Publication:

Surgical management of follicular carcinoma of thyroid with spinal metastasis

Background Spine is the most common part of bone metastasis of follicular carcinoma and is primarily osteolytic. The primary concern with metastasis is pathologic fracture and/or spinal cord compression, which may lead to intractable pain, sensory alterations, weakness, and/or paralysis. Management is curative or palliative and includes surgery, radioiodine ablation, selective embolization, medical management. In this study, we present a retrospective analysis of five patients with follicular carcinoma of thyroid with spinal metastasis treated surgically.

Methods With the approval of the institutional review board, we retrospectively analyzed all the patients who underwent surgery for follicular carcinoma of thyroid with spinal metastasis from Jan 2011 to Jan 2015 at Sri Ramachandra Medical Centre. Patients were considered for spine surgery, when they had severe pain and/or neurological deficit, spinal instability and Tokuhashi score of at least 9. Total of 5 patients with follicular carcinoma underwent spinal surgery.

Results Three patients had improvement in KPS scores; one had no change and remaining one had lower KPS score at final follow up. Four out of the five patients (80%) had improvement in VAS pain scores.

Conclusions Even though there are no established regimens in treating spinal metastasis from follicular carcinoma of thyroid and very few reports published in this regard, curative/palliative spine surgery along with radioiodine ablation gives short to midterm remission and clinical improvement in this patient group.