EPIDURAL SPINAL-CORD COMPRESSION IN CHILDREN WITH SOLID TUMORS

The incidence of epidural spinal cord compression in pediatric maligna ncies is reported to be about 3%. Early diagnosis is important, since delay in diagnosis may lead to significant morbidity. In this retrospe ctive study, 15 children (8 boys and 7 girls) having epidural spinal c ord compression among 551 pediatric patients with malignancies (2.7%) admitted to the Division of Pediatric Oncology, Oncology Institute, be tween September 1989 and December 1995 have been reviewed. The median age at diagnosis was 6 years (range, 1 month to 14 years). Spinal cord compression occurred in 7 patients with sarcomas, in 2 with non-Hodgk in's lymphomas, in 3 with neuroblastomas, in 2 with germ cell, tumors and in 1 with Wilms' tumor. Motor weakness occurred in 87%, sphincter dysfunction in 87%, back pain in 53%, sensory abnormalities in 33%, an d extremity pain in 27% of the patients. The median time from onset of symptoms to diagnosis of spinal cord compression was 1 month (range, 3 days to 6 months). Urgent treatment consisted of surgical decompress ion and laminectomy in 3 patients, radiation therapy in 4, surgical de compression and radiotherapy in 6 and only chemotherapy in 2. Neurolog ic dysfunction recovered completely in 5 and partially in 6 patients a t a median time of 2 months. Early recognition of symptoms and signs o f cord compression and immediate therapy are necessary to avoid signif icant morbidity.