Bone tumors of the spine and epidural cord compression: Treatment options

Cord compression secondary to spine tumors, is generally associated with metastatic disease and are often caused by epidural involvement of a primary malignant bone tumor and is even observed- although rarely-with a benign tumors. The rarity of primary bone tumors makes it very important to point out the diagnostic therapeutic neurological complications. Emergency decompression surgery is generally effective (temporarily at least) for neurological symptoms but sometimes prevents or even interferes with the appropriate oncological treatment. The treatment of primary tumors is based on a combination of surgery and adjuvants, and must be decided after a careful oncological and surgical staging. Missing the differential diagnosis between primary and secondary neoplastic disease may lead to incorrect treatment of a primary tumor, which is the first objective to achieve. Incidence and patterns of cord compression due to bone tumors of the spine have been studied on 599 cases observed at Rizzoli Institute, Bologna, Italy. A rate of 35% of cord compression, mostly permanent, was observed in primary malignant bone tumors, higher than the incidence verified in metastases and malignant hemopathies (20%). Even benign tumors can cause severe neurological damage (6%), though most recover after treatment. The higher incidence of cord compression associated with primary malignant tumors can be explained by the rapidity of the tumor growth, which could also be responsible also for the permanent effects on the involved neurological structures: A 77% recovery rate is associated with incomplete neurologic deficits caused by benign tumors versus 22% in malignant tumors. The treatment of neurological problems caused by primary tumors is included in the oncological-guided planning of the tumor, whereas in metastatic lesions the first objective to pursue is to achieve a complete decompression and to provide adequate stabilization. A definitive histological diagnosis- obtained at least by frozen section-must precede any therapeutic approach to cord compression caused by neoplastic disease.