Epidural malignant lymphomas of the spine: collected experiences with epidural malignant lymphomas of the spinal canal and their treatment

• Published in: Spinal cord 2008-04, Vol.46 (4), p.278-281
• Main Authors: Székely, G, Miltényi, Z, Mezey, G, Simon, Z, Gyarmati, J, Gergely, L, Bognár, L, Illés, Á
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anatomy; Ataxia; Ataxia - etiology; Back Pain - etiology; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Bone surgery; Cerebrospinal fluid. Meninges. Spinal cord; Cohort Studies; Computed tomography; Decompression; Epidural Neoplasms - mortality; Epidural Neoplasms - pathology; Epidural Neoplasms - therapy; Female; Human Physiology; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Internet; Lymphoma - mortality; Lymphoma - pathology; Lymphoma - therapy; Male; Medical sciences; Middle Aged; Myelography; N.M.R; Nervous system (semeiology, syndromes); Neurochemistry; Neurology; Neuropsychology; Neurosciences; Neurosurgery; Non-Hodgkin's lymphoma; original-article; Pain; Paraparesis - etiology; Retrospective Studies; Spinal cord; Spine (lumbar); Survival Rate; Thorax; Traumas. Diseases due to physical agents; Treatment Outcome; Tumors
• ISSN: 1362-4393; 1476-5624
• DOI: 10.1038/sj.sc.3102124

Study design: Retrospective study of 13 patients treated by the authors. Objective: To examine the course of the disease of malignant lymphoma (ML) presenting in the epidural area of the spine. Setting: Department of Neurosurgery, Third Department of Internal Medicine, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary. Subjects and methods: The epidural presentation in eight patients was heralded by motor signs (paraparesis and plegia), in one by a lesion of the posterior columns of the spinal cord (ataxia), and in three by pain. One patient was free of complaints and symptoms. The affected epidural area was diagnosed previously by myelography and computerized tomography (CT), and later by magnetic resonance (MR), over the course of which the location was verified as thoracic in eight patients, cervical in one, and lumbar in four. The authors recommended surgical intervention in 9 out of 13 cases, in seven cases of Hodgkin's and six cases of non-Hodgkin's lymphoma. Seven patients were treated for recognized manifestations of malignant lymphoma while six were diagnosed by intraoperative-histological examination. Results and conclusion: The decompression operations for tumors resulted in limited improvement in seven patients (reduction in pain and return of ability to walk). Four patients were not operated on, two of which had significant improvement in their neurological symptoms. Paraparesis remained unchanged in one patient. One patient remained symptom-free. The authors emphasize the importance of interdisciplinary consultation and weighing individual priorities in the indications for operation on epidural ML.