Pancreatic Cancer Metastasis to the Spine: A Systematic Review of Management Strategies and Outcomes with Case Illustration

Objective: We aim to provide a thorough review of the literature regarding patient characteristics, treatment options, and outcomes of pancreatic cancer metastasis to the spine. We also provide an illustrative case from our institution of a patients with pancreatic adenocarcinoma presenting initially as cervical radiculopathy with an isolated cervical spine lesion. Methods: Using the PRISMA guidelines, the literature in PubMed, Google Scholar, and Web of Science databases was searched. We excluded systematic reviews and meta-analyses that did not provide novel cases, as well as reports of metastatic disease from other nonpancreatic primary cancers. Results: Thirty-two patients across 21 studies met the inclusion criteria. The patients were predominantly male (58%), with a mean age of 59 years. Of patients, 64% presented with back pain, 39% with motor deficits, and 15% with bladder or bowel dysfunction. For treatment, chemotherapy was used in 55% of cases and radiotherapy in 42%. Surgical treatment was performed in 42% of cases, with complete tumor resection achieved in 24% of cases. The mean patient survival after treatment was 28 weeks (range, 1–83 weeks), with patients undergoing treatment involving surgery having increased survival (44 weeks) compared with noninvasive treatment alone (18 weeks). Conclusions: Spinal metastasis of pancreatic cancer is rare and typically portends a poor prognosis. It is vital to recognize the presence of spinal involvement early in the disease course and initiate treatment.