J Neurol Surg A Cent Eur Neurosurg 2012; 73 - P033
DOI: 10.1055/s-0032-1316235

Intradural Spinal Tumor and Degenerative Spine Disease in Patients with Back Pain: Treatment Strategies

D. Bellut 1, U. Mutter 1, M. Sutter 2, A. Eggspuehler 2, A. F. Mannion 3, F. Porchet 1
  • 1Spine Center, Schulthess Clinic, Zurich, Switzerland
  • 2Department of Neurology, Schulthess Clinic, Zurich, Switzerland
  • 3Division of Research and Development, Schulthess Clinic, Zurich, Switzerland

Introduction: Back pain is common in industrialized countries and one of the most frequent causes of work incapacity. Successful treatment is therefore important for socioeconomic reasons. Back pain is frequently caused by degenerative spine disease. Intradural spinal tumors are rare with an annual incidence of 2 to 4/100,P033 and are mostly associated with neurological deficits, radicular, and nocturnal pain. Back pain is not commonly described as a concomitant symptom, such that in patients with both tumor and degenerative spine disease, any back pain is typically attributed to the degeneration rather than the tumor.

Methods: We analyzed the data of 58 patients with intradural spinal tumor undergoing surgery between 2006 and 2011. General patients’ data, pre/postoperative imaging, type/severity of symptoms, severity of degenerative spine disease, and surgical methods were examined. Outcome of surgical therapy was examined by Spine Tango registry and Core Outcome Measures Index to measure outcome from the surgeons’ and the patients’ perspective.

Results: Back pain was one of the leading symptoms in 47 patients (81%). There were 27 patients (47%) with back pain as the predominant symptom and degenerative spine disease in adjacent segments to the intradural spinal tumor. After surgical tumor removal, the proportion of patients with back pain reduced to 9 patients (33%) within the first 12 months of follow-up. Only three patients underwent further invasive therapy for back pain caused by degenerative spine disease after tumor surgery.

Conclusions: Tumor surgery of intradural spinal tumors improves back pain in patients with coexisting severe degenerative spinal disease. Intradural spinal tumors seem to be the only cause of back pain more often than appreciated. Therefore elaborate clinical and radiological examinations should be performed preoperatively and stabilization/fusion should be discussed carefully in patients foreseen for first time tumor surgery.