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Management of Spinal Lymphomas: Spinal Instability Assessment Using the Spinal Instability Neoplastic Score and a Proposed Treatment Algorithm.

AIM
Spinal lymphomas rarely cause spinal cord compression. The treatment of spinal lymphomas that cause spinal cord compression is still controversial. The aim of this study was to propose a treatment algorithm and assess spinal instability.


MATERIAL AND METHODS
Demographics, symptoms, tumor level and location, and presence of spinal instability were reviewed in 22 patients with spinal lymphomas. Each patient's neurological state was reviewed using McCormick scale scores, and spinal instability was assessed using the Spinal Instability Neoplastic Score (SINS).


RESULTS
Initially, percutaneous biopsy was performed in 16 patients, and open biopsy was performed in 6 patients. Eight of the patients who underwent percutaneous biopsy were followed up with hematological examination alone, as they had no additional complaints. The SINS was used to evaluate the presence of spinal instability, and the type of surgery to be performed was decided accordingly. In the second surgery, decompression and stabilization were performed in 5 of the remaining 8 patients, and only decompression was performed in 3 of them. Neurological improvement was observed in 6 of 7 patients with acute neurological deficit.


CONCLUSION
We concluded that percutaneous biopsy for tissue diagnosis is the first step in the management of spinal lymphomas. Patients without deficit should be referred for hematological examination. Those with acute neurological deficit require emergency surgery, and those with chronic symptoms must undergo operation for decompression and/or stabilization. This study confirmed the safety of the SINS in the evaluation of spinal instability in spinal lymphoma cases.