Objectives: To assess the magnitude of management delay of pediatric malignant spinal cord compression (MSCC).
Methods: Twenty-four patients with MSCC were recruited from 3 Egyptian pediatric oncology centers and assessed for MSCC clinical presentations, evaluation, and treatment response.
Results: There was a median delay of 42 days from the onset of symptom until confirmed diagnosis. All studied patients presented inability to walk; 79% had pain (more in older patients) and 17% had sphincteric dysfunction. A total of 58.3% had a single level of cord compression, 41.7% had multiple levels. Thoracic spine was commonly involved (41%). Final diagnosis was: neuroblastoma (29.2%), soft-tissue sarcomas (20.8%), neuroectodermal tumor (16.6%), non-Hodgkin lymphoma (12.5%), astrocytoma (4.2%), malignant teratoma (8.4%), Wilms tumor (4.2%), and leukemia (4.2%). Magnetic resonance imaging of the spine was diagnostic in all cases. A total of 83.3% of patients received emergency steroid therapy and 75% showed improvement. Disease-specific therapy was multimodality therapy in 88.5% with 71.42% showing improvement. Lymphomas had the best neurological outcome (100%) followed by soft-tissue sarcomas (80%) and neural tumors (72.7%). The 3-year overall survival was 79.2%.
Conclusions: Spinal cord compression is a serious complication and unacceptable management delay can result in preventable loss of function. Emergency magnetic resonance imaging evaluation is the most sensitive diagnostic imaging. Majority of patients improve after definitive therapy.