title: Metastatic spinal cord compression as a result of the unknown primary tumour.
abstract: OBJECTIVE
  Patients presenting with metastatic spinal cord compression (MSCC) due to an unknown primary tumour (UPT) present an interesting problem with limited literature available to provide guidance on management. Our aim was twofold-first, to analyse all our patients with MSCC due to a UPT pre-operatively, to review their treatment and outcome; second, make comparisons with those patients who presented with MSCC due to a known primary tumour (KPT) during the same period.
  
  
  METHODS
  All data was collected retrospectively from October 2004 to October 2009, then prospectively from October 2009 to October 2012 (8 years). We reviewed all patient records held on the database, including patient demographics, primary tumour, neurological outcome (Frankel grade), complications and survival.
  
  
  RESULTS
  During the 8-year study period, out of the 382 patients who underwent emergency surgery for MSCC, 285 patients were included in whom complete information was available. Of these, 17 patients presented with MSCC due to a UPT (6 %; mean age 61 years, 5 M, 12 F). When compared to those with a known primary, the UPT group trended to a longer duration of symptoms prior to surgery (200 vs. 156 days, p = 0.86). They had a similar neurological outcome (88 % remained the same or improved post-operatively vs. 90 % in KPT group; p = 0.42), similar complication rate (23.5 vs. 33.6 %; p = 0.32) and survival (222 vs. 251 days, p = 0.42). The primary site in the UPT group was confirmed in 10/17 (58.8 %)-all 10 were adenocarcinoma [lung (6) and GI (4)].
  
  
  CONCLUSIONS
  In our series, the incidence of MSCC due to an unknown primary was 6 %. They had similar overall outcome (neurology post-operatively, complications and survival) to those patients with MSCC from a known primary. Our experience would suggest that we need to treat these patients expeditiously with thorough evaluation and urgent treatment.
authors.affiliation: Centre for Spine Studies and Surgery, West Block, D Floor, Queens Medical Centre, Derby Road, Nottingham, NG7 2UH, UK, nasir.quraishi@nuh.nhs.uk.
authors.forename: N A
authors.initials: NA
authors.lastname: Quraishi
authors.forename: D
authors.initials: D
authors.lastname: Ramoutar
authors.forename: D
authors.initials: D
authors.lastname: Sureshkumar
authors.forename: S R
authors.initials: SR
authors.lastname: Manoharan
authors.forename: A
authors.initials: A
authors.lastname: Spencer
authors.forename: G
authors.initials: G
authors.lastname: Arealis
authors.forename: K L
authors.initials: KL
authors.lastname: Edwards
authors.forename: B M
authors.initials: BM
authors.lastname: Boszczyk
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000401:mortality / Q000556:secondary / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary; D011183:Postoperative Complications; D011446:Prospective Studies; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000150:complications / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D055815:Young Adult