Swelling and enhancement of the cervical spinal cord: when is a tumour not a tumour?

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...

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Bibliographic Details
Published in:British journal of neurosurgery 2012-08, Vol.26 (4), p.450-455
Main Authors: Nurboja, Besnik, Chaudhuri, Abhijit, David, Karoly M., Casey, Adrian T. H., Choi, David
Format: Article
Language:English
Subjects:
Adult
Biopsy
cervical decompression
Clinical outcomes
cord enhancement
cord swelling
Decompression, Surgical - methods
Diagnosis, Differential
Edema - etiology
Edema - pathology
Edema - surgery
Female
Humans
Male
Middle Aged
Neurosurgery
Patients
Prospective Studies
Radiology
Spinal cord
Spinal Cord - pathology
Spinal Cord Compression - etiology
Spinal Cord Compression - pathology
Spinal Cord Compression - surgery
Spinal Cord Diseases - etiology
Spinal Cord Diseases - pathology
Spinal Cord Diseases - surgery
Spinal Cord Neoplasms - pathology
Spondylosis - complications
Spondylosis - pathology
Spondylosis - surgery
Treatment Outcome
Tumors
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Summary: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.
ISSN:0268-8697
1360-046X
DOI:10.3109/02688697.2011.633636