METASTATIC TUMORS OF THE SPINAL CORD; SECONDARY INTRAMEDULLARY TUMORS

Objective: Intramedullary tumor metastasis in the spinal cord is a rare clinical entity but is increasing in incidence due to advances in primary tumor treatment and longer survival.The authors present one of the most extensive patient series yet on intramedullary spinal cord metastasis to provide treatment guidance for improved quality of life.Materials and Methods: All spinal tumor cases treated between January 2012 and May 2021 at the Neurosurgery Department, Baheehir University Faculty of Medicine, were screened for intramedullary spinal cord metastasis.Results: Fifty-one patients were treated for spinal intramedullary lesions during the study period, of which 11 were diagnosed with radiologically and (or) pathologically confirmed intramedullary spinal cord metastasis (median age at presentation: 50 years, 54.5% female).Ten of these 11 patients received surgical intervention, and five (45.5%) were previously treated for primary breast cancer.The metastatic spinal lesion was cervical in 5 patients (45.5%), thoracic in two (18.2%), and within the conus medullaris in three (27.3%).The patient not receiving surgical intervention presented with a lesion at C2. Eight of 11 patients (72.7%) had accompanying intracranial metastasis, and 7 (63.6%)required additional neurosurgical interventions.Seven patients (63.6%) also presented with systemic metastasis requiring radiotherapy, systemic chemotherapy, or both, among whom four patients (36.4%) received post-operative radiotherapy.The median overall survival was only six months, but the median Modified McCormick scale score for neurological status improved (decreased) significantly post-surgery (2.5 vs. 4 pre-surgery, p<0.001).Conclusion: Despite effective local and systemic treatment modalities, overall survival is short among patients with intramedullary spinal cord metastasis.Therefore, the main aims of surgery are to prevent further neurological decline and improve health-related quality of life.