Spinal Solid Cord Compression Malignant Tumors Caused By Children

The medical records of 154 children with solid malignant primary tumors outside the central nervous system were retrospectively reviewed to achieve a better understanding of the incidence, presentation, outcome and treatment options for metastatic spinal cord disease. Of the 154 total, 12 children had symptomatic and 5 had asymptomatic spinal metastases (total 17 cases; 11%). In eight cases, the spinal epidural space had been invaded by the primary malignancy. Four of these eight tumors were sarcomas, and the other four were neuroblastomas. Eight of the 12 symptomatic patients underwent laminectomy, and gross total or subtotal tumor resection andi or spinal fusion. Six of the 12 individuals were ali ve during their last follow-up visit. The study revealed that biological behavior of malignant tumors that produce spinal cord compression in children differs from the behavior of similar tumors in adults. In the children with neuroblastoma who have reasonably good motor function, chemotherapy works rapidly and neurologic improvement can be achieved without surgery. Surgical decompression is recommended for neuroblastoma cases that show rapid neurologic deterioration or complete loss of motor function despite chemotherapy. Compared to neuroblastomas, sarcomas of soft tissue and bone, do not respond as rapidly or dramatically to chemotherapy and radiation. The neurologic outcome in sarcoma cases treated with surgical decompression was significantly better than the outcome in the group that was treated non-surgically. A combined approach with chemotlierapy, radiotherapy and surgery should be the treatment of choice for both primary and metastatic spinal sarcoma.