Surgical Management of Primary Thyroid Carcinoma Spinal Metastases: Demographics, Clinical Characteristics, and Treatment Outcomes

Introduction: Metastatic spinal tumors represent a rare but concerning complication of primary thyroid carcinoma. We identified demographics, metastatic features, outcomes, and treatment strategies for these tumors in our institutional cohort.

Methods: We retrospectively reviewed patients surgically treated for spinal metastases of primary thyroid carcinoma. Demographics, tumor characteristics, and treatment modalities were collected. Functional outcomes were quantified using Nurik, Modified Rankin, and Karnovsky Scores.

Results: 12 patients were identified who underwent 17 surgeries for resection of spinal metastases. The primary thyroid tumor pathologies included papillary (4/12), follicular (6/12), and Hurthle cell (2/12) subtypes. The average number of spinal metastases was 2.5. Of the primary tumor subtypes, follicular tumors averaged 2.8 metastases at the highest, and Hurthle cell tumors averaged 2.0 spinal metastases at the lowest. Five patients (41.7%) underwent pre-operative embolization for their spinal metastases. Seven patients (58.3%) received post-operative radiation. There was no significant difference in progression-free survival between patients receiving surgery with adjuvant radiation and surgery alone (p = 0.0773). Five patients (41.7%) experienced post-operative complications. Two patients (16.7%) succumbed to disease progression, and two patients (16.7%) experienced tumor recurrence following resection. Post-surgical mean Nurik scores decreased 0.54 points, mean Modified Rankin scores decreased 0.48 points, and mean Karnovsky scores increased 4.8 points.

Conclusion : Surgery presents as an important treatment modality in the management of spinal metastases from thyroid cancer. Further work is needed to understand the predictive factors for survival and outcomes following treatment.