Intramedullary spinal cord metastases: a clinical and pathological study of nine cases

The clinical and pathological findings in nine cases of intramedullary spinal cord metastases are reported and are compared with those of previous studies. Intramedullary metastases are more common than is generally believed and the incidence is probably increasing with the more prolonged survival of cancer patients. A wide spectrum of symptoms and signs may be produced, frequently with attendant diagnostic difficulties. Most patients present with myelopathy as the first manifestation of cancer or of its recurrence. Symptoms may be present for several months, with few clinical signs, despite distortion and destruction of much of the spinal cord by tumour. The extent of metastatic disease remains limited in a significant proportion of patients. No neurological symptoms or signs differentiate intramedullary metastases clearly from the more common extradural deposits. However, the diagnosis should be considered when myelopathy evolves more slowly, where plain radiographic evidence of adjacent vertebral disease is absent, and particularly when myelography is normal. Early diagnosis and aggressive medical treatment may provide for a more favourable outcome.