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. 2013 Mar;22(3):569-76.
doi: 10.1007/s00586-012-2534-2. Epub 2012 Oct 18.

Surgery and survival outcomes of 22 patients with epidural spinal cord compression caused by thyroid tumor spinal metastases

Dan Zhang  1 , Huabin Yin, Zhipeng Wu, Xinghai Yang, Tielong Liu, Jianru Xiao
Affiliations

Surgery and survival outcomes of 22 patients with epidural spinal cord compression caused by thyroid tumor spinal metastases

Dan Zhang et al. Eur Spine J. 2013 Mar.

Abstract

Purpose: The aim of this study was to discuss the clinical presentation, imaging findings, treatments received, and outcome of therapies for patients with epidural spinal cord compression caused by thyroid spinal metastases, with the goal of emphasizing the importance of surgery in this setting and discussing therapeutic plan for treating these patients.

Methods: A total of 22 patients with spinal cord compression due to thyroid tumor spinal metastases who received surgery in our department were identified from 2004 to 2011. The series of 22 patients collected from our institution over the past 7 years was used to discuss treatment options for thyroid cancer spinal metastases on the basis of literature review and our own extensive experience.

Results: The mean age of the patients in this study was 57 years (range 37-78 years). The duration of the preoperative symptoms was 1-24 months, with an average of approximately 6 months. All patients attained improvement of at least one level of the Frankel classification after surgery. Two patients received more than one operation at our institution. Two patients died during follow-up, two patients had stable disease, and all other patients maintained a disease-free status during follow-up.

Conclusions: As thyroid tumor spinal metastases have a favorable prognosis, a radical therapeutic attitude should be considered in decision-making. Dorsal spinal decompression through curettage and stabilization can preserve or restore neurological function for most patients. For patients who have more than one metastatic lesion of the spine, surgeries can be sequentially performed based on the urgency of the case. In addition to treatment of primary disease, surgery and bisphosphonate treatment are the most important therapies for these patients.

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Figures

Fig. 1
Fig. 1
A 63-year-old woman (case 1). Preoperative computed tomography (CT) scan (a) and magnetic resonance imaging (b) allowed evaluation of tumor size and spinal involvement. The patient underwent a total spondylectomy of the anterior and posterior combination. A post-surgical plain radiograph (c) showed reconstruction with an anterior titanium plate and titanium mesh filled with bone cement and a posterior screw–rod system. (d) Magnetic resonance imaging at the 3-month follow-up where no relapse was detected. No worsening of the neurologic status has been observed and the patient is continuing follow-up
Fig. 2
Fig. 2
A 59-year-old man (case 17). Preoperative computed tomography (CT) scan (a) and magnetic resonance imaging (b). c The left thyroid gland showed high Tc-99 m uptake. Pre-surgical embolization (d). Post-surgical X ray (e). A titanium mesh filled with bone cement was used as a replacement of the involved vertebral body. Extra bone cement was used to consolidate the structure
See this image and copyright information in PMC

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