165 - Neurological Compromise in Nasopharyngeal Carcinoma with Spinal Metast...

#165 Neurological Compromise in Nasopharyngeal Carcinoma with Spinal Metastasis

Spine Tumors

Poster Presented by: N.S. Kumar

Author(s):

N.S. Kumar (1)
J. Tan (1)
J. Lim (1)
A.S. Zaw (1)

(1) National University Health System, Orthopaedic Surgery, Singapore, Singapore

Abstract

Summary: The incidence, presentation and management of neurological involvement related to spinal metastasis from nasopharyngeal carcinoma (NPC) were evaluated among 814 patients with NPC. Spinal metastasis is common in patients with NPC and back pain is the usual presentation. Neurological deficits resulting from spinal cord compression occur infrequently. When presented with neurological compromise, the most common management was radiotherapy, with surgery only being offered to patients who developed neurological deficit or pathological fracture resulting in unresolved severe pain post radiotherapy.

Introduction: Nasopharyngeal carcinoma has been reported to have a higher incidence of distant metastases to the spine. This study was conducted to evaluate the incidence, presentation and management of neurological involvement related to spinal metastasis from nasopharyngeal carcinoma.

Methods: 814 patients with the diagnosis of NPC who presented to the National University Hospital (NUH), Singapore, over a 5-year period (2007-2011) were recruited for this study. Case records from clinics, wards, operating theatres at NUH and nationwide electronic records of polyclinics and Emergency Medical Department (EMD) were obtained and reviewed. The data collected included demographics, medical history, radiologic and histopathology reports.

Results: Of 814 patients with NPC, 99 had spinal metastasis. 26 were treated with radiotherapy, 25 with chemotherapy, 5 with both chemo and radiotherapy and 6 with surgery. Out of 6 patients requiring spinal surgical procedure, 3 had neurological deficits in the form of focal sensory or motor deficits and 4 had symptoms of pathologic fracture. One patient had both neurological deficit and pathological fracture. All these 6 patients were treated with a spinal surgical procedure of stabilization and/or decompression.

Conclusion: Spinal metastasis is common in patients with NPC and back pain is the usual presentation. Neurological deficits resulting from nerve root or spinal cord compression occur infrequently. When presented with neurological compromise, the most common management was radiotherapy, with surgery only being offered to patients who developed neurological deficit or pathological fracture resulting in unresolved severe pain post radiotherapy.