Clinical Neuroscience

[Unusually located metastatic tumors of the spine]

BAZSÓ Péter, NAGY László

FEBRUARY 20, 2003

Clinical Neuroscience - 2003;56(01-02)

[Metastatic spine tumors are representing a growing number of oncological patients. In this paper the authors would like to focus on a rare type of metastatic spine tumors, the unusually located ones. Since the advent of MRI and with the progress in general oncology this formerly rare tumors became more frequently recognized. Consequently these tumors are causing a new challenge for the oncologists, neurologists and neurosurgeons as well. The aim of the authors with this paper was to raise, especially the neurologists' attention to this emerging problem.]



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Clinical Neuroscience

[Primary intramedullary glioblastoma multiforme of the spinal cord: report of eight cases]

BANCZEROWSKI Péter, SIMÓ Magdolna, SIPOS László, SLOWIK Felícia, BENOIST György, VERES Róbert

[Primary glioblastoma multiforme located intramedullary in the spinal cord is a very rare entity. The authors report eight cases and discuss the clinical features, the possibility of diagnosis, combinated treatment and pathomorphological signs focusing on the relevant literature and their experience.]

Clinical Neuroscience

[The role of electrical neuromodulation in the therapy for chronic lower urinary tract dysfunction]


[The electrostimulation techniques may be used as a supplement or an alternative to standard therapy. Electrical therapy for chronic lower tract dysfunction comprises of noninvasive pudendal nerve neuromodulation and invasive sacral nerve stimulation. Short-term functional electrical stimulation seems favourable in selected patients with detrusor hyperreflexia. Sacral nerve stimulation may be a successful treatment option for patients with refractory detrusor overactivity and some forms of urinary retention.]

Clinical Neuroscience

[Anterior and posterior stabilization following the resection of a thyroid gland tumor destroying more cervical segments]

FECZKÓ József, BARÁTH István, SÁRVÁRY András

[Case report - Authors report a case of thyroid gland carcinoma. The tumor had metastases into the CV-VI-VII vertebras. Through an anterior approach, they removed the malignant tumor together with the bodies of the affected cervical vertebras and a two stage combined (anterior and posterior) cervical instrumentation was performed. The anterior fusion was carried out with iliac crest bone grafting and plate fixation. After four years the patient is alive and well, without symptoms of tumor recurrence or neurologic deficiency. The ventral fusion is stable. Conclusions - Authors present a case of a successful operation of thyroid gland malignant tumor having metastatases in the CV-VI-VII vertebras. Tumor resection, fusion and instrumentation is suggested to be carried out in one stage. The anterior and posterior instrumentation is essential. Radical removal of the tumor is mandatory even with complex instrumentation and oncotherapy procedures.]

Clinical Neuroscience

[Spinal stabilizations in our department 1989-2002]

HÁVEL János, GÖBÖL László, GÖRÖMBEY Zoltán, KISS Tibor, LAJKÓ Albert, VALÁLIK István, VIOLA Árpád, JULOW Jenő

[With the aim to compare results to those found in the literature, authors present a retrospective overview of the spinal stabilisations carried out in the Neurosurgical Department at the St. John’s Hospital, Budapest, Hungary between 1989 and 2002. This 37 bed department provides neurosurgical services to the Buda region with its one million inhabitants. Out of 156 000 injuries in total in the past 13 years, the department has dealt with 9360 neurotraumatologic cases, 560 of them suffering from spinal injuries. In parallel, non-traumatic cases were also treated for tumour, infections, degenerative diseases and for the instability of the spine. The 224 stabilised cases were classified into three groups: cervical, thoracic, lumbar. The authors enumerate the type of operation in each level and they present the number of cases belonging to each type. Septic complications occured in 2.5% of cases. Screw breaking or slackening of the implanted devices was observed in 2% of the cases. The types of spinal operations applied provide satisfactory method for controlling the problems caused by the instability the spinal trauma, degenerative and tumourous cases. These results do not diverge from those found in the literature.]

Clinical Neuroscience

[Operative treatment of pressure sores of the pelvic region in spinal cord-injured patients]


[by either conservative or surgical methods. Shortened healing period and long lasting results can be achieved by surgery. Between 1993 and 2001 the authors performed 64 operations with musculocutaneous or musculo-fasciocutaneous flaps in all cases. All patients healed primary except one, whose 20-year-old pressure sore transformed malignant and gave metastasis. The complication rate was 21.42%, that equals with the data of the literature. Measuring the late postoperative results by follow-up questionnaire, a 9.52% ratio of recurrence was found, which was significantly smaller than data of the literature (19-82%). Authors analyse the causes of their (good) results.]

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[New, innovative prognosis calculator for patients with metastatic spinal tumors]


[The aim of our research was to create a scoring system that predicts prognosis and recommends therapeutic options for patients with metastatic spine tumor. Increasing oncological treatment opportunities and prolonged survival have led to a growing need to address clinical symptoms caused by meta­stases of the primary tumor. Spinal metastases can cause a significant reduction in quality of life due to the caused neurological deficits. A scoring system that predicts prognosis with sufficient accuracy could help us to achieve personalised treatment options. Methods – We performed a retrospective clinical research of data from patients over 18 years of age who underwent surgery due to symptomatic spinal metastasis at the National Institute of Mental Disorders, Neurology and Neurosurgery between 2008 and 2018. Data from 454 patients were analysed. Survival analysis (Kaplan-Meier, log-rank, Cox model) was performed, network science-based correlation analysis was used to select the proper prognostic factors of our scoring system, such that its C value (predictive ability index) was maximized. Multivariate Cox analysis resulted in the identification of 5 independent prognostic factors (primary tumour type, age, ambulatory status, internal organ metastases, serum protein level). Our system predicted with an average accuracy of 70.6% over the 10-year study period. Our large case series of surgical dataset of patients with symptomatic spinal metastasis was used to create a risk calculator system that can help in the choice of therapy. Our risk calculator is also available online at]

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BAGÓ Attila György

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Clinical Neuroscience

[A case of destructive cervical spondylarthropathy related to chronic dialysis]

BERTA Balázs, KOMÁROMY Hedvig, SCHWARCZ Attila, KAJTÁR Béla, BÜKI András, KUNCZ Ádám

[A case of a 61-year-old male patient suffered chronic renal failure and dialysed for 23 years with destructive cervical spondylarthropathy is presented. The patient presented with sudden onset of cervical pain radiating into his shoulders without neurological deficits. CT and MRI of the cervical and thoracic spine revealed severe destructive changes and compressive fractures of C6 and C7 vertebrae which caused the narrowing of the nerve root canals at these levels. A 360-degree fixation was performed to treat the unstable fracture and the patient’s pain (C6 and C7 corpectomy, autolog bone graft replacement of the two vertebral bodies, anterior plate fixation and posterior instrumentation with screws and rods). Postoperatively the patient had no significant pain, no neurological deficit and he was able to manage independent life himself. During the immediate follow-up CT of the neck showed the satisfactory position of the bone graft and the metal implantations. The 6 months follow-up CT revealed the anterior migration of the two screws from the Th1 vertebral body and 2 mm ventral elevation of the caudal end of the plate from the anterior surface of the Th1 vertebral body. The 1-year follow-up could not be performed because the patient died due to cardio-pulmonary insufficiency. This is the second Hungarian report of a chronic dialysis related severe spondylarthropathy which may cause pathologic fractures of the vertebral bodies. The typical radiological and histological findings are discussed. This disease affect patients’ quality of life and the conservative treatment alone seems to be ineffective in most cases. Based on the literature and personal experiences, the authors suggest 360-degree fixation of the spine to provide sufficient stability for the vertebrae of ”bad bone quality”, and early mobilisation of the patient can be achieved.]