent types of spinal metastases, their most frequent locations within the spine, as well as their clinical behavior. We also analyze the neurological conditions most frequently associated with spinal metastases: root compression, spinal cord compression, cauda equina, and spinal cord involvement.(AU)
Subject(s)
Humans , Male , Female , Spine , Spinal Neoplasms/drug therapy , Neoplasm Metastasis , Spinal Cord Compression , Osteoprotegerin , Spain/epidemiology , Traumatology , Orthopedic Procedures , OrthopedicsABSTRACT
Cancer is in Spain the second cause of death in women (22%) and the first in men (31%). In this chapter, we describe the most frequent types of spinal metastases, their most frequent locations within the spine, as well as their clinical behaviour. We also analyse the neurological conditions most frequently associated with spinal metastases: root compression, spinal cord compression, cauda equina, and spinal cord involvement.
ABSTRACT
Cancer is in Spain the second cause of death in women (22%) and the first in men (31%). In this chapter we describe the most frequent types of spinal metastases, their most frequent locations within the spine, as well as their clinical behavior. We also analyze the neurological conditions most frequently associated with spinal metastases: root compression, spinal cord compression, cauda equina, and spinal cord involvement.
ABSTRACT
La lumbalgia es una patología muy frecuente en nuestro medio, con una enorme repercusión sanitaria y sociolaboral. Con la edad, se inicia una cascada degenerativa en la columna lumbar, que comienza en el disco intervertebral, continuando por las facetas articulares y demás elementos vertebrales. Esta degeneración del raquis forma parte del envejecimiento normal del individuo, aunque en ocasiones puede causar dolor y/o alteraciones neurológicas. Para comprender la fisiopatología del dolor lumbar, será preciso conocer que la inervación de la columna lumbar se hace fundamentalmente por tres ramos nerviosos: ramo dorsal de los nervios espinales lumbares (o rami dorsal), nervio sinuvertebral de Luschka y ramos ventrales de la cadena simpática. Existen dos tipos de patrones de dolor en la columna lumbar: el dolor irradiado y el dolor referido. La cascada de la degeneración consta en tres estadios. El primer estadio sería la disfunción. El anillo fibroso se fisura y pierde la capacidad de contener al núcleo pulposo. Esto ocasiona primero el síndrome de disrupción discal y, si el núcleo supera el contorno del annulus, las hernias discales. El segundo estadio de Kirkaldy-Willis es el de inestabilidad. En este estadio la movilidad en el segmento móvil aumenta de forma patológica. En esta revisión describiremos los signos radiológicos asociados a esta inestabilidad. La tercera fase es la de estabilización, caracterizada por la estenosis, asociada o no a inestabilidad
Low back pain is a very frequent condition in our country and has great social and occupational repercussions. With advancing age, a degenerative cascade occurs in the lumbar spine, which starts at the intervertebral disc and subsequently involves the facet joints and other vertebral elements. This spinal degeneration is part of the normal ageing process, although it can sometimes cause pain and/or neurological alterations. To understand the physiopathology of lumbar pain, it is necessary to know that the innervation of the lumbar spine occurs mainly through three nerve rami: dorsal ramus of the lumbar spine nerves (or «dorsal rami»), Luschka's sinuvertebral nerve and the ventral rami of the sympathetic chain. There are two types of pain pattern in the lumbar spine: irradiated pain and referred pain. The degeneration cascade is divided up into three stages. The first is that of dysfunction, whereby the annulus fibrosus is fissured and can no longer contain the nucleus pulposus. This leads, first to the so-called disc disruption syndrome and, if the nucleus exceeds the contour of the annulus, to disc herniations. The second stage, also called the Kirkaldy-Willis stage, is that of instability. At this stage, the mobility of the mobile segment increases pathologically. We describe the radiological signs associated to this instability. The third phase is that of stabilization and is characterized by stenosis, which may or may not be associated to instability
Subject(s)
Humans , Low Back Pain/physiopathology , Lumbar Vertebrae/physiopathology , Intervertebral Disc Displacement/physiopathology , Joint Instability/physiopathologyABSTRACT
Forty-five patients with advanced squamous cell carcinoma of the head and neck, 23 of whom had received no prior therapy, were given the combination of vinblastine, 4 mg/m2 intravenously (IV) on Day 1; bleomycin, 15 mg/day intramuscularly on Days 1-7; and cis-diamminedichloroplatinum (II), 60 mg/m2 with mannitol diuresis on Day 8. The regimen was repeated at three-week intervals, for a maximum of three cycles. Among the 23 patients without prior surgery or radiation, there were 5 complete responses and 12 partial responses, a 74% response rate; whereas, among the 22 with prior therapy, there were 2 complete responses and 8 partial responses, a response rate of 45%. Nineteen of 23 previously untreated patients were subsequently given radiation, 1 had surgery, and 1 had surgery plus radiation. Twelve of these 19 patients are currently free of disease, with a median duration of ten months from initial response. Four of the 22 previously treated patients received radiation and 2, surgery; 4 of these 6 patients are without evidence of disease. Renal dysfunction with elevation of serum creatinine occurred in 5 patients, a leukocyte count of less than 3,000/mm3 in 3, a platelet count of less than 100,000/mm3 in 2, skin changes in 11, hearing loss in 1, and both peripheral neuropathy and pulmonary changes in 1 patient. This combination of agents has substantial activity in untreated patients and may be useful as initial therapy in advanced head and neck malignancies by diminishing the incidence of local recurrence and distant metastasis.
