1686 SPINAL CORD COMPRESSION (SCC) IN CHILDREN WITH SYSTEMIC CANCER

Abstract

SCC is a neurologic emergency requiring immediate diagnosis and intervention. Over a 40-month period, 21 of 643 newly-diagnosed patients under age 18 with systemic cancer developed SCC; occurring in 12 of 102 (11%) with sarcoma; 5 of 82 (6%) with neuroblastoma and 3 of 94 (3%) with lymphoma. SCC occurred at presentation of illness in 6 children and symptoms were present for a median of 2 weeks (range 5 days to 4 weeks) before diagnosis. In the remaining 14 patients, SCC occurred a median of 13 months after initial diagnosis. Symptoms of SCC included back pain in 17 (80%), weakness in 14 (67%), sphincter dysfunction in 12 (57%) and sensory abnormalities in 3 (14%). Because of delayed diagnosis, 9 children were paraplegic and 10 had complete loss of sphincter control at diagnosis. Plain radiographs of the spine were abnormal in 7 of 20 patients with SCC. During this time period, 4 other children with cancer had cord dysfunction symptoms (2 transverse myelographies, 1 stroke, 1 plexopathy); myelography differentiating these from SCC. Treatment included high-dose corticosteroids followed by surgery and/or radiotherapy. Post-treatment, 8 of 14 nonambulatory patients became ambulatory and 5 of 10 incontinent patients regained sphincter control. We conclude that SCC is relatively frequent in children with cancer (especially with solid tumors) and is often misdiagnosed early in the illness. Any child with cancer suffering back pain is suspect for SCC and plain x-rays are inadequate to rule out SCC. Recommendations concerning evaluation and management of children with possible SCC will be presented.

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