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A Neonatal Mouse Spinal Cord Compression Injury Model
Published on: March 27, 2016
Malignant spinal cord compression in the paediatric population-a systematic review, meta-analysis
N A Quraishi1, N Palliyil1, Mohamed A Hassanin2,3
1Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
Insights
Malignant spinal cord compression (MSCC) in children is most commonly caused by neuroblastoma and sarcoma. Prompt diagnosis and multimodality treatment are crucial for neurological recovery in pediatric cancer patients.
Area of Science:
- Pediatric Oncology
- Neurology
- Systematic Review
Background:
- Malignant spinal cord compression (MSCC) affects 3-5% of children with primary tumors, potentially causing permanent neurological deficits.
- Prompt diagnosis and treatment are essential for managing MSCC in pediatric patients.
- This systematic review aims to inform national guidelines for MSCC in children under 18.
Approach:
- A systematic review adhering to PRISMA guidelines was conducted.
- Searched English-language literature from 1999-2022 using terms like 'MSCC in children,' 'pediatric,' and 'metastases.'
- Excluded case reports/series with fewer than 10 patients, analyzing 7 eligible articles (Level III/IV evidence).
Key Points:
- Neuroblastoma (62.7%) and sarcoma (14.2%) are the leading causes of pediatric MSCC.
- Motor deficits (95.6%) were the most common presenting symptom, followed by pain (65.4%).
- A median delay of 26 days occurred between symptom onset and diagnosis, impacting prognosis.
Conclusions:
- Neuroblastoma and sarcoma are primary drivers of MSCC in children, with soft tissue sarcomas more common in older children (>5 years).
- Multimodality treatment (chemotherapy, radiotherapy, surgery) is recommended, with early surgical consideration for rapid neurological decline.
- Future spinal deformities are a risk following laminectomy/decompression and asymmetrical radiation.
Background:
Malignant spinal cord compression (MSCC) has been noted in 3-5% of children with primary tumours. MSCC can be associated with permanent neurological deficits and prompt treatment is necessary. Our aim was to perform a systematic review on MSCC in children < 18 years to help formulate national guidelines.
Methods:
A systematic review of the English language was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search criteria included 'MSCC in children, paediatric and metastases' for papers published between January1999 and December 2022. Isolated case reports/case series with < 10 patients were excluded.
Results:
From a total of 17 articles identified, a final 7 were analysed (Level III/IV). Neuroblastoma constituted the most common cause for MSCC in children (62.7%) followed by sarcoma (14.2%). Soft tissue sarcomas were the most frequent cause of MSCC in children > 5 years old, while for neuroblastomas, the mean age of presentation was 20 months. The median age at time of diagnosis for the entire cohort of patients was 50.9 months (14.8-139). The median follow-up duration was 50.7 months (0.5-204). Motor deficits were the presenting symptom in 95.6% of children followed by pain in 65.4% and sphincter disturbance in 24%. There was a delay of about 26.05 days (7-600) between the onset of symptoms and diagnosis. A multimodality approach to treatment was utilised depending on the primary tumour. The prognosis for neurological recovery was found to be inversely proportional to the degree of neurological deficits and duration of symptoms in four studies.
Conclusion:
Neuroblastoma is the most common cause for MSCC in children (62.7%) followed by sarcoma (14.2%), whilst soft tissue sarcomas constituted the most frequent cause of MSCC in children > 5 years old. The majority of patients presented with motor deficit, followed by pain. In children with neuroblastoma /lymphoma, chemotherapy was the primary treatment. Early surgery should be a consideration with rapid deterioration of neurology despite chemotherapy. A multimodality approach including chemo-radiotherapy and surgery should be the treatment of choice in metastatic sarcomas. It is worth noting that multi-level laminectomy/decompression and asymmetrical radiation to the spine can lead to spinal column deformity in the future.
