Spinal Tumor Prognosis [Neurosurgery Wiki]

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====== Spinal Tumor Prognosis ======

The prognosis of spinal tumors depends on **tumor type, location, neurological status, and treatment response**. Below is an overview of prognosis factors.

===== 1. Prognosis Based on Tumor Type =====

==== A. Primary Spinal Tumors (Benign & Malignant) ====
^ **Tumor Type** ^ **Growth Pattern** ^ **Neurological Impact** ^ **Recurrence Rate** ^ **Survival Outlook** ^
| **Schwannoma** (intradural-extramedullary) | Slow-growing, well-circumscribed | Rarely severe | Low (after total resection) | Excellent |
| **Meningioma** (intradural-extramedullary) | Slow-growing | Can cause progressive compression | Low (after total resection) | Excellent |
| **Ependymoma** (intramedullary) | Slow-growing | Commonly causes progressive deficits | Moderate (depends on resection extent) | Good |
| **Astrocytoma** (intramedullary) | Infiltrative | High risk of progression | High (especially high-grade) | Variable (low-grade: 5+ years, high-grade: poor) |
| **Hemangioblastoma** (intramedullary) | Slow-growing | Can cause significant edema | Low (after complete removal) | Excellent |
| **Chordoma** (extraluminal, bone-based) | Locally aggressive | Can erode vertebral structures | High | Poor (5-year survival: ~50%) |

==== B. Metastatic Spinal Tumors ====
^ **Primary Cancer** ^ **Spinal Metastases Behavior** ^ **Median Survival (after diagnosis of metastasis)** ^
| Breast Cancer | Commonly osteolytic, responds to hormonal therapy | **1-3 years** |
| Prostate Cancer | Commonly osteoblastic, slow progression | **2-4 years** |
| Lung Cancer | Aggressive, rapid progression | **<6 months** |
| Renal Cell Carcinoma | Hypervascular, resistant to radiation | **~1 year** |
| Multiple Myeloma | Multilevel involvement, responsive to therapy | **3-5 years** |

===== 2. Prognostic Factors =====

==== A. Neurological Status (Frankel or ASIA Score) ====
  * Better preoperative function → Better postoperative outcome.
  * Patients with **complete motor deficits** (Frankel A/ASIA A) rarely regain function.
  * Patients with **incomplete deficits** (Frankel C/D) often improve postoperatively.

==== B. Surgical Resection Extent ====
  * **Gross Total Resection (GTR)**: Best prognosis for benign tumors.
  * **Subtotal Resection (STR) + Radiation**: Used for malignant or infiltrative tumors.

==== C. Spinal Instability & Compression ====
  * **Spinal Instability Neoplastic Score (SINS)**: Guides surgical stabilization.
  * Severe cord compression → Poorer prognosis if not treated promptly.

==== D. Tumor Biology ====
  * **Low-grade tumors (WHO Grade I-II)**: Longer survival.
  * **High-grade tumors (WHO Grade III-IV)**: Poorer prognosis due to rapid progression.

==== E. Response to Adjuvant Therapy ====
  * **Radiation therapy**: Improves local control in metastatic and unresectable tumors.
  * **Chemotherapy**: Effective only for select tumors (e.g., lymphomas, myeloma).

===== 3. Survival & Quality of Life Considerations =====
  * **Benign spinal tumors**: Can be cured with complete resection, minimal impact on life expectancy.
  * **Malignant primary tumors**: Survival depends on histology, with some (e.g., ependymomas) having good long-term outcomes.
  * **Metastatic tumors**: Prognosis depends on systemic disease control; **median survival ranges from months (lung CA) to years (breast/prostate CA).**

==== Key Takeaways ====
  * Early detection & intervention **improve neurological function & survival**.
  * **Benign tumors** generally have **excellent** prognosis with complete resection.
  * **Malignant/metastatic** tumors have **variable survival**, requiring multimodal therapy.