Neurological decline due to a vascular etiology in patients with spine tumors: a patient series and cautionary tale.

Objective: Patients harboring spine tumors may experience neurological decline due to vascular etiology, such as hypoperfusion or vascular steal. Spinal cord ischemia or stroke in the setting of spine tumors is a rarely reported but potentially catastrophic complication. Therefore, the authors sought to report a case series of patients with spine tumors who experienced neurological decline due to vascular reasons, with a proposed etiology and alternative management strategies.

Methods: A dual-institution, retrospective case series was conducted of patients with spine tumors who experienced neurological decline due to vascular etiologies between 2004 and 2021. Inclusion criteria were as follows: diagnosis of a primary or metastatic spine tumor and a neurological decline due to anterior spinal cord ischemia or stroke. A description of each case is outlined, as well as the etiology of neurological decline, real-time interventions, and preventative alternative management strategies.

Results: Five patients were identified who experienced a neurological decline due to vascular reasons at the following times: 2 occurred preoperatively, 2 intraoperatively, and 1 postoperatively.

Conclusions: Patients with spine tumors are at risk of spinal cord ischemia or stroke with a catastrophic neurological decline. Early recognition of vascular events in patients with spine tumors is critical to initiating timely interventions that can lead to spinal cord recovery.