Malignant Lymphoma of the Spinal Epidural Space

Experiences with 21 cases of spinal cord compression in malignant lymphoma are reviewed. Observations of interest concerning incidence, pathogenesis, and prognosis are noted from a study of the literature. The encouraging overall results of treatment in such a grave situation are noted. The possibility of avoiding spinal compression by early myelography during the prodromal stage is described. Cervical or cisternal, in addition to lumbar, myelography may allow better definition of the extent of epidural lymphoma. It is suggested that the contrast medium be left in situ to follow the response to irradiation. Particular attention is given to discussion of the changing approach to management, especially the increasing use of irradiation alone in many cases. Laminectomy is performed without delay if rapid improvement is not seen with irradiation. In severely affected cases laminectomy, with limited tumor excision, should provide adequate initial decompression. Irradiation is always given postoperatively as early as possible.