Article
Spinal metastases – study about the incidence of neurological deficits with and without known primary tumour
Wirbelsäulenmetastasen – Studie zur Inzidenz neurologischer Defizite mit und ohne vorbekannten Primärtumor
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Authors
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Bawarjan Schatlo
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
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Katharina Söchting
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
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Tammam Abboud
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
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Ronja Löber-Handwerker
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
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Annalen Bleckmann
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
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Christian von der Brelie
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
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Veit Rohde
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: Spinal metastases are present in a sizeable proportion of patients with malignant neoplasia. Once neurologic deficits are present, life quality and prognosis decrease. This work is based on the assumption that patients with known malignant disease more frequently obtain medical care and screening. It is also assumed that unspecific back pain in these patients quicker leads in further diagnostic measures. Our aim is to evaluate the hypothesis that the incidence of neurologic deficits is higher in patients without previously known malignant neoplasia.
Methods: We analyzed a consecutive dataset of patients with spinal metastases. Besides demographic and clinical baseline characteristics, we assessed whether neurological deficits were present at admission. Furthermore, we evaluated whether a primary tumor was already known at first admission for spinal symptoms. Uni- and multivariate analyses were performed to assess potential associations of known primary and tumor type with neurological deficits.
Results: N=731 patients were included in the present analysis. Mean age was 63+-13 years. In 182 cases (25%) a motor deficit led to initial presentation. In 549 cases (75%), other symptoms or routine imaging led to the diagnosis of the spinal metastases. 539 patients (74%) already had a previously known primary tumor. In 192 patients (26%) the primary was unknown. In the patient group with known primary, neurologic deficits led to initial presentation in 119/539 cases (22%). In the patient group without known primary this rate was 63/192 (32%; p=0.003).
Conclusion: The likelihood of a symptomatic spinal metastasis to present with a motor deficit is markedly higher in patients without a known primary. However, one in five patients with a known primary tumor suffer from motor deficits at admission. This knowledge should prompt a discussion about the efficacy of current screening intervals and contribute to the prevention of neurological deficits in patients with known malignancies.
