Spinal epidural involvement in haematological tumors: clinical features and therapeutic options

Haematological malignancies that may cause epidural spinal cord compression (SCC) include plasma cell dyscrasias, lymphomas and infrequently leukemias. Bone lesions are the major clinicopathologic manifestations in plasma cell dyscrasias but are evident in less than 30% of patients with SCC due to lymphomas. The incidence of SCC in solitary plasmacytomas is between 43 to 71%, in contrast to 7.4 to 16% in multiple myeloma where vertebral involvement is always present. The incidence of SCC in Hodgkin's disease and in non-Hodgkin's lymphomas is about 4 and 2.5% respectively. Spinal computed tomography, myelography and magnetic resonance imaging serve for establishing a definite diagnosis, assessment of tumor location within the spinal canal, delineation of the involved spinal levels, evaluation of spinal stability and for detection of extraosseous paravertebral extension. Treatment planning is based on the information obtained above, combined with clinical considerations. The primary modalities of therapy are radio- and chemotherapy. Surgery is reserved for those cases presenting with SCC when tissue diagnosis is unavailable, recurrence of SCC after previous irradiation and for spinal instability or compression of the neural elements by impinging bone fragments.