Presentation, management and short-term outcomes of extradural spinal tumours at the University Teaching Hospital in Lusaka, Zambia

Abstract

Objectives: To investigate the clinical presentation of patients with extradural spinal tumours and establish the factors that determined the treatment they received and outline the outcomes of that treatment at the University Teaching Hospital between January 2013 and December 2016.

Material and Methods: This was a retrospective study of the presentation, management and shortterm outcome of extradural spinal tumours at the University Teaching Hospital. A questionnaire was used to obtain data from patients' hospital records. Data was analysed using Microsoft Excel and the Statistical Package for Social Sciences version 25 software.

Results: Of the 62 patients in the study, 34 were female and 28 male. The age range was 14 to 87 years, with a mean of 55.03. Backache (93.8%), Limb weakness (91.9%), loss of sensation (50%), urine and stool incontinence (43.5% and 41.9% respectively), back deformity (11.3%), night pain (85.5%), weight loss(67.7%), poor appetite (61.3%), fever (35.5%) and night sweats(29%) were common symptoms. Sixty-eight percent of patients were bedridden. Visual Analogue Scale scores were  greater than 5 in 84% of patients. A muscle power grade of 3 or less (n=48), impaired muscle tone (n=38), abnormal reflexes (n=52), presence of a sensory level(n=37) and back deformity (n=17) were common signs. Plain radiography, Computed Tomography Scans, Magnetic Resonance Scans and Tecnetium Bone scans were done in 60, 35, 17 and 2 patients respectively. The commonest surgical host category was A (64%). Secondary Extradural Spinal Tumours comprised 82% while 18% were primary. Surgery was done in 14 patients with 1 failing to afford implants. Forty-eight received nonsurgical treatment. Nineteen percent of patients had improved pain scores but the rest remained the same or worsened after treatment. Complications included decubitus ulcers, Urinary Tract Infection, Deep Veinous Thrombosis, pneumonia, sepsis and joint stiffness. Fourty patients died and eighteen patients were lost to follow-up.

Conclusions: The ages of patients followed normal distribution with female to male ratio of 1.2 to 1. Most patients presented with symptoms and signs of advanced disease. The type of extradural spinal tumour, stage of disease, completeness of diagnostic workup, availability of implants, need for tissue diagnosis, type of surgical host and availability of nonsurgical treatment modality determined the choice of treatment. Poor outcomes in quantity and quality of life are a reflection of the late presentation, delayed diagnosis, lack of resources and difficulty of  treating these tumours. Extradural spinal tumours are not uncommon and cause significant morbidity and mortality in those affected.