Case Report: Management of cervical intramedullary spinal cord metastasis from NSCLC with a literature review

TL;DR

A rare case of cervical spinal cord metastasis from lung cancer is presented with a literature review showing that combined treatments can improve survival and function.

Contribution

A surgical-led, multimodal management approach for cervical ISCM from NSCLC is proposed, supported by a literature review of 68 cases.

Findings

Multimodal therapy combining surgery and chemotherapy improved survival to 15.0 months in a subgroup.

Cervical spine was the most commonly involved segment in 47.1% of cases reviewed.

Aggressive yet strategic interventions achieved long-term functional preservation and survival in the presented case.

Abstract

Intramedullary spinal cord metastases (ISCM) from non-small cell lung cancer (NSCLC) are rare and carry a grave prognosis. Cervical segment involvement is exceptionally uncommon, and its distinct clinicopathological profile is not well characterized.

We present the case of a 72-year-old male with a history of NSCLC who developed acute quadriparesis and sphincter dysfunction. Cervical magnetic resonance imaging (MRI) revealed a C7 intramedullary mass. The patient underwent C6-T1 laminectomy with microsurgical gross-total resection. Histopathology confirmed metastatic lung adenocarcinoma. We supplemented this case with a systematic literature review of NSCLC-derived ISCM cases to summarize demographic, clinical, and therapeutic outcomes.

Histopathology confirmed metastatic lung adenocarcinoma. Postoperatively, the patient's neurological function improved. Although local recurrence was detected at 11 months and treated with salvage radiotherapy, the patient nevertheless maintained ambulatory function and was alive at the 18-month follow-up. Our literature review of 68 cases with complete data identified a male predominance (4.2:1 ratio) and a mean age of 58.1 years. The cervical spine was the most commonly involved segment (47.1%). Analysis of treatment modalities revealed that multimodal therapy, particularly the combination of surgery and chemotherapy (potentially incorporating modern agents such as immune checkpoint inhibitors), was associated with improved survival, with a mean overall survival of 15.0 months in this subgroup. This paradigm, centered around maximal safe resection, successfully achieved long-term functional preservation and survival.

Cervical ISCM from NSCLC represents one of the most challenging complications in spinal oncology. This case, supported by our literature review, provides a surgical-led, multimodal management template for spine surgeons, demonstrating that aggressive yet strategic intervention can achieve favorable long-term neurological and survival outcomes.

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