PEDIATRICS Vol. 78 No. 3 September 1986, pp. 438-443
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Incidence, Presentation, and Outcome of Spinal Cord Disease in Children With Systemic Cancer

Donald W. Lewis MD1, Roger J. Packer MD1, Beverly Raney MD1, Ihor W. Rak MD1, Jean Belasco MD1, and Beverly Lange MD1

1 From the Divisions of Neurology and Pediatrics, Children's Hospital of Philadelphia; and Departments of Neurology and Pediatrics, University of Pennsylvania, Philadelphia

During a 40-month period, in 24 of 643 (4%) newly diagnosed patients with systemic cancer younger than 18 years of age (range: 3 months to 17 years) spinal cord disease developed. Patients with spinal cord disease included 21 children with metastatic spinal cord compression, two with treatment-related transverse myelopathies, and one with an anterior spinal artery stroke. Spinal cord disease occurred in 13 of 102 children (12%) with sarcomas, six of 82 (7%) with neuroblastomas, and four of 94 (4%) with lymphomas. Spinal cord compression occurred as the presenting sign of malignancy in six children (four with sarcomas and two with lymphomas). In the remaining 15 patients, cord compression occurred a median of 13 months after initial diagnosis, and in four patients it occurred at the time of first relapse. Symptoms of metastatic cord compression included back pain in 17 patients (80%), weakness in 14 (67%), sphincter dysfunction in 12 (57%), and sensory abnormalities in three (14%). Findings on plain radiographs of the spine were abnormal in only seven of 20 patients with cord compression, and myelography was needed to differentiate compression from other causes of spinal cord disease. Treatment included high-dose corticosteroids followed by operation (seven patients) or radiotherapy (14 patients). After treatment, nine of 15 nonambulatory patients became ambulatory, and five of 10 incontinent patients regained sphincter control. None of the patients with nonmetastatic spinal cord disease had a satisfactory outcome. Incorrect and delayed diagnosis was frequent in children with spinal cord disease (median time from onset of symptoms to diagnosis, 2 weeks) and 12 children were paraplegic and ten had loss of sphincter control at diagnosis. Spinal cord disease is a relatively common neurologic emergency in children with cancer, especially in those with sarcoma, and requires immediate investigation and intervention.

Key Words: spinal cord disease • spinal cord compression • epidural cord compression • metastatic cancer • neurooncology

Submitted on November 15, 1985
Accepted on December 26, 1985




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