Clinical features and outcomes of spinal involvement in lymphoma: a single-center retrospective study

To investigate the clinical characteristics, neurological manifestations, and survival outcomes of patients with pathologically confirmed spinal lymphoma and to identify factors associated with prognosis.

We retrospectively reviewed consecutive patients with pathologically confirmed spinal lymphoma treated at the First Affiliated Hospital, Zhejiang University School of Medicine, between Jan 2012 and Dec 2025. Clinical characteristics, treatment patterns, and survival outcomes were analyzed. Overall survival (OS) was estimated using the Kaplan-Meier method, and prognostic factors were evaluated using Cox proportional hazards models.

Sixty-three patients were included. The median age was 63 years, and 90.5% presented with primary spinal disease. Pain (82.5%) and neurological impairment (58.7%) were the most common presenting manifestations. Aggressive B-cell lymphoma was the predominant histological subtype (54.0%), and the thoracic spine was the most frequently involved level (61.9%). The estimated 5-year OS was 54% (95% CI, 32%-77%). Neurological impairment, paraplegia, histological subtype, and primary versus secondary spinal involvement were not associated with OS. In multivariable analysis, age >60 years independently predicted inferior survival (HR, 4.04; 95% CI, 1.22-13.39; *P*=0.023).

This study represents one of the largest single-center cohorts of pathologically confirmed spinal lymphoma. Spinal lymphoma most commonly presented with pain, neurological impairment, and thoracic involvement. Although neurological deficits were frequent at diagnosis, they were not independently associated with long-term survival. Older age was the only independent prognostic factor, while the prognostic value of neurological status requires confirmation in larger multicenter studies.