Metastatic spinal cord compression from synovial sarcoma: Surgical resection

Synovial sarcoma is rare, and metastasis of synovial sarcoma to the spine is even rarer. Surgeons should have a high index of suspicion when evaluating patients who present with a history of synovial sarcoma, a spine lesion, and concomitant back pain and neurologic symptoms. Thorough radiological work-up should include CT and MRI in order to confirm the diagnosis and ensure appropriate management. Although not curative, surgical resection followed by spinal decompression, fusion, and fixation can lead to neurologic improvement in patients who present with spinal cord compression. In this chapter, two illustrative cases are presented describing the surgical treatment of spinal cord compression caused by metastatic synovial sarcoma. The clinical presentation and prognostic factors of synovial sarcoma are discussed, as well as its cellular and histopathologic classification. Methods of diagnosis are described, which include histopathology, immunohistochemistry, and molecular studies, as well as the use of radiographs, CT, and MRI. Lastly, the treatment of both primary and metastatic synovial sarcoma is discussed, with sections on surgery, radiation, and chemotherapy.