Survival and Functional Outcomes in Patients with Thoracic Spinal Epidural Lymphoma with Spinal Cord Compromise: Three Cases Requiring Emergent Surgical Management

Spinal epidural lymphoma is a rare pathological entity that usually responds well to chemotherapy. However, it occasionally requires immediate surgical treatment for progressive neurological symptoms caused by a bulky epidural mass and bone destruction. In the management of spinal epidural lymphoma, the role of surgical interventions has not yet been fully defined, and few reports on long-term functional outcomes are available. We report 3 cases of thoracic spinal epidural lymphoma that required emergent surgical management for neural decompression and were followed postoperatively over 2 years or until death. Two patients (cases 1 and 2) underwent spinal instrumentation to prevent subsequent spinal deformity, whereas instrumentation was avoided in case 3 due to atopic dermatitis, which increases the risk of surgical site infection. During the 2-year postoperative period, 2 patients (cases 1 and 3) maintained disease-free survival and achieved sufficient neurological recovery to remain ambulant, while the other patient (case 2) died due to spinal epidural lymphoma relapse. Given the high treatment responsiveness and the potential for long-term disease-free survival in spinal epidural lymphoma, treatment should aim to maximize functional outcomes. Prompt surgical decompression is mandatory in patients with neurological deficits. Although spinal instrumentation is typically recommended to prevent spinal deformity, it should be withheld if it poses a risk of delaying chemotherapy, such as in cases with a high risk of surgical site infection. Therefore, spinal surgeons play several essential roles in managing spinal epidural lymphoma from the acute to the chronic phase, aiming to improve patients' prognosis and quality of life.