Introduction
Spinal cord tumors are rare tumors in children, with an estimated incidence of 0.27 per 100,000. The most common presenting symptoms are pain of the bony segment directly over the tumor, abnormal gait or coordination difficulties, spinal deformity, focal motor weakness, and sphincter dysfunction. Spinal tumors are one of the childhood tumors most frequently presenting with musculoskeletal symptoms. A recently published nationwide registry-based cohort study by our group, including all children with cancer in Denmark over 23 years, identified a musculoskeletal diagnosis prior to the diagnosis of cancer in one-fifth of the children with spinal tumors. Symptoms among these patients were often nonspecific pain and might mimic rheumatic diseases, which can lead to misdiagnosis and diagnostic delay.
Non-specific musculoskeletal pain is frequent among children and although the percentage of children with cancer among those sent to the rheumatology department is low, up to 60% of children with cancer initially evaluated in the rheumatology department are misdiagnosed. Hematological cancers are predominant in the literature evaluating musculoskeletal misdiagnosis in childhood cancer, including only few cases of spinal tumors.
Misdiagnoses imply a risk of diagnostic delay, and earlier studies have found the diagnostic interval (time from first symptoms until diagnosis) to be twice as long for childhood cancers with a musculoskeletal misdiagnosis. Prompt diagnosis and treatment of pediatric spinal tumors is of special importance, as diagnostic delay can lead to damage to the spinal cord, which may inflict permanent neuronal dysfunction. Survivors of spinal tumors face a high disease burden of long-term effects from tumor and treatment, with substantial morbidity, markedly reducing their quality of life.
The objective of this retrospective cohort study was to identify and characterize the subgroup of children with spinal tumors having a prior musculoskeletal misdiagnosis and evaluate any patterns or red flags. Further, we compared the group with and without musculoskeletal misdiagnosis in terms of clinical presentation, diagnostic interval, and outcome.