Delay in diagnosis of intradural spinal tumors

Fifty-seven patients with primary intradural spinal tumors operated on in North Manchester and Salford between 1978 and 1988 were reviewed retrospectively. The commonest diagnoses were meningioma and nerve sheath cell tumors (neurilemmomas and neurofibromas). The median delay in diagnosis was 2.5 years (range 3 days to 24 years). Fifty-eight percent were initially referred to orthopaedic surgeons and 95% percent to specialties other than neurosurgery. The commonest presenting symptom was back pain, but later neurologic and urinary symptoms came to predominate. Eighty-eight percent are disease-free at a mean follow-up of 5.7 years. Symptoms were partially or completely relieved in the majority of patients. Delay in diagnosis of these tumors arises from failure to consider the diagnosis in patients with longstanding back pain or neurologic problems.