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Intramedullary spinal cord metastases: an institutional review of survival and outcomes

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Abstract

Introduction

Intramedullary spinal cord metastases (ISCMs) are rare lesions affecting the spinal cord in patients with disseminated malignancy. Today, due to increased survival, these lesions are more frequently diagnosed. Literature on survival and neurologic outcomes is sparse. Herein, we describe a single institutional case series on ISCMs reported to date in the English literature.

Methods

We retrospectively analyzed the medical records of patients diagnosed with intramedullary metastatic lesions at our institution between 1997 and 2016. We analyzed different approaches to management and factors influencing survival and neurologic outcomes.

Results

A total of 70 patients (86 lesions) were analyzed. Most lesions were found in thoracic spinal cord (50%) followed by cervical (34%) and conus medullaris (14%). Mean age at diagnosis was 55.6 ± 10.6 years with 60% (n = 42) being females. Median survival was 104.5 days (range 1–888 days). Twenty-three patients (33%) received conservative management, 39 (56%) received palliative radiotherapy, whereas 8 (11%) underwent surgery with one patient receiving only a biopsy. Age, sex, presence of concomitant brain and other systemic metastasis didn’t influence survival. Patients with solitary metastases had longer survival compared to multiple lesions (3.6 vs. 2.2 months, p = 0.01). In patients with solitary lesions without brain metastasis, surgical resection was associated with significantly longer survival (6 months vs. 3 months, p = 0.02).

Conclusion

The overall survival in patients with intramedullary metastasis remains poor. Surgical management may contribute to improved survival and neurologic outcomes in selected patients. Intramedullary metastasis may have a greater role on overall survival compared to systemic metastatic burden.

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Abbreviations

ISCM:

Intramedullary spinal cord metastases

SD:

Standard deviation

MMCS:

Modified McCormick Score

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Author notes

  1. Anshit Goyal and Yagiz Yolcu have contributed equally to the manuscript.

Authors and Affiliations

  1. Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA

    Anshit Goyal, Yagiz Yolcu, Panagiotis Kerezoudis, Mohammed Ali Alvi & Mohamad Bydon

  2. Department of Neurologic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA

    Anshit Goyal, Yagiz Yolcu, Panagiotis Kerezoudis, Mohammed Ali Alvi, William E. Krauss & Mohamad Bydon

Authors
  1. Anshit Goyal
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  2. Yagiz Yolcu
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  3. Panagiotis Kerezoudis
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  4. Mohammed Ali Alvi
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  5. William E. Krauss
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  6. Mohamad Bydon
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Correspondence to Mohamad Bydon.

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The authors declare that they have no conflicts of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Goyal, A., Yolcu, Y., Kerezoudis, P. et al. Intramedullary spinal cord metastases: an institutional review of survival and outcomes. J Neurooncol 142, 347–354 (2019). https://doi.org/10.1007/s11060-019-03105-2

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  • DOI: https://doi.org/10.1007/s11060-019-03105-2

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