Swelling and enhancement of the cervical spinal cord: when is a tumour not a tumour?
Swelling and enhancement of the cervical spinal cord: when is a tumour not a tumour?
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颈脊髓肿胀强化：什么时候肿瘤不是肿瘤？
DOI：
10.3109/02688697.2011.633636
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发表时间：
2012
影响因子：
1.1
通讯作者：
D. Choi
中科院分区：
文献类型：
--
作者：
B. Nurboja;A. Chaudhuri;K. David;A. Casey;D. Choi
Objective.描述对颈椎压迫和不明原因髓内肿胀并存的患者的治疗。我们描述的主要特点，提出了管理计划，并审查文献。材料和方法。本文报告六例脊髓型颈椎病的影像学表现，包括脊椎受压、颈髓肿胀及髓内强化。详细描述的临床特点，影像学表现，手术方法和结果进行了讨论。所有患者均经前路、后路或两者联合行颈椎减压术。尽管最初担心病因可能是肿瘤，但在任何病例中均不需要进行颈髓活检。结果4例患者的症状得到改善，而2例患者在减压后的对比增强仅得到改善。1例术后未改善的患者被发现患有神经结节病。颈椎减压术后无患者病情加重。结论脊髓肿胀，增强和共存的脊髓压迫，在第一个例子中，应该只通过减压治疗。除非在充分减压的情况下仍有放射学或临床进展，否则不应进行活检以诊断内源性肿瘤或炎性疾病。
Objective. To describe the management of patients with co-existing cervical spondylotic compression and enhancing intramedullary swelling of uncertain aetiology. We describe the key features, suggest a management plan and review the literature. Material and methods. A short series of six cases with cervical myelopathy and radiological features of spondylotic compression, swollen cervical cord and intramedullary enhancement is described. Detailed descriptions of clinical features, radiological findings, surgical approaches and outcomes are discussed. All patients underwent cervical decompression via an anterior approach, posterior approach or both. Despite initial concerns that the aetiology might be tumour, no biopsy of cervical cord was required in any of the cases. Results. Symptoms improved in four cases whilst contrast enhancement only improved in two cases following decompression. One patient who failed to improve postoperatively was found to have neurosarcoidosis. No patient became worse after the cervical decompression. Conclusion. Swelling of the spinal cord with enhancement and co-existing spondylotic cord compression, in the first instance, should be treated by decompression only. Biopsy to diagnose intrinsic tumour or inflammatory conditions should not be performed unless there is radiological or clinical progression despite adequate decompression.