Spinal cord compression in pediatric oncology: the importance of early recognition and optimal management

Introduction: Pediatric malignant spinal cord compression (MSCC) is a rare oncologic emergency that can have severe consequences without prompt and optimal management in specialized centers. The lack of established guidelines can make treatment complex. Methods: This is a descriptive retrospective analysis of 16 cases of MSCC in a Pediatric Oncology and Hematology department between 1998 and 2023. Results: Neuroblastoma was the most frequent etiology (44%), followed by Ewing’s sarcoma (31%). MSCC was the first manifestation of a new disease in 88% of patients. The most frequent initial symptom was back pain (44%), followed by motor deficit (31%). All cases received corticosteroids, and 15 received chemotherapy. Radiotherapy was reserved for cases with insufficient response to medical treatment or with palliative aim, and surgery was indicated in four cases. Despite initial symptoms lasting >7 days for most patients (81%), complete or partial recovery was frequent (69%), and overall survival was 75% at 5 years. The most frequent sequelae were motor symptoms and sphincter disfunction. Conclusion: Pediatric MSCC is a rare oncologic emergency that requires high diagnostic suspicion to detect it in the early stages. A prompt referral to specialized centers for multidisciplinary management is important in order avoid severe life-long sequelae, especially in pediatric cases that could show favorable outcomes despite initial severe presentation.