Surgical management of spinal metastases originating from thyroid cancer

Abstract Background The spine is an uncommon metastatic location from thyroid cancer. Here, we describe our experience with spinal cord compression as presentation of metastatic thyroid carcinoma, including surgical management and outcome. Methods Five patients with spinal metastases from thyroid cancer were identified over a 20-year period. Results This descriptive case series comprised 5 women with a median age of 61 years. Three patients presented to the emergency room without a previous diagnosis of thyroid carcinoma. Clinical symptoms at presentation included pain, ataxia, and bladder and bowel incontinence. Imaging (MRI in four patients and CT in one) revealed thoracic spinal metastases in four cases and a sacral lesion in one case. Surgical treatment consisted of en-bloc resection in one patient and subtotal resection in the remaining four. The median Karnofsky Performance Score improved from 70% to 90%, postoperatively. Histopathological analysis confirmed follicular thyroid carcinoma in all cases. Postoperatively, all patients received radioactive iodine therapy, and three patients additionally underwent radiotherapy. One patient had a recurrence. The median survival time was 69 months (range 19–188 months). Conclusion The main goals of surgical management in patients with spinal metastases from thyroid cancer are preservation of neurological function and restoration of spinal stability. This is followed by comprehensive evaluation and treatment of the primary malignancy. Multidisciplinary management is essential, with subsequent therapy directed toward control of systemic disease.