ABSTRACT
OBJECTIVE: Our study aimed to analyze morphological features of spinal epidural metastases using magnetic resonance imaging (MRI) and investigate the formation mechanism and clinical significance of the "toxic twin-leaf" sign in spinal epidural metastasis. MATERIALS AND METHODS: We retrospectively studied 108 patients with spinal epidural metastases who underwent MRI. Patients were divided into "toxic twin-leaf" sign group (group A) and irregular group (group B). Chi-square test was used to analyze data on sex, vertebra location, presence of fracture in the corresponding vertebral body, involvement of the corresponding pedicle, and the primary tumor. Further, group data were analyzed using the rank sum test; p â< â0.05 was considered significant. RESULTS: The "twin-leaf" sign was noted in 88 cases with 136 epidural masses and 20 cases of irregular shape in 108 patients; the "toxic twin-leaf" sign accounted for 87.18% of spinal epidural metastases. A difference between groups in the vertebra location (p â< â0.01) was observed, but no differences were found in sex, presence of fractures in the corresponding vertebral body, involvement of the corresponding pedicle, and primary tumor (p â> â0.05). Intergroup differences in the rate of spinal stenosis on axial and sagittal images were significant. CONCLUSIONS: MRI axial sequences clearly revealed the morphology of spinal epidural metastases. Detection of the "toxic twin-leaf" sign in spinal epidural metastases was of great clinical significance. Furthermore, determining the degree of spinal stenosis in the axial sequence provided a more accurate evaluation of patients' condition compared to the sagittal sequence.
ABSTRACT
BACKGROUND: Treatment of symptomatic lumbar disc herniation with Modic type I endplate changes is complex and challenging, requiring systemic and local therapies which include conservative therapy, epidural infiltrations, percutaneous therapeutic techniques, and surgical options. The clinical management of symptomatic lumbar disc herniation involving Modic type I endplate changes is uniquely challenging because it requires alleviating pain caused by both the herniated disc and the endplate osteochondritis. Through different approaches, percutaneous lumbar discectomy (PLD) and percutaneous cementoplasty (PCP) have been introduced into clinical practice as alternatives to traditional surgical and radiotherapy treatments of symptomatic lumbar disc herniation and other spine diseases. OBJECTIVE: To evaluate the feasibility of PLD and PCP for symptomatic lumbar disc herniation with Modic type I endplate changes. STUDY DESIGN: PLD and PCP in 7 patients with symptomatic lumbar disc herniation with Modic type I endplate changes and its clinical effects were retrospectively evaluated. SETTING: This study was conducted by an interventional therapy group at a medical center in a major Chinese city. METHODS: Seven consecutive patients (2 men, 5 women; median age, 74.14 ± 5.34 years; age range, 68 - 82 years) who underwent percutaneous lumbar discectomy and cementoplasty for the treatment of symptomatic lumbar disc herniation with Modic type I changes between May 2013 and August 2015 were retrospectively analyzed. The MacNab Criteria, visual analog scale (VAS), and Oswestry Disability Index (ODI) for pain were assessed before and one week, 6 months, and one year after the procedure. Furthermore, the procedure duration, hospital stay length, and complications were assessed. RESULTS: The VAS of the back and leg decreased from 6.14 ± 0.69 (range, 5 - 7) and 7.29 ± 0.76 (range, 6 - 8) preoperatively to 2.29 ± 1.38 (range, 1 - 5) and 2.71 ± 0.60 (range, 1 - 6) one week, 1.86 ± 0.69 (range, 1 - 3) and 2.00 ± 0.58 (range, 1 - 3) 6 months, and 1.71 ± 0.76 (range, 1 - 3) and 1.85 ± 0.69 (range, 1 - 3) one year postoperatively. The ODI dropped from 76.86 ± 7.45 (range, 70 - 82) preoperatively to 26.29 ± 19.47 (range, 16 - 70) one week, 19.14 ± 2.79 (range, 16 - 24) 6 months, and 18.57 ± 2.99 (range, 16 - 24) one year postoperatively. The mean procedure duration was 55.71 ± 6.07 minutes (range, 50 - 65 minutes). The average length of hospital stay was 7.57 ± 1.27 days (range, 6 - 10 days). No obvious complications were noted. LIMITATIONS: This was a retrospective study with a relatively small sample size. CONCLUSION: PLD plus PCP is a feasible technique for symptomatic lumbar disc herniation with Modic type I endplate changes.
Subject(s)
Cementoplasty , Diskectomy , Intervertebral Disc Displacement/surgery , Aged , Aged, 80 and over , Feasibility Studies , Female , Humans , Length of Stay , Lumbar Vertebrae/surgery , Male , Operative Time , Retrospective Studies , Treatment OutcomeABSTRACT
PURPOSE: To evaluate safety and efficacy of fluoroscopy-guided percutaneous vertebroplasty (PVP) for painful osteoblastic spinal metastases. MATERIALS AND METHODS: PVP was performed in 39 consecutive patients (median age, 60.1 y ± 9.5) with 51 osteoblastic metastatic spinal lesions; 14 patients had pathologic fractures. The patients were followed for 3-30 months (average, 14.5 mo ± 7.4). Visual analog scale (VAS), Oswestry Disability Index (ODI), and Karnofsky performance scale (KPS) were used to evaluate pain, quality of life, and performance status before the procedure and at 3 days and 1, 3, 6, 12, and 18 months after the procedure. RESULTS: Technical success was achieved in all patients. Minimal follow-up time was 3 months. Mean VAS scores declined significantly from 7.4 ± 1.1 before the procedure to 2.5 ± 0.9 by day 3 after the procedure and were 2.1 ± 1.1 at 1 month, 2.0 ± 1.1 at 3 months, 1.9 ± 1.1 at 6 months, 1.8 ± 0.9 at 12 months, and 1.7 ± 0.7 at 18 months after the procedure (P < .001). ODI and KPS scores also changed after the procedure, with significant differences between baseline scores and at each follow-up examination (P < .001). Extraosseous cement leakage occurred in 15 cases without causing any clinical complications. CONCLUSIONS: PVP is a safe and effective treatment for painful osteoblastic spinal metastases. It can relieve pain, reduce disability, and improve function.
