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Intramedullary spinal cord metastases

Clinical features and treatment outcome

From the Division of Neuro-Oncology, Mayo Clinic and Mayo Foundation, Rochester, MN.
Received February 9, 1996. Accepted in final form March 27, 1996.
Address correspondence and reprint requests to Dr. David Schiff, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Our objective was to delineate clinical features and treatment outcome of patients with intramedullary spinal cord metastasis (ISCM).There are no reports of a large experience with this rare cancer complication. We reviewed records retrospectively from 1980 to 1993 to identify patients with histologically confirmed systemic cancer, clinical features of myelopathy, and either tissue-proven ISCM or abnormal neuroimaging findings consistent with ISCM. We identified 40 patients who fulfilled these criteria. In nine, ISCM was the initial presentation of cancer. Nineteen patients had lung primaries (small cell in 12). Twenty-one patients had pain, 35 had demonstrable sensory loss, 37 had weakness, and 25 had urinary incontinence at presentation. Nine patients had true Brown-Sequard syndrome and nine others had pseudo-Brown-Sequard syndrome. Median duration of symptoms at diagnosis was 28 days (range 3 days to 18 months). Thirteen patients had prior brain metastasis, nine had brain metastasis simultaneous with ISCM, and one had brain metastasis after ISCM; 11 had concomitant leptomeningeal metastases. Spinal magnetic resonance findings were abnormal in 30/30 patients, myelographic results were abnormal in 16/20, and eight had pathologic confirmation of ISCM. Thirty-five patients had radiotherapy and five had surgery; four were untreated or treated elsewhere. Median survival was 4 months for patients receiving radiotherapy and 2 months for patients not receiving radiotherapy. Eleven patients survived >6 months. Twenty-three were ambulatory at ISCM diagnosis, and 21 were ambulatory at latest follow-up. We conclude that ISCM as the initial presentation of malignancy is not rare, and hemicord syndromes occur frequently. Although long-term survival is poor, treatment preserves ambulation in most patients still ambulatory at diagnosis. Focal radiotherapy is indicated in most patients.

NEUROLOGY 1996;47: 906-912

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