Skip to main content
SpringerLink
Log in

Intradural spinal metastases: a surgical series of 15 patients

  • Clinical Article
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Intradural spinal metastases are rare, and little is known regarding surgical indications and outcomes.

Methods

A retrospective search identified adults with intradural spinal metastases operated on at the Mayo Clinic from 1994-2011. Data were collected regarding demographics, tumor type and location, and outcomes.

Results

Fifteen patients with intradural spinal metastases were investigated. The age range was 38-74 years (mean = 55 years; ±SD = 11.1). Predominant tumor location and type were lumbosacral and adenocarcinoma, respectively: 3 intramedullary and 12 extramedullary. Patients were operated on to relieve or prevent progressive/intractable neurological sequelae and/or pain. Of 13 who underwent resection, gross total removal was reported in 10; simple biopsy was performed in 2. There was one surgical complication, no medical complications, and no surgical mortality. At median follow-up of 1 month postoperatively, 10 of 15 patients were stable or improved. Of 13 patients who underwent resection, 10 were stable or improved. Of two patients who underwent biopsy, neither was stable or improved at follow-up. Using the Modified McCormick Scale, 11 of 15 patients were “functional” preoperatively and 4 went from “functional” preoperatively to “non-functional” postoperatively. Three of those four died within 60 days of surgery from systemic disease progression. Median hospital stay was 8 days. Ten of 15 patients died by the end of the study period, and the median survival of 15 patients was 5 months.

Conclusions

With improved outcomes in metastatic cancer, more patients are encountered in practice. An aggressive surgical approach is warranted for extramedullary lesions, whereas caution is advised for intramedullary lesions. Postoperative functional decline is more likely due to systemic disease progression rather than surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

MMS:

Modified McCormick Scale

References

  1. Bartels RH, Feuth T, van der Maazen R, Verbeek AL, Kappelle AC, André Grotenhuis J, Leer JW (2007) Development of a model with which to predict the life expectancy of patients with spinal epidural metastasis. Cancer 110(9):2042–2049

    Article  PubMed  Google Scholar 

  2. Bartels RH, van der Linden YM, van der Graaf WT (2008) Spinal extradural metastasis: review of current treatment options. CA Cancer J Clin 58(4):245–259

    Article  PubMed  Google Scholar 

  3. Chow TS, McCutcheon IE (1996) The surgical treatment of metastatic spinal tumors within the intradural extramedullary compartment. J Neurosurg 85:225–230

    Article  PubMed  CAS  Google Scholar 

  4. Cole JS, Patchell RA (2008) Metastatic epidural spinal cord compression. Lancet Neurol 7(5):459–466

    Article  PubMed  Google Scholar 

  5. Fornasier VL, Horne JG (1975) Metastases to the vertebral column. Cancer 36:590–594

    Article  PubMed  CAS  Google Scholar 

  6. Frey I, Le Breton C, Lefkopoulos A, Perrot N, Khalil A, Chopier J, Le Blanche A, Bigot JM (1998) Intradural extramedullary spinal canal secondary neoplasms: MR findings in 30 patients. Eur Radiol 8:1187–1192

    Article  PubMed  CAS  Google Scholar 

  7. Grant R, Papadopoulos SM, Greenberg HS (1991) Metastatic epidural spinal cord compression. Neurol Clin 9:825–841

    PubMed  CAS  Google Scholar 

  8. Harel R, Angelov L (2010) Spine metastases: current treatments and future directions. Eur J Cancer 46(15):2696–2707

    Article  PubMed  Google Scholar 

  9. Kim DY, Lee JK, Moon SJ, Kim SC, Kim CS (2009) Intradural spinal metastasis to the cauda equina in renal cell carcinoma: a case report and review of the literature. Spine 34(24):892–895

    Article  Google Scholar 

  10. Loblaw DA, Laperriere NJ, Mackillop WJ (2003) A population-based study of malignant spinal cord compression in Ontario. Clin Oncol (R Coll Radiol) 15(4):211–217

    Article  CAS  Google Scholar 

  11. McCormick PC, Torres R, Post KD (1990) Intramedullary ependymoma of the spinal cord. J Neurosurg 72:523–532

    Article  PubMed  CAS  Google Scholar 

  12. Mosdal C, Bang F (1981) Intradural spinal metastases. Acta Neurochir (Wien) 56:107–110

    Article  CAS  Google Scholar 

  13. Perrin RG, Livingston KE, Aarabi B (1982) Intradural extramedullary spinal metastasis. a report of 10 cases. J Neurosurg 56(6):835–837

    Article  PubMed  CAS  Google Scholar 

  14. Schick U, Marquardt G, Lorenz R (2001) Intradural and extradural spinal metastases. Neurosurg Rev 24(1):1–5 [discussion 6–7]

    Article  PubMed  CAS  Google Scholar 

  15. Tognetti F, Lanzino G, Calbucci F (1988) Metastases of the spinal cord from remote neoplasms. study of five cases. Surg Neurol 30(3):220–227

    Article  PubMed  CAS  Google Scholar 

  16. van der Linden YM, Dijkstra SP, Vonk EJ, Marijnen CA, Leer JW (2005) Prediction of survival in patients with metastases in the spinal column: results based on a randomized trial of radiotherapy. Cancer 103(2):320–328

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Conflicts of interest

None.

Disclosures

No financial disclosures

Disclosure of funding

Non-funded

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Jason M. Hoover, William E. Krauss & Giuseppe Lanzino

Authors
  1. Jason M. Hoover
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. William E. Krauss
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giuseppe Lanzino
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jason M. Hoover.

Additional information

Comments

Spinal intradural metastases are a growing medical problem; accordingly, publications on the topic are welcomed. A recent paper (October 2011) published in Acta Neurochirurgica on the same subject, harboring a similar number of patients, displayed similar conclusions. The conclusions presented in this paper should be regarded with caution, as this is a highly selected population of surgical patients, and indications for surgery were not clear, in comparison with non-operated patients featuring the same disease.

No doubt, I can see an interest in surgery of spinal intradural metastasis in order to obtain a histopathological diagnosis, to decompress neural elements and increase functional capability, and to relieve pain. However, in this paper there is little data presentation or discussion about the systemic staging of the primary disease, which for me is a key element in the surgical treatment decision. Patients who have a short mean survival after a surgical procedure (5 months as the mean survival rate, and 2 months for non-functional preoperative patients) probably shouldn't be operated on as it comprises an inappropriate use of resources, despite the low complication rate (7%) or the short length of stay (8 days). A pertinent fact, as the authors showed, is that the percentage of functional patients decreased with surgery from 73% to 53%, despite only one patient going from functional to non-functional.

Nevertheless, the authors present interesting data on the epidemiology, location, and natural history of surgically treated patients harboring spinal intradural metastasis. It seems that intramedullary tumors have worse outcomes, and of course biopsy is not a successful form of treatment.

In the strict sense, I don't fully agree with the authors' statement that "an aggressive approach is warranted for extramedullary lesions, whereas caution is advised for intramedullary ones." Even for extramedullary lesions the decision to treat surgically depends on the extent of primary disease and on the systemic disease progression. The key element is systemic oncologic stating and consequent life expectancy. In this perspective, their management isn't different from that for spinal extradural metastases.

Oscar Alves

Porto, Portugal

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hoover, J.M., Krauss, W.E. & Lanzino, G. Intradural spinal metastases: a surgical series of 15 patients. Acta Neurochir 154, 871–877 (2012). https://doi.org/10.1007/s00701-012-1313-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-012-1313-5

Keywords

Search

Navigation