Introduction: Patients with lymphoma involving the spinal column may present with debilitating pain, neurological compromise resulting from spinal cord compression, or loss of spinal integrity. We sought to compare the clinical presentation, treatment, and post-treatment clinical outcomes of patients diagnosed with malignant lymphoma of the spinal column who underwent either medical or surgical intervention.
Methods: The medical records of 30 patients with histologically proven spinal lymphoma were retrospectively reviewed for demographic information, presenting characteristics, treatment, and outcome data. This study excluded patients who failed medical clearance for surgery and patients with insufficient follow-up data.
Results: Eleven patients were managed with chemotherapy and/or radiotherapy, and 19 patients underwent surgical intervention (84% of surgical patients with an unknown diagnosis at time of surgery). All surgical patients received postoperative adjuvant therapy with 21% also being exposed to adjuvant therapy preoperatively. The median length of follow-up was 16 and 3 months for the medical and surgical groups, respectively. In both groups, the thoracolumbar spine was the most common site for these lesions. In patients undergoing surgical intervention, 4 patients were non-ambulatory at baseline with only one of these patients surviving beyond 6 months. All living patients with complete follow-up data (n=14) saw an improvement or a preservation of neurological function at one year, regardless of treatment group. The overall mean survival was 87.6 months with a mean survival of 100.4 and 79.6 months for the medical and surgical groups, respectively.
Conclusions: For this study cohort, indications to undergo surgery included: emergent neurological deterioration, mechanical stabilization of the spine, refractoriness to medical management, or most frequently performing an open biopsy to obtain a pathological specimen. Comparison of medical and surgical management found no significant difference in the initial presentation and clinical outcomes following treatment. However, future prospective studies on patients with surgical indications are needed to provide further information.
Patient Care: Clinicians will be able to identify patients who are potentially more suitable for surgical intervention in the treatment of malignant lymphoma of the spinal column.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe potential indications for surgery in patients diagnosed with malignant lymphoma of the spinal column; 2) Describe the comparative outcomes of patients treated with either medical or surgical intervention.