Analysis Of Motor Dysfunction And Imaging And Clinical Features In Metastatic Epidural Spinal Cord Compression

Malignant tumor is a serious hazard to human health of major diseases。Bone metastasis is very common malignant tumor performance。Spine is themost common site of the bone metastases and metastatic spinal vertebralpathological fractures or spinal cord compression will result in patientswith severe pain, numbness, and even paralysis of bowel and bladderdisorders, motor dysfunction, which greatly reduces the patient’slifequality. Clinical observations epidural spinal cord compression inpatients with spinal metastases were paralyzed difficult to fully recovertheir motor function.So analysis metastases degree of epidural spinalcord compression and clinical characteristics of patients with motordysfunction and prognosis, early diagnosis of metastases and reasonablechoice of treatment is of great significance.Objective To explore the relationship of motor dysfunction of the lowerextremities with the imaging appearances and clinical features ofmalignant spinal cord compression(MESCCs), and offer the clinicalevidence for metastatic epidural spinal cord compression motordysfunction in patients with risk assessmentand early diagnosis andreasonable treatment.Methods From July2006through December2007,26successive patients(17men and9women)) with metastases of the thoracic, lumbar and the cervicalspine were treated in our department. retrospectively．43main involved vertebra in all26patients were evaluable by magnetic resonance imagingand computed tomography on admission and were scored according motordysfunction in this study. Forty-six patients had motor dysfunction atinitiation. Their age range from31to71years,and the mean age is50years．．Their primary tumor are lung cancer in12cases,breast Cancerin3cases,liver cancer in2cases,esophageal carcinoma in2cases,colon cancer,bladder cance,nasopharyngeal carcinoma, renal carcinomain1case each, adenocarcinoma of unknown origin in3case. Imagingassessed factors of main lesion vertebraes were level of vertebraelmetastases location, epidural space involvement, vertebrael-bodyinvolvement, lamina involvement, posterior protruding of posterior wallof main involved vertebraee, pedicle involvement, continuity of maininvolved vertebraee, fracture of anterior column, fracture of posteriorwall, location in the cervicothoracic junction and/or upper thoracicspine.Results Patients with visceral metastasis in26cases MESCC,10caseshad motor dysfunction; patients without visceral metastasis, motordysfunction occurred in4cases(P=0.0079) Vertebral presence ofcontinuity of43main involved vertebrae,16cases had motor dysfunction;vertebral absence of continuity, motor dysfunction occurred in9patients(P=0.1034). Vertebral presence of lamina involvement of43maininvolved vertebrae,11patients had motor dysfunction; vertebral absenceof lamina involvement, motor dysfunction occurred in14cases(P=0.0205).Vertebral presence of protruding of vertebral posterior wall of43maininvolved vertebrae,12patients had motor dysfunction; vertebral absenceof protruding of vertebral posterior wall,13patients had motordysfunction(P=0.0334). Vertebral presence of involvement epidural spaceof43main involved vertebrae, all11patients had motor dysfunction;vertebral absence of involvement epidural space,14patients had motor dysfunction(P=0.0036). Age, sex, whether or not received regular Chembefore admission,back pain degree of metastasis,received regular Chembefore admission, therapeutic efficacy of primary tumor, number of bonymetastases outside spine, number of the main involved vertebrae, levelof vertebral metastases location, level of continuous involved vertebrae,vertebral-body involvement, fracture of anterior column,fracture ofposterior wall, and pedicle involvement were not statisticallysignificant factors for incidence of motor dysfunction due to MESCC (P=0.6348, P=0.6828, P=0.6951, P=0.0511, P=0.6922, P=0.0846, P=0.2177,P=1.000, P=0.6000, P=0.1034, P=0.2337, P=0.7707, P=0.3318, P=0.3951respectively).Conclusions MESCC with visceral metastases, lamina involvement,presence of outstanding buttocks sign of posterior wall, involvementepidural space tended to cause symptomatic MESCC. Incidence of continuityof main involved vertebrae occurred more frequently in the CUTS comparedwith other levels of spine.