The Role of the Surgery in the Case of an Intramedullary Spinal Cord Metastasis as a Primary Presentation of a Malignant Disease

Abstract

Introduction: Spinal cord metastases represent a small proportion of intramedullary tumors. The occurrence of such lesion over the course of malignant disease is usually a predictor for shortened life expectancy and is often associated with severe neurological deficits. Treatment options include microsurgical excision, radio-, chemo- or palliative therapy. Despite these possibilities the optimal management of patients with intramedullary spinal cord metastases (ISCM) is difficult due to the wide variety of clinical situations and the lack of controlled studies on the results of different therapeutic options. Materials: We are presenting a case of a 68-year-old male with gradually increasing spinal neurological deficit – axial low back pain, numbness and muscle weakness in both legs and gait disturbance. Arterial hypertension was pointed as the only comorbidity of the patient. The MRI showed an intramedullary solitary lesion in the lumbar intumescence at the level of Th12 and L1 vertebra. Results: The patient underwent surgery and the tumor was totally excised. The symptoms improved dramatically. The histology evidence a metastasis from a lung adenocarcinoma. Six months later he presented with severe back pain, progression of the paresis and urinary retention. Tumour recurrence was detected by MRI. After careful decision making and taking into consideration the risk of permanent neurological deficit a reoperation was performed. The lesion was gross-totally removed with improvement in functions and no neurological deterioration registered in the postoperative period. Conclusion: It is possibly the symptoms from an intramedullary metastatic lesion to precede the detection of the primary tumour. The low frequency of occurrence and the absence of a manifested and diagnosed primary malignant process should not stop us thinking in the direction of metastasis. Surgical resection with function preservation is highly aimed. Operation and even reoperation in some cases is acceptable.