脊椎ジャーナル

Metastatic spine disease is increasing in incidence and is a major cause for patient morbidity and mortality. The clinical presentation is often characterised by pain and spinal deformity and often progresses to neurological deficits without treatment. The cornerstones of treatment have been chemotherapy, radiation therapy and surgery to debulk and stabilize the spine. However, these are considered palliative procedures being limited by damage to normal healthy tissues. Recent studies have focused on the key pathways that mediate tumour progression and spread to bone and more targeted therapies that may reduce the injury to normal cells. This article reviews the key features, clinical presentation, workup and treatment options of spinal metastases.

Neurocysticercosis is the disease caused by the larval stage of the parasite Taenia Solium which is the most common parasitic infection of the nervous system which is the public health burden in Nepal. However, the involvement of the spinal cord i.e., intramedullary cysticercosis is very rare. The symptoms can vary from the backache or radicular pain to the development of cauda equina syndrome. We report a case of 21 years’ male presented with history of low back pain and weakness of bilateral lower limbs. Magnetic resonance imaging (MRI) whole spine was done which shows hyper-intense lesion in T2 sequence at the level of 10th thoracic vertebra. Intramedullary cysticercosis have very good result after surgery. Patient had gained the motor power after decompression of spinal cord and the quality of life has been improved. Though it’s a rare disease but in country like Nepal it could be presented as various other diseases which could be neglected or misdiagnosed.

Background: Ganglioneuroma (GN) is a very rare neoplasm of the central nervous system, accounting for 0.1% - 5% of all brain tumors and less than 10% of the lesions occur in the spinal cord. Because of the low incidence, there are few reports at home and abroad. It can occur in the cervical, thoracic and lumbar spines of the spine.
Method: In this case, we describe a rare GN that occurs in the thoracic 6-8 spinal canal and extends into the thoracic cavity in a 5-year-old female. Her symptoms were progressive sensory abnormalities in both lower limbs and weakness of both lower limbs for one year. The patient underwent detailed investigations including CT, MRI and 3D printing technology. Before operation, 3D model of tumors and corresponding tissue structures was printed at the ratio of 1:1 in size. As far as we know, this is the first case of spinal GN treated with 3D printing technology in the English literature.
Results: The patient had an uneventful postoperative recovery and no evidence of tumor recurrence could be demonstrated on clinical examination. Histopathological diagnosis was GN for all resected tumors.
Conclusion: In conclusion, resection of intraspinal GN occurring simultaneously in the spinal canal and thoracic cavity is effective for improving the symptoms of patients. Preoperative 3D printing based on imaging data is helpful to visually identify the location of tumors in the spinal canal and the degree of compression of spinal nerve roots before operation, and to judge the key part of compression of spinal cord by tumors during operation.

Many pathologic conditions of the spine and pelvis have posterior gluteal or “hip” pain as a presenting symptom. It is critical that a thorough history is taken as well as a detailed physical examination of the patient. From this information, pertinent imaging studies may be ordered to better direct the physician towards an accurate diagnosis for the patient’s symptoms. Because pain in this region can be from many different pathologic processes, it is very important that the evaluating physician considers and evaluate the patient in a systematic fashion to properly work up the patient.