Article
Incidence of neurological deficits prior to detection of a spinal metastasis in patients with or without known primary tumor
Search Medline for
Authors
-
Turab Gasimov
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
-
Bawarjan Schatlo
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
-
Veit Rohde
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
| Published: | June 18, 2018 |
|---|
Outline
Text
Objective: Spinal metastases are present in a sizeable proportion of patients with neoplasia. In some patients, the spinal metastasis is the primary manifestation of the disease, sometimes even with sudden neurological deficits such as paraplegia. Once neurological deficits are present, the resulting functional impairment has a detrimental impact on survival. In patients with a known primary, regular staging and minor symptoms should hypothetically lead to a more expedient detection of spinal metastases. The aim of the present analysis was to assess whether previously known primary tumors present less frequently with neurological deficits.
Methods: We analyzed a consecutive dataset of patients undergoing surgery for metastatic spinal disease. Patient symptoms at presentation were dichotomized into presence and absence of neurological deficits. Moreover, we assessed whether a primary tumor was known at the time of detection of the spinal metastasis.
Results: N=224 patients were included in the present analysis. Mean age was 65±11years. Neurological deficits were present in 122 cases (54.5%) at first diagnosis of spinal involvement. Other symptoms or routine imaging led to discovery of spinal metastases in 102 cases (45.5%). In 180/225 (80.4%) patients the primary tumor was known at the time of spinal manifestation. In the remaining 44 (19.6%) the primary was unknown. Patients with a known primary tumor had preoperative neurological deficits in 103/179 cases (57.5%) while in patients without a known primary, this rate was 19/45 (42.2%). This difference showed a trend towards a higher rate of neurological deficits in patients with known primaries but failed to reach significance (Chi2, p=0.065).
Conclusion: Contrary to our initial hypothesis, the rate of patients presenting with a neurological deficit was higher – although not statistically significant – in patients with a known primary tumor. Preventive measures and increased screening efforts may be necessary to detect spinal metastases earlier and improve outcomes and quality of life.
