Clinical Characteristics, Histopathological Profile, and Postoperative Outcomes of Tumoral Radiculomedullary Compressions

TL;DR

This study examines spinal tumors causing nerve compression, finding that benign tumors are more common and that metastases from prostate cancer lead to worse outcomes.

Contribution

The study provides a detailed analysis of clinical and histopathological features of tumor-related spinal compressions in a specific clinical setting.

Findings

Benign tumors, especially meningiomas, were more common than malignant tumors in causing radiculomedullary compression.

Metastatic tumors, primarily from prostate cancer, were associated with significantly worse neurological outcomes.

Male patients over 50 years old were more likely to have malignant spinal tumors.

Abstract

Background and objectives

Spinal tumors can cause slow radiculomedullary compression and often lead to severe neurological dysfunction for the patient. The objective of this study was to describe the clinical characteristics, histopathological profile, and postoperative outcomes of tumor-related radiculomedullary compressions.

Methods

This was a prospective cohort study conducted from January 2020 to June 2024 concerning cases of spinal tumors responsible for a radiculomedullary compressive syndrome at the Department of Neurosurgery, University Teaching Hospital of Kinshasa. The variables of interest included sex, age, cause, level of the lesion, the American Spinal Injury Association (ASIA) score, the Spinal Cord Independence Measure (SCIM) score, treatment, postoperative outcome, and complications.

Results

Thirty-four patients were operated on for tumor-related radiculomedullary compression. There were 19 males and 15 females, and the male-to-female ratio was 1.2:1. Patients under 50 years represented 52.9% of cases. The average age was 48.06 ± 18.92 years. Most patients presented with pain at the lesion site (64.7%), incomplete paraplegia (76.6%), and bladder-sphincter dysfunction (41.2%). The average preoperative delay was 124.18 ± 73.34 days. Less than one-third of the patients (29.4%) had comorbidities. Twenty-six patients (76.6%) were classified as ASIA grade B, and 27 patients (79.4%) had a SCIM score below 40. Most lesions were located in the thoracic (55.9%) and lumbar (36.3%) segments. Nineteen tumors (55.9%) were intradural extramedullary, 14 were extradural (41.2%), and one was an intramedullary tumor, an ependymoma (2.9%). There were 20 benign lesions (58.8%) and 14 malignant lesions (41.2%). Benign lesions, mainly meningiomas (47.1%), predominated in female patients (p = 0.002), with no age preference (p = 0.082). Malignant tumors predominated in male patients (p = 0.002) over the age of 50 years (p = 0.017), all of which were metastases (14/14: 100%), mostly from prostate adenocarcinoma (64.2%), followed by breast adenocarcinoma (21.4%). Patients with metastatic compression had 16 times higher risk of worsening or persistent neurological deficits (OR: 16.32, CI: 2.61-100.44, p = 0.003) compared to those with benign tumors (OR: 0.06, CI: 0.01-0.38, p = 0.003).

Conclusion

This study shows that benign tumors are more frequent than malignant tumors as causes of tumor-related radiculomedullary compression operated on in our department. Meningiomas predominate among intradural extramedullary tumors. Metastases are the most frequent malignant tumors, with prostate adenocarcinoma being the most common histopathological type, often associated with poor neurological outcomes.

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