SPINAL CORD COMPRESSION IN PEDIATRIC MALIGNANCIES

The incidence of epidural spinal cord compression in pediatric malignancies is reported to be about 3 %. Early diagnosis is important, because delay in diagnosis may lead to significant morbidity. In this retrospective study, 12 children (8 males, 4 females) presenting with epidural spinal cord compression among 339 pediatric malignancies (3.5 %) admitted to the Pediatric Oncology and Radiation Oncology Divisions, Oncology Institute, University of Istanbul, between September 1989 and December 1993 have been reviewed. The median age is 4 years (1 month-14 years). 10/12 (83 %) had motor weakness, 9/12 (75 %) sphincter disturbances, 7/12 (58 %) back pain, 3/12 (25 %) sensory dysfunction, 2/12 (17 %) extremity pain. The median time from onset of symptoms to diagnosis is 1 month (1 day-6 months). The diognosis was sarcoma in 5 (1 rabdomyosarcoma, 2 Ewing sarcomas, 2 osteosarcomas), non-Hodgkinp lymphoma in 2, neuroblastoma in 2, Wilms tumor in 1, retinoblastoma in 1, yolk-sac tumor in 1 patient; Urgent treatment was surgical decompression and laminectomy in 2, radiotherapy in 4, radiotherapy and surgery in 5, chemotherapy in 1 patient. Neurologic status improved in 8 patients although 6 of them had applied quite late (>1 month) from the onset of symptoms. Early recognition of symptoms and signs of cord compression and immediate therapy is necessary to avoid significant morbidity, but in children it is worthwhile to treat the patient even the diagnosis is late.