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Órgano Oficial de difusión científica de la Asociación Mexicana de Cirujanos de Columna A. C. y de la Sociedad Iberolatinoamericana de Columna. SILACO.

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2026, Number 4

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Cir Columna 2026; 4 (4)

Intramedullary spinal metastasis: diagnostic and therapeutic challenges in a rare condition. A case report and literature review

Paz-Jaimes OD, Pérez-Carranza S, Aldape-Ocañas FG, Cortés-González PT, González-Gómez MA, Vázquez-Martínez BR

Language: Spanish
References: 17
Page: 334-343
PDF size: 1064.67 Kb.


ABSTRACT

Intramedullary spinal cord metastases (ISCM) are rare entities, representing approximately 8.5% of central nervous system metastases. They occur in only 0.1-0.4% of cancer patients and account for 1-3% of all intramedullary neoplasms. Lung cancer, particularly small cell carcinoma, is the most frequent primary tumor leading to ISCM (54%), followed by breast cancer (13%). Other less common sources include malignant melanoma, lymphoma, and colorectal cancer. Gastrointestinal tumors rarely metastasize to the spinal cord, more commonly spreading to the liver, lymph nodes, bones, and adrenal glands. Most ISCM cases are diagnosed in patients with a known history of cancer. Diagnosis is primarily based on gadolinium-enhanced magnetic resonance imaging, with T2-weighted sequences providing essential details on lesion location, morphology, and associated edema. Surgical treatment has become a valid option in selected cases due to advances in imaging. It is indicated for patients with a single, well-demarcated lesion, limited systemic metastases, progressive neurological deterioration, and good functional status. The goals of surgery include spinal cord decompression, neurological function preservation or improvement, and histopathological confirmation. Early resection can improve both survival and quality of life, with postoperative survival averaging up to 11.6 months. Encapsulated or cystic tumors favor complete resection, whereas leptomeningeal or infiltrative lesions require partial resection to avoid irreversible neurological damage. Although radiotherapy remains the standard treatment, surgical intervention is increasingly favored due to better functional outcomes and symptom control. Treatment decisions should be individualized based on patient age, tumor type, radiosensitivity, and the potential to enhance quality of life. This report of a patient with an intramedullary metastasis at L1 whose initial symptom was recent-onset lumbosacral pain followed by lower limb weakness (Karnofsky score: 80). Diagnosis was confirmed by gadolinium-enhanced MRI, and surgical resection was performed. Histopathology revealed a metastatic lesion originating from a gastrointestinal adenocarcinoma.


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