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Spinal Cysts

A cyst is a fluid-filled sac that can develop in the spine as a result of degeneration and can lead to spinal stenosis or other painful, serious conditions. There are several different types of cysts that may develop within the spinal cord, although synovial cysts are most common. Synovial cysts develop within the facet joints as cartilage wears away and excess fluid is produced within the joint. The excess fluid is retained within synovium of the joint and forms a cyst. Other types of spinal cysts include arachnoid cysts, Tarlov cysts, extramedullary cysts and many more.

Symptoms of Spinal Cysts

Patients with a spinal cyst may not experience any symptoms if the cyst remains small and stable. As the cyst progresses and becomes more severe, it may cause pain in the back that travels down the legs as well, and can also lead to spinal stenosis, which may cause pain, cramping and numbness. Spinal cysts tend to cause pain in certain positions, such as while standing or remaining still for prolonged periods of time. Many patients can reduce the severity of their symptoms by frequently changing positions or by adjusting their activities to remain in a seated position more often.

Typical symptoms will usually include one or a combination of the following:

  • Lower back pain may or may not be present
  • Lumbar radiculopathy or leg pain (also called sciatica). The leg pain may occur in one or both legs, and may radiate down the back of the leg and into the foot.
  • Typically, there is minimal or no pain if the patient is seated, because in the seated position the spinal canal opens up and there is not as much pressure on the spinal nerves. When standing up straight or walking, however, the spinal canal closes down and creates more pressure on the nerves.
  • Neurological deficits, which may include numbness or tingling, or muscle weakness, in one or both legs. Weakness may include foot drop.
  • Neurogenic claudication, which usually presents as a painful, cramping feeling in the legs

Spinal Cyst Diagnosis

For a patient reporting symptoms, a doctor may recommend an X-ray to rule out other problems, but the cyst is usually found through magnetic resonance imaging, or MRI. The cyst will clearly appear as bubble-like growth near a facet joint in the spine. Knowing the cyst’s size and position will help the doctor develop a treatment plan.

Spinal Cyst Treatment

Cysts that do not cause symptoms and do not seem to be growing at a rapid rate may not require any treatment other than regular monitoring of the condition. Conservative treatment may include rest, anti-inflammatory painkillers, steroid injections, and drainage. Though these approaches may temporarily relieve the symptoms, cysts may reform or refill, resulting in further discomfort. Surgery is suggested for stubborn cysts that are causing you pain and impaired movement. There are several different surgical approaches to removing the cyst and preventing a recurrence. Patients should discuss their options with their neurosurgical spine surgeon for guidance on what’s most likely to provide lasting relief.

By |Monday, October 16, 2017|Blog, News|0 Comments

Metastatic brain tumors

A brain tumor is a mass of cells in your brain that are not normal. There are two general groups of brain tumors:

Primary brain tumors start in brain tissue and tend to stay there. Most malignant brain tumours develop from the glial tissue, which supports the brain’s nerve cells. These tumours are known as gliomas.

  • These usually arise in the largest part of the brain, the cerebrum. They can be any grade. They often cause seizures or changes in behavior.
  • Oligodendrogliomas are the third most common glioma, accounting for 2-5% of all primary brain tumours and 5-18% of gliomas. They are more common in adults, particularly in people aged 40-60.
  • Ependymoma is rare. It is a type of brain tumour called glioma. They start from ependymal cells. These cells line the fluid filled areas of the brain (ventricles) and the spinal cord. Their job is to repair any damaged nerve tissue. About 2 out of 100 (2%) of brain tumours are ependymomas. Most ependymomas are diagnosed in children or young adults and can occur in any part of the brain or spinal cord. In older people they tend to occur in the lower spinal cord.

Secondary brain tumors are more common. These cancers start somewhere else in the body and travel to the brain. Lung, breast, kidney, colon, and skin cancers are among the most common cancers that can spread to the brain.

The cancer cells break away from the primary tumor and travel to the brain, usually through the bloodstream, then commonly go to the part of the brain called the cerebral hemispheres or to the cerebellum. Cancer can also spread to the spine (metastatic spine tumors).

Metastatic brain tumors are five times more common than primary brain tumors (those that originate in the brain).

Metastatic brain tumors can grow rapidly, crowding or destroying nearby brain tissue. Sometimes a patient may have multiple metastatic tumors in several different areas of the brain.

By |Saturday, October 14, 2017|Blog, News|0 Comments

Cervical Disc Herniations

Millions of people suffer from neck, shoulder, and arm pain. While there are numerous conditions that can result in this type of pain, a common cause is a herniated disc.

A herniation occurs when the outer band of the disc breaks or cracks and the gel-like substance from the inside of the disc leaks out, placing pressure on the spinal canal or nerve roots. In addition, the nucleus releases a chemical that can cause irritation to the surrounding nerves causing inflammation and pain.

Symptoms

The symptoms of a cervical herniated disc might include:

  • Dull or sharp pain in the neck or between the shoulder blades, which can intensify in certain positions or after certain movements.
  • Pain that radiates down the arm to the hand or fingers (this is called radiculopathy).
  • Numbness or tingling in the shoulder or arm.

How Do Discs Herniate?

Most Cervical Disc Herniations occur as a result of sudden stress. This occurs during movements resulting in sudden flexion, extension, or twisting of the neck, such as during a fall or auto accident. Sometimes herniations occur gradually, over weeks or months. However, there are risk factors that can contribute to the chances of a disc herniation, including:

  • Aging. As we get older, discs gradually dry out, affecting their strength and resiliency.
  • History of major or minor trauma to the cervical spine.
  • Lifestyle choices. Lack of regular exercise, not eating a well-balanced diet, and tobacco use substantially contribute to poor disc health.
  • Poor posture, incorrect and/or repetitive lifting or twisting can place additional stress on the cervical spine.

Diagnosis

Good treatment is always based on an accurate diagnosis. The comprehensive diagnostic process includes:

  • Medical history. You doctor will talk to you about your symptoms, how severe they are, and what treatments you have already tried.
  • Physical examination. You will be carefully examined for limitations of movement, problems with balance, and pain. During this exam, the doctor will also look for loss of reflexes in the extremities, muscle weakness, loss of sensation or other signs of spinal cord damage.
  • Diagnostic tests. Generally, doctors start with plain x-ray films, which enable them to rule out other problems such as infections. CT scans and MRIs are often used to give three-dimensional views of the lumbar spine and can help detect herniated discs.

Non – Operative Treatment

The good news is that most cases of cervical disc herniation do not require surgery. There are a number of non-surgical treatments that can help relieve symptoms. These include the following:

  • Pain medications such as anti-inflammatories to reduce swelling and pain, muscle relaxants to calm spasm, and narcotic painkillers to alleviate acute pain.
  • Heat/cold therapy, especially during the first 24-48 hours.
  • Physical therapy exercises such as gentle massage, stretching, and neck bracing or traction to decrease pain and increase flexibility.

In conjunction with these treatments, the medical staff will educate patients about risk factors to avoid, healthy posture, good body mechanics, and suitable exercises. Quality education can lead to a healthier spine in the long run.

Surgical Treatment

If non-operative measures do not work, surgery may be recommended. An anterior (from the front) cervical discectomy is the most common surgical procedure to treat damaged cervical discs. The goal of this procedure is to relieve pressure on the nerve roots or on the spinal cord by removing all or part of the damaged disc.

Reference:

http://www.princetonbrainandspine.com/spine-surgery/cervical-disc-herniation-symptoms-and-treatment/

By |Saturday, September 23, 2017|Blog, News|0 Comments

After Spine Fusion Surgery

Wound infections are most likely at about 10 days after surgery. Some symptoms to look for include:

  • Fever (101 degrees or higher)
  • Expanding redness at the incision site
  • Increasing pain
  • Change in the amount, appearance, or odor of drainage

If these signs appear, it is important to contact the treating surgeon immediately. As the back continues to heal, patients usually start to feel better and find they can take on more activities. The worst pain is generally over by four weeks after surgery. Pain is likely to continue to decrease gradually, but some patients continue to have pain until three to six months after surgery. It remains important to be careful and to view pain as a warning to slow down.

Crucial Time for Fusion

During this time, the lumbar fusion bone mass is becoming established. These movements should continue to be avoided to avoid stress at the fused segments:

  • Excess lifting (anything over 10 to 15 pounds)
  • Bending
  • Twisting

Patients who were prescribed a back brace to help immobilize the back will probably be advised to continue with it for six weeks to three months after surgery.

Outpatient physical therapy is may be started at least 6 weeks after surgery and lasts 2 to 3 months. Techniques are tailored to the individual, with more and more activities added as the patient improves. Therapy helps patients rethink how they walk, sit, stand, and lie down. Safe ways to lift, pull, or push objects are also covered.

Patients may progress from slow, short walks to more demanding exercises, such as swimming. Special exercises to strengthen the muscles supporting the lower back are emphasized.

To keep the incision clean, it’s important to wash the site with soap and water at least once a day and pat it dry.

Walking is the ideal form of exercise during this period. Not only does it increase muscle strength, it helps the heart, lungs, and digestive system. Gradually increasing the amount of walking, and stopping when there is added pain, is the best approach.

Reference:

https://www.spine-health.com/treatment/spinal-fusion/spinal-fusion-surgery-recovery-one-three-months-post-operation

By |Sunday, September 17, 2017|Blog, News|0 Comments

Radiation therapy for pituitary tumors

Radiation therapy uses high energy x-rays or particles to kill tumor cells. This type of treatment is given by a doctor called a radiation oncologist. Radiation is directed at the tumor from a source outside the body.

Radiation therapy may be recommended if surgery is not an option, if a pituitary tumor remains or comes back after surgery, or if the tumor causes symptoms that aren’t relieved by medicines.

Radiation therapy is much like getting an x-ray, although the doses of radiation used are much higher. Before your treatments start, the radiation team will get imaging tests such as MRI scans to define the exact size and shape of the tumor. This is used to determine the correct angles for aiming the radiation beams, the shape of the beams, and the proper dose of radiation.

Conventional radiation is usually given in a series of treatments 5 times a week over 4 to 6 weeks. At each session, you lie on a special table while a machine delivers the radiation from precise angles. The treatment is not painful. Each session lasts about 15 to 30 minutes. Much of that time is spent making sure the radiation is aimed correctly. The actual treatment time each day is much shorter.

This therapy can be very effective, but it also has some drawbacks:

  • It works slowly, so it can take months or years before the tumor growth and/or excess hormone production is fully controlled.
  • It can damage the remaining normal pituitary. In most cases, normal pituitary function will be lost over time, requiring treatment with hormones.
  • It may damage some normal brain tissue, particularly near the pituitary gland, which could affect mental function years later.
  • The optic nerves may be damaged, resulting in impaired vision.
  • The radiation may increase the risk of developing a brain tumor later in life, although this risk is still likely to be low.

These risks are likely to be lower with the use of newer techniques that focus the radiation more precisely on the pituitary, such as intensity modulated radiation therapy (IMRT), stereotactic radiation, and proton beam therapy. The use of these techniques might be limited for some tumors that are very close to the optic nerves.

Intensity modulated radiation therapy (IMRT)

IMRT is an advanced form of three-dimensional radiation therapy. It uses a computer-driven machine that actually moves around the patient as it delivers the radiation. IMRT lets the doctor shape the radiation beams and aim them at the tumor from several angles. The intensity (strength) of the beams can also be adjusted to limit the dose reaching the most sensitive nearby normal tissues. This may result in fewer side effects. Many major hospitals and cancer centers now use IMRT.

Stereotactic radiosurgery/stereotactic radiation therapy

This type of treatment delivers a large, precise radiation dose to the tumor area in a single session (radiosurgery) or in a few sessions (radiotherapy). It targets the tumor more precisely than standard radiation, causing less harm to the remaining normal pituitary gland and limiting the radiation exposure to the rest of the brain.

Proton beam radiation therapy

This form of treatment uses a beam of protons rather than x-rays to kill cancer cells. Protons are positive parts of atoms. X-rays release their energy both before and after they hit their target, which can damage nearby healthy tissues. Protons, on the other hand, cause little damage to tissues they pass through and only release their energy after traveling a certain distance. Doctors can use this property to deliver more radiation to the tumor with less damage to nearby normal tissues. Like stereotactic radiation, it has the advantage of focusing the radiation more precisely on the pituitary tumor.

Reference:

http://www.cancer.org/cancer/pituitarytumors/detailedguide/pituitary-tumors-treating-radiaton-therapy

By |Saturday, September 16, 2017|Blog, News|0 Comments