Presentation, management and short-term outcomes of extradural spinal tumours at the university teaching hospital in Lusaka, Zambia
Date
2019
Authors
Mutembo, Hilgard
Journal Title
Journal ISSN
Volume Title
Publisher
The University of 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
Description
Thesis
Keywords
Spinal tumour--Treatment , Extradural spinal tumours--Treatment