395 - Primary or Metastatic Spine Tumors with Back/Neck and/or Radicular Pai...

#395 Primary or Metastatic Spine Tumors with Back/Neck and/or Radicular Pain as Initial Presentation: Experience from a Scoliosis and Spine Tumor Center at a Community Hospital

Spine Tumors

Poster Presented by: I.H. Lieberman

Author(s):

I.H. Lieberman (1)
X. Hu (1)

(1) Texas Back Institiute, Texas Health Presbyterian Hospital Plano, Scoliosis and Spine Tumor Center, Plano, TX, United States

Abstract

Introduction: Back/neck and/or radicular pain is commonly caused by spinal degenerative diseases. However, patients with primary or metastatic spine tumors could also have such symptoms as their initial presentation. Clinically, these patients could easily be misdiagnosed as degenerative diseases by healthcare providers which could lead to delayed and/or inappropriate treatments. The purpose of this study was to review the presentation and treatment course of a series of patients presenting with back/neck and/or radicular pain and treated for such, but whose pain was related to tumor.

Methods: Between April 2010 and May 2013, we treated 21 patients who initially presented with back/neck and/or radicular pain but were diagnosed with primary or metastatic spine tumors after further workup and surgery. Medical records were reviewed and the patients┬┤ treatment course were documented. The VAS for back/neck pain and leg/arm pain, ODI and NDI scores were recorded pre-operatively and at the latest follow up.

Results: Eleven of the 21 patients were male. The mean age of the patients was 54 years (range 28-86 years). The initial presentations were: back pain (10 patients), back pain and leg pain (6 patients), leg pain (2 patients), neck pain (2 patients), neck and arm pain (1 patient). The median duration of the symptoms was 3 months (range 2 weeks - 3 years) and most of the patients had received various non-operative treatments including physical therapy, epidural steroid injection, facet block, SI joint injection, intramuscular steroid injection, pain medications, etc (Figure 1). One patient had received a CT guided biopsy but the result was negative. Further workup at our center showed vertebral body lesions in 10 patients, vertebral compression fracture in 4 patients, extradual mass in 3 patients, spinal canal mass in 2 patients and intradural mass in 2 patients. All patients received surgical intervention including biopsy, vertebroplasty, kyphoplasty, laminectomy, decompression, tumor resection and/or instrumentation and stabilization. Pathological diagnosis was obtained in all the patients which included metastatic lung cancer (5), multiple myeloma (4), metastatic renal cancer (3), schwannoma (2), lymphoma (2), metastatic breast cancer (1), paraganglioma (1), myeloid sarcoma (1), giant cell tumor (1) and angiosarcoma (1). Fourteen patients reported improvements of their initial symptoms at the latest follow up (range 2-26 months) and seven patients were lost to follow up (Figure 2).

Conclusions: Primary or metastatic spine tumors with back/neck and/or radicular pain as initial presentation are uncommon and may be easily misdiagnosed. A malignant cause of back/neck and/or radicular pain should not be forgotten during the initial evaluation as misdiagnosis and mistreatment can have serious consequences.

Figure 1

Figure 2