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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

De Paz-Jaimes O, 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.


REFERENCES

  1. Grasso G, Meli F, Patti R, Giambartino F, FlorenaAM, Iacopino DG. Intramedullary spinal cord tumorpresenting as the initial manifestation of metastatic coloncancer: case report and review of the literature. SpinalCord. 2007; 45: 793-796.

  2. Hommadi M, Belemlih M, Marnouch E, Maghous A,Zaghba N, Hamidi FZ, et al. Intramedullary spinal cordmetastases: report of three cases and review of theliterature. Cancer Radiother. 2021; 25: 169-174. doi:10.1016/j.canrad.2020.10.003.

  3. Pérez-Suárez J, Barrio-Fernández P, Ibáñez-Plágaro FJ,Ribas-Ariño T, Calvo-Calleja P, Mostaza-Saavedra AL.Metástasis intramedular de adenocarcinoma gástrico:caso clínico y revisión de la literatura. Neurocirugía.2016; 27: 28-32.

  4. Carvajal F, García R, Rojas F, Sallabanda K. Stereotacticradiosurgery for intramedullary spinal cord metastases:a systematic review and meta-analysis. Cureus. 2025;17: e80025.

  5. Goncharov YE, Zubatkina IS, Ivanov PI. Stereotactichigh-dose irradiation for intramedullary metastases. ZhVopr Neirokhir Im N N Burdenko. 2024; 88: 22-30.

  6. Hrabalek L. Intramedullary spinal cord metastases:review of the literature. Biomed Pap Med Fac UnivPalacky Olomouc Czech Repub. 2010; 154: 117-122.

  7. Kaya S, Lam FC, Stevenson MA, Motiei-LangroudiR, Kasper EM. Intramedullary metastases to conusmedullaris: a review of the literature with a caseillustration. Brain Sci. 2024; 14: 761.

  8. Gazzeri R, Telera S, Galarza M, Callovini GM, Sperduti I,Alfieri A. Surgical treatment of intramedullary spinal cordmetastases: functional outcome and complications—amulticenter study. Neurosurg Rev. 2021; 44: 3267-3275.doi: 10.1007/s10143-021-01491-8.

  9. Quraishi NA, Gokaslan ZL, Boriani S. The surgicalmanagement of metastatic epidural compression of thespinal cord. J Bone Joint Surg Br. 2010; 92: 1054-1060.doi: 10.1302/0301-620X.92B8.22296.

  10. Payer S, Mende KC, Westphal M, Eicker SO.Intramedullary spinal cord metastases: an increasinglycommon diagnosis. Neurosurg Focus. 2015; 39: E15.

  11. Kalayci M, Cağavi F, Gül S, Yenidünya S, AçikgözB. Intramedullary spinal cord metastases : diagnosisand treatment —an illustrated review . Acta Neurochir(Wien). 2004; 146(12): 1347-1354. doi:10.1007/s00701-004-0386-1.

  12. Taniura S, Tatebayashi K, Watanabe K, WatanabeT. Intramedullary spinal cord metastasis from gastriccancer: case report. J Neurosurg Spine. 2000; 93:145-147.

  13. Hashii H, Mizumoto M, Kanemoto A, Harada H, AsakuraH, Hashimoto T, et al . Radiotherapy for patients withsymptomatic intramedullary spinal cord metastasis.J Radiat Res. 2011; 52 (5): 641-645. doi:10.1269/jrr.10173.

  14. Schiff D, O'Neill BP. Intramedullary spinal cordmetastases: clinical features and treatment outcome.Neurology. 1996; 47 (4): 906-912. doi:10.1212/WNL.47.4.906.

  15. Dam -Hieu P, Seizeur R, Mineo JF, Metges JP, MeriotP, Simon H . Retrospective study of 19 patients withintramedullary spinal cord metastasis. Clin NeurolNeurosurg. 2009; 111 (1): 10-17. doi:10.1016/j.clineuro.2008.07.005.

  16. Scalia G, Costanzo R, Viola A, Bonosi L, PorzioM, Giovannini A, et al. Intramedullary spinal cordmetastases from breast cancer: a systematic review.Anticancer Res. 2023; 43: 523-535.

  17. Connolly ES Jr, Winfree CJ, McCormick PC, CruzM, Stein BM, Antonescu R. Intramedullary spinalcord metastasis: report of three cases and review ofthe literature. Surg Neurol. 1996; 46 (4): 329-338.doi:10.1016/S0090-3019(96)00189-2.




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