Dynamics of neurological deficit after surgical decompression of symptomatic vertebral metastases.

STUDY DESIGN: We conducted a retrospective study to examination the influence of preoperative duration of symptoms on the clinical outcome of patients that underwent surgical decompression because of neurologic deficit in metastatic disease of the spine. OBJECTIVES.: Our aim was to investigate possible correlations between the duration of neurologic deficit before surgery and postoperative outcome with respect to neural recovery in patients with spinal metastases, and second, based on those results, propose criteria for the timing of surgery in these patients. SUMMARY OF BACKGROUND DATA: It has not yet been determined whether the duration of preoperative symptoms has an influence on the postoperative outcome of patients with vertebral metastases. A standardized treatment or protocol defining a strategy of surgical treatment has yet to be designed. METHODS: This study includes 194 patients. The duration of symptoms before surgical treatment and the neurologic status before and after operation were determined and classified according to the Frankel score. RESULTS: Of 401 patients, who underwent surgery due to metastases to the spine, 194 suffered from neurologic deficit. Analyzing the postoperative neurostatus in these patients revealed an improvement in 78 patients (40%), impairment in 13 patients (7%), and in 103 patients it did not change. The relation of duration of neurologic symptoms before surgery, and the outcome after an operation was highly significant (P < 0.001). In patients with less than 3 days of neurologic deficit, the probability of improvement in neurostatus was highly significantly higher (P < 0.001) than in patients with neurologic deficit existing for more than 15 days. CONCLUSION: Patients with neurologic deficit because of spinal bone metastases benefit from early operative intervention. Urgent surgery is indicated in patients with less than 3 days of neurologic deficit.

Eosinophilic granuloma of the cervical spine.

STUDY DESIGN: A meta-analysis was performed based on 53 cases of cervical eosinophilic granuloma reported in the literature and 1 in an adult treated by the authors. OBJECTIVE: To stress the clinical and radiologic differences between cervical and thoracolumbar spinal eosinophilic granuloma and to point out differences between adults and children with cervical eosinophilic granuloma to avoid false diagnosis. SUMMARY OF BACKGROUND DATA: Until now, cervical eosinophilic granuloma has been reported in 43 children and 9 adults. In 1 case the age is unknown. In previous studies, differences between adults and children with cervical eosinophilic granuloma have not been analyzed, nor has cervical eosinophilic granuloma been compared with thoracolumbar eosinophilic granuloma. METHODS: All reported cases of cervical eosinophilic granuloma were analyzed concerning age and sex distribution, clinical and radiologic presentation, therapy, and outcome. The authors' case in a 46-year-old patient is discussed. RESULTS: The presenting symptoms of cervical eosinophilic granuloma are usually pain and restricted range of motion. In contrast to eosinophilic granuloma of the thoracic spine and lumbar spine, the neurologic symptoms are less frequent, and the first radiographic sign is an osteolytic lesion. Vertebra plana is a rare sign in cervical eosinophilic granuloma. In children, the middle cervical spine is most often affected, whereas in adults it is the second vertebra. The outcome of the patients has been good in most cases, independently of treatment. CONCLUSION: In most cases of cervical eosinophilic granuloma, immobilization is an adequate therapy. If the process continuous to progress, radiotherapy is recommended. Surgical treatment should be reserved for cases with instability or neurologic defects.