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Treatment of spinal cord compression by epidural malignancy in childhood
C Raffel1, V C Neave, S Lavine
1Division of Neurosurgery, Childrens Hospital Los Angeles, California.
Insights
Severe spinal cord compression in children due to malignant tumors requires prompt intervention. Surgical decompression combined with adjuvant therapy significantly improves outcomes compared to non-surgical treatments for these critical cases.
Area of Science:
- Pediatric Oncology
- Neurosurgery
- Spinal Cord Imaging
Background:
- Epidural spinal cord compression from malignant tumors is rare in children, differing from adult presentations.
- Early diagnosis often allows for non-surgical management with radiation and/or chemotherapy.
- Severe cases present with significant spinal canal compromise, necessitating alternative treatment strategies.
Purpose of the Study:
- To compare the efficacy of surgical decompression and adjuvant therapy versus non-surgical management for severe pediatric epidural spinal cord compression.
- To evaluate outcomes in terms of tumor control, neurological function, and pain relief.
Main Methods:
- Retrospective review of 33 pediatric patients with severe spinal cord compression (myelography block or ≥50% canal filling on MRI).
- Comparison of outcomes between 26 patients treated with decompressive laminectomy, subtotal tumor resection, and adjuvant therapy versus 7 patients treated with adjuvant therapy alone.
- Assessment of neurological status, pain levels, and overall patient outcomes.
Main Results:
- Surgical intervention resulted in improvement or stability in 25 of 26 patients, while 4 of 7 non-surgical patients deteriorated.
- Significant pain reduction was observed immediately following surgery in the operative group.
- No surgical mortality or morbidity was reported.
Conclusions:
- Children with severe spinal cord compression require aggressive management.
- A combination of surgical decompression, tumor removal, and adjuvant therapy is the optimal treatment strategy.
- This multimodal approach offers superior outcomes for pediatric patients with malignant epidural spinal cord tumors.
Abstract:
Epidural spinal cord compression by a malignant tumor is a rare occurrence in children. Both the tumors involved and the extent of involvement of the vertebral column are different in children and adults. Often, the epidural tumor in a child is identified before significant spinal canal compromise has occurred, and these children frequently can be managed by radiation therapy and/or chemotherapy. There is a group of children, however, who have severe spinal canal encroachment by a tumor, as evidenced by a near complete or complete block on myelography. In this study, we report a group of patients with severe spinal cord compression, as documented by imaging studies. We compared the results of a decompressive laminectomy and subtotal tumor resection followed by adjuvant therapy with the results obtained with radiation therapy and/or chemotherapy alone. Thirty-three patients met the criteria for inclusion in the study. Twenty-six were treated with a laminectomy and adjuvant therapy, and 7 were treated without surgical intervention. With surgical therapy, 25 of 26 epidurals were either improved or stable, whereas 4 of 7 nonsurgical patients deteriorated. Especially notable was a decrease in pain in the operative patients immediately after their procedure. There was no surgical mortality or morbidity. The results of this study indicate that children with severe spinal cord compression as evidenced by a near complete or complete block on myelography or filling of 50% or more of the spinal canal on magnetic resonance imaging are best treated by a combination of surgical decompression and tumor removal followed by adjuvant therapy.