Presentation, management and short-term outcomes of extradural spinal tumours at the university teaching hospital in Lusaka, Zambia

Abstract

Following an observation of lack of statistics locally, a retrospective study to determine the presentation, management and short-term outcomes of extradural spinal tumours from 2013 to 2016 at the University Teaching Hospital was conducted after approval from the University of Zambia Biomedical Research Ethics Committee. The objectives were to investigate the clinical presentation of patients with extradural spinal tumours at the University Teaching Hospital establish the factors that determine the treatment they receive and the outcomes of that treatment. A questionnaire was used to obtain data from patients’ records. This data was analysed using the Statistical Package for Social Sciences software. Of the 62 patients in the study,34 were female and 28 male. The age range from 14 to 87 years had a mean of 55.03 years. 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. 68% of patients were bedridden. Visual Analogue Scale scores were more 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% (51 patients) while 18% (11 patients) were primary. Surgery was done in fourteen (14) patients with one (1) failing to afford implants. The rest (48) received nonsurgical treatment. Eleven percent of patients reported improvement in pain scores but the rest of the symptoms remained the same or worsened after treatment. Complications included decubitus ulcers, Urinary Tract Infection, Deep Veinous Thrombosis, pneumonia, sepsis and joint stiffness. Fourty (40) patients died and eighteen (18) patients were lost to follow-up. The ages of patients followed normal distribution with female to male ratio of 1.2 to 1. Most patients presented with symptoms of late or advanced disease, a finding similar to studies done elsewhere. The physical signs at presentation are supportive of this. 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 terms of quantity and quality of life are a reflection of the late presentation, delayed diagnosis, lack of resources and difficulty of treating these tumours. The relocation of the main hospital registry led to loss of documentation and this negatively affected the sample size.Extradural spinal tumours are relatively uncommon but cause significant morbidity and mortality in those affected. Keywords: spinal tumour, extradural, clinical presentation, treatment outcome