The most common neurologic complication of malignant lymphoma is compression of the spinal cord. The seriousness of this complication is somewhat allayed by the high degree of success which customarily follows early diagnosis and treatment. This is one clinical manifestation of malignant lymphoma which should be readily recognized. Usually the earliest symptom is pain, and this paper has been written with the intention of emphasizing (a) the importance of pain in establishing early diagnosis and (b) the success which adequate early treatment ordinarily produces. During the years 1956 through 1962 there were 26 patients with malignant lymphomas at Roswell Park Memorial Institute in whom myelographic and/or spinal fluid dynamics of block were demonstrated as evidence of spinal cord compression. Four of these had two separate compressive episodes at different periods in the course of the disease (interval-average of ten months, median of twenty months, extremes of one and forty months). Williams et al. (1959) reported a large number of cases, but a great many were never proved by myelography to have true epidural tumors. Their monograph does not describe essential radiotherapeutic details. Material Histologic Classification: Of our 26 patients, 14 had Hodgkin's disease, 11, reticulum-cell sarcoma, and 1, lymphosarcoma. This last case was unusual, since it is rare for lymphosarcoma to cause a spinal cord compression syndrome. In this 48-year-old woman, with general manifestations of lymphosarcoma for seven years, two separate levels were involved over a four-month interval. She died ten days after a second compression (C5–D6) because of sepsis (bone-marrow depression, etc.). Sex and Age: There were 16 males and 10 females varying in age from eight to seventy-four years (average, fifty, median, forty-one). The average age for the reticulum-cell sarcoma group was sixty-three with extremes of forty-two and seventy-four (median, fifty-eight), whereas the Hodgkin's disease group had an average age of forty with extremes of eight and sixty (median, thirty-six). Since there was only 1 lymphosarcoma patient (forty-eight years old), data here are meaningless. The eight-year-old girl with Hodgkin's disease gave a three-week history of pain in the lower back and difficulty in walking. Following laminectomy (D5–8) and irradiation (2,100 rads in fourteen days) she showed an excellent result. Although the patient died twenty-one months later of disseminated disease, there was no further trouble from compression of the spinal cord. Diagnosis Level of Cord Compression and Vertebral Bone Involvement: The thoracic vertebral segment was more frequently involved in patients with Hodgkin's disease than in those with reticulum-cell sarcoma. Cord compression was associated with vertebral bone involvement more often when the lumbar vertebrae were infiltrated. This is particularly the case in those patients with reticulum-cell sarcoma.
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Murphy et al. (1964) studied this question.