Non-Hodgkin lymphoma and Hodgkin’s lymphoma in the cervical spine can be a cause of spinal cord compression and neck pain but these serious underlying causes may be overlooked, especially in the elderly where weakness and falls are attributed to other conditions.
In a paper published in the Journal of Medical Case Reports back in 2010, Smith, Sedrak and Khoo detailed the unfortunate case of a 23 year old American man who had experienced two months of night sweats, fatigue, parasthesias, and progressive weakness and who had become nearly quadriplegic. An MRI was carried out and the man was found to have serious compression of the spinal cord, mostly at the level of C7 due to aggressive, fast-growing anaplastic large cell lymphoma (ALCL).
To decompress the cervical spine the man underwent a corpectomy with dorsal segmental fusion, meaning that the diseased vertebral body was removed and the spine fused to restore stability. Chemotherapy and radiation therapy were also administered and the cancer’s progression was halted, with neurological function preserved.
What is Lymphoma?
ALCL arises when abnormal T-cells (immune system cells) build up in the lymph nodes or elsewhere in the body (such as in the skin or the lungs). In this unusual case the T-cells built up in the cervical spine, creating a large mass that compressed the spinal cord.
This man’s case is a good reminder to consider all possible explanations of symptoms of neck pain, fatigue, paraesthesia, and weakness as, even though non-Hodgkin lymphoma originating in bone is extremely rare, spinal cord compression is thought to occur in around 5% of cases of Hodgkin’s disease, usually in the advanced stages of the condition. Only a handful of cases have been reported with spinal cord compression as the presenting symptom of lymphoma.
Hodgkin’s Lymphoma and Neck Pain
In another case, a 46-year-old man was found to have an extradural mass in the cervical and thoracic spine, determined by biopsy to be Hodgkin’s disease (Higgins and Peschel, 1995). The man had signs and symptoms of spinal cord compression which were relieved after chemotherapy and external beam radiation therapy.
The authors in the above case noted that spinal cord involvement in Hodgkin’s disease appears to respond well to treatment using radiation and chemotherapy alone. They note that as well as having good long term survival, 86% of patients have functional recovery and 61% of patients have a complete resolution of symptoms.
Is Surgery Necessary for Hodgkin’s Lymphoma and Spinal Cord Compression?
Another case, this time of a 42 year old woman with Hodgkin’s lymphoma and spinal cord compression, highlights how surgery may not be necessary to resolve the compression. Al-Khayat and colleagues (2007) reported that with chemotherapy and radiation therapy the woman’s symptoms improved without back surgery, which is likely preferable in terms of maintaining spinal stability and avoiding surgical risks.
Primary bone lymphoma that occurs in the cervical spine and which is aggressive may, however, warrant early intervention to decompress the spine and halt any tissue damage that may be irreversible. This would be the case with neurological deficits as these symptoms indicate existing cord compression.
One such patient was a 73 year old man whose case was recently reported on in the journal of Turkish Neurosurgery. The man had neck pain, progressive loss of strength, and frequent falls and was found to have a large B-cell lymphoma that had infiltrated the fourth cervical vertebra. The vertebrae was removed and te patient had radiotherapy to address any residual aberrant cells.
As with the other cases cited, the authors here note the potential for confusion over the unusual presentation of neck pain and other symptoms of spinal cord compression as the first symptoms of non-Hodgkin’s or Hodgkin’s lymphoma. These cases demonstrate the need for caution when applying a diagnosis to those with seemingly simple neck pain.
Undabeitia J, Noboa R, Boix M, Garcia T, Panadés MJ, Nogués P. Primary bone non-hodgkin lymphoma of the cervical spine: case report and review. Turk Neurosurg. 2014;24(3):438-42. doi: 10.5137/1019-5149.JTN.8520-13.1.
Smith ZA, Sedrak MF, Khoo LT. Primary bony non-Hodgkin lymphoma of the cervical spine: a case report. J Med Case Rep. 2010 Feb 2;4:35. doi: 10.1186/1752-1947-4-35.
Higgins SA, Peschel RE. Hodgkin’s disease with spinal cord compression. A case report and a review of the literature. Cancer. 1995 Jan 1;75(1):94-8.
Al-Khayat H, Al-Khayat H, Al-Baker O, Groof A, Sadeq A, Hayati H, Zarka ZA. Cervical radiculopathy secondary to Hodgkin’s lymphoma. Surg Neurol. 2007 May;67(5):540-3.