An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy.

Introduction Elderly patients have glioblastomas (GBM) that are aggressive and poorly responsive to treatment. They are also prone to the side effects of treatment of GBM. Methods To shed light on the treatment of elderly patients with GBM, we reviewed the treatment toxicities and survival of patients 65 years of age or older who were treated with chemoradiotherapy, which is the new standard of care for GBM in younger patients. Results Thirty-nine patients at a single cancer center in Canada met the eligibility criteria for this retrospective study. Nineteen patients were treated initially with TMZ and radiotherapy and 20 others were treated with radiotherapy alone (only two had TMZ subsequently). Eight patients in the chemoradiotherapy group (42%) experienced Grade III or IV toxicity versus none in the radiotherapy group. The median overall survival in the chemoradiotherapy group was 8.5 months (range, 2.0–24.7 months) versus 5.2 months (range, 1.5–14.2 months) in the radiotherapy group, an apparent benefit which may have been due to an imbalance in age at diagnosis, extent of resection and performance status. In this series of GBM cases, methylation of the MGMT gene promoter was not associated with longer survival, either overall, or within the chemoradiotherapy treated subset. Conclusions Elderly patients with GBM treated with chemoradiotherapy can be expected to experience significant toxicity. Large randomized trials will be necessary to determine whether chemoradiotherapy prolongs the survival of elderly patients and whether MGMT promoter status predicts benefit from temozolomide in this subset of patients.

Toxicity from chemoradiotherapy in older patients with glioblastoma multiforme

Object This study was undertaken to evaluate the association between age at diagnosis, patterns of care, and outcome among elderly individuals with anaplastic astrocytoma (AA) and glioblastoma multiforme (GBM). Methods Using the Surveillance, Epidemiology and End Results database, the authors identified 1753 individuals with primary GBM and 205 individuals with primary AA (diagnosed between June 1991 and December 1999) who were 66 years and older and whose records were linked to Medicare information. To facilitate gathering of prediagnosis comorbidity and postdiagnosis treatment information, only those individuals were included who had the same Medicare coverage for 6 months before and 12 months after diagnosis. The odds of undergoing various combinations of treatments and the associations with outcome were calculated by tumor type and age and adjusted by various predictors. Results Age was not associated with treatment differences in individuals with AA. Very elderly individuals (≥ 75 years old) with GBM...

Patterns of care and outcomes among elderly individuals with primary malignant astrocytoma.

Background. Optimal extent of surgical resection (EOR) of high-grade gliomas (HGGs) remains uncertain in the elderly given the unclear benefits and potentially higher rates of mortality and morbidity associated with more extensive degrees of resection. Methods. We undertook a meta-analysis according to a predefined protocol and systematically searched literature databases for reports about HGG EOR. Elderly patients (≥60 y) undergoing biopsy, subtotal resection (STR), and gross total resection (GTR) were compared for the outcome measures of overall survival (OS), postoperative karnofsky performance status (KPS), progression-free survival (PFS), mortality, and morbidity. Treatment effects as pooled estimates, mean differences (MDs), or risk ratios (RRs) with corresponding 95% confidence intervals (CIs) were determined using random effects modeling. Results. A total of 12 607 participants from 34 studies met eligibility criteria, including our current cohort of 211 patients. When comparing overall resection (of any extent) with biopsy, in favor of the resection group were OS (MD 3.88 mo, 95% CI: 2.14‐5.62, P , .001), postoperative KPS (MD 10.4, 95% CI: 6.58‐14.22, P , .001), PFS (MD 2.44 mo, 95% CI: 1.45‐3.43, P , .001), mortality (RR ¼ 0.27, 95% CI: 0.12‐0.61, P ¼ .002), and morbidity (RR ¼ 0.82, 95% CI: 0.46‐1.46, P ¼ .514) . GTR was significantly superior to STR in terms of OS (MD 3.77 mo, 95% CI: 2.26‐5.29, P , .001), postoperative KPS (MD 4.91, 95% CI: 0.91‐8.92, P ¼.016), and PFS (MD 2.21 mo, 95% CI: 1.13‐3.3, P , .001) with no difference in mortality (RR ¼0.53, 95% CI: 0.05‐5.71, P ¼.600) or morbidity (RR ¼ 0.52, 95% CI: 0.18‐1.49, P ¼ .223). Conclusions. Our findings suggest an upward improvement in survival time, functional recovery, and tumor recurrence rate associated with increasing extents of safe resection. These benefits did not result in higher rates of mortality or morbidity if considered in conjunction with known established safety measures when managing elderly patients harboring HGGs.

Biopsy versus partial versus gross total resection in older patients with high-grade glioma: a systematic review and meta-analysis

Recurrent back and leg pain and cyst reformation after surgical resection of spinal synovial cysts: systematic review of reported postoperative outcomes.

Survival trends in elderly patients with glioblastoma multiforme: resective surgery, radiation, and chemotherapy

Pathological evaluation of intervertebral disc tissue specimens after routine cervical and lumbar decompression. A cost-benefit analysis retrospective study.

Spontaneous regression of the herniated lumbar discs is a well-established phenomenon. This phenomenon of disappearance of the disc has been reported occasionally in the cervical spine and very rarely in the thoracic regions. In this article, we report the rare occurrence of spontaneous resolution of one large herniated cervical disc (C6-7) with simultaneous progression of another disc prolapse (C4-5) in a 46-year-old man.

MRI-documented spontaneous regression of cervical disc herniation: a case report and review of the literature.

Synovial cysts most commonly involve the joints of the extremities. These cysts are rarely found in the spinal canal or the vertebral facet joints. However, if manifested as such, they can pose serious diagnostic and therapeutic problems due to the presentation, which most often resembles nerve root or spinal cord compression. Acute low back pain and radiculopathy are often attributed to a herniated nucleus pulposus. This paper presents a case of synovial cyst in a 62-year-old woman with a 2-year history of refractory low back pain with distal radiation. A facet joint cyst was encountered upon neuroimaging, resulting in excision of the cyst. In this report, we discuss the differential diagnosis of synovial cysts, the role of computed tomography and magnetic resonance imaging in the diagnosis, and treatment options for this uncommon entity.

Synovial cyst of lumbar spine presenting as disc disease: a case report and review of literature.

Intramedullary spinal cord metastasis (ISCM) is a rare condition that causes serious diagnostic and therapeutic problems. ISCM is usually discovered in less than 1% of autopsies, with fewer than 5% being diagnosed antemortem. The uncertain and non-standardized treatment of patients diagnosed with ISCM is a major concern of neurosurgeons today. Presented is a case of ISCM detected in an 80-year-old man with a history of lung carcinoma. The progression of his illness, diagnostic role of MRI, and ISCM management options are discussed.

Praveen Reddy

Papers

Survival trends in elderly patients with glioblastoma multiforme: resective surgery, radiation, and chemotherapy

Pathological evaluation of intervertebral disc tissue specimens after routine cervical and lumbar decompression. A cost-benefit analysis retrospective study.

MRI-documented spontaneous regression of cervical disc herniation: a case report and review of the literature.

Synovial cyst of lumbar spine presenting as disc disease: a case report and review of literature.

Intramedullary spinal cord metastases: case report and review of literature.