Experiences with metastatic neoplasms involving the spinal cord

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Abstract
Clinical and pathologic data are presented concerning 127 autopsied patients with involvement of the spinal cord and cauda equina by metastatic neoplasms. Carcinomas (C) of the lung, breast, and kidney and malignant lymphomas were the most common primary tumors. Important differences exist in the clinical and radiologic behavior of metastases from different primary sources. Dissociation between motor and sensory dysfunction and the importance of the false sensory level, which may occur below the site of the lesion, are discussed. Sacral sparing with extradural neoplasms is recorded. The syndromes accompanying metastasis at different levels of the cord are examined. Thoracic lesions are most likely to be associated with fulminant onset and progression. Herpes zoster may occur prior to, coincident with, or after the development of symptoms of cord disease and is an accurate index to the site of the lesion. Of 38 patients who had operation 6 had striking improvement. Operation is unlikely to be valuable when (1) the patient manifests a flaccid, areflexic paraplegia or paraplegia has developed in less than 72 hr., (2) sensory loss is complete, and (3) the primary tumor is a carcinoma of the lung. The pathologic changes in the spinal cord are quite variable and consistent clinicopathologic correlation is not possible. The gray matter is spared to a large extent, while the white matter is most often affected by an edematous type of malacia distinct from infarction. Intramedullary metastasis was found in 2 of the 127 patients. Dorsal column, ascending de-myelination is rapid, but the other sensory tracts are irregularly involved.

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