Journal article
Survival and neurological outcomes following management of intramedullary spinal metastasis patients: a case series with comprehensive review of the literature
Neurosurgical review, Vol.47(1), 75
02/06/2024
DOI: 10.1007/s10143-024-02308-0
PMID: 38319484
Abstract
Intramedullary spinal cord metastasis (ISCM), though rare, represents a potentially debilitating manifestation of systemic cancer. With emerging advances in cancer care, ISCMs are increasingly being encountered in clinical practice. Herein, we describe one of the larger retrospective single institutional case series on ISCMs, analyze survival and treatment outcomes, and review the literature. All surgically evaluated ISCMs at our institution between 2005 and 2023 were retrospectively reviewed. Demographics, tumor features, treatment, and clinical outcome characteristics were collected. Neurological function was quantified via the Frankel grade and the McCormick score (MCS). The pre- and post-operative Karnofsky performance scores (KPS) were used to assess functional status. Descriptive statistics, univariate analysis, log-rank test, and the Kaplan-Meier survival analysis were performed. A total of 9 patients were included (median age 67 years (range, 26-71); 6 were male). Thoracic and cervical spinal segments were most affected (4 patients each). Six patients (75%) underwent surgical management (1 biopsy and 5 resections), and 3 cases underwent chemoradiation only. Post-operatively, 2 patients had an improvement in their neurological exam with one patient becoming ambulatory after surgery; three patients maintained their neurological exam, and 1 had a decline. There was no statistically significant difference in the pre- and post-operative MCS and median KPS scores in surgically treated patients. Median OS after ISCM diagnosis was 7 months. Absence of brain metastasis, tumor histology (renal and melanoma), cervical/thoracic location, and post-op KPS ≥ 70 showed a trend toward improved overall survival. The incidence of ISCM is increasing, and earlier diagnosis and treatment are considered key for the preservation of neurological function. When patient characteristics are favorable, surgical resection of ISCM can be considered in patients with rapidly progressive neurological deficits. Surgical treatment was not associated with an improvement in overall survival in patients with ISCMs.
Details
- Title: Subtitle
- Survival and neurological outcomes following management of intramedullary spinal metastasis patients: a case series with comprehensive review of the literature
- Creators
- Michael Kritikos - University of Iowa Hospitals and ClinicsJuan Vivanco-Suarez - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USANahom Teferi - University of IowaSarah Lee - University of IowaKyle Kato - College of Medicine, University of Iowa, Iowa City, IA, USAKathryn L Eschbacher - University of IowaGirish Bathla - Mayo Clinic in ArizonaJohn M Buatti - University of IowaPatrick W Hitchon - University of Iowa Hospitals and Clinics
- Resource Type
- Journal article
- Publication Details
- Neurosurgical review, Vol.47(1), 75
- DOI
- 10.1007/s10143-024-02308-0
- PMID
- 38319484
- ISSN
- 1437-2320
- eISSN
- 1437-2320
- Language
- English
- Date published
- 02/06/2024
- Academic Unit
- Pathology; Orthopedics and Rehabilitation; Radiation Oncology; Neurosurgery; Otolaryngology
- Record Identifier
- 9984557944702771
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