Title: Patterns of Spinal Metastases in Head and Neck Cancer: A Tertiary Centre Review

Background: Spinal metastases (SM) in head and neck cancer is a rare entity, with paucity in the literature, posing dilemmas for determining treatment strategies.
Methods: A prospectively kept database in a tertiary referral centre was analysed, evaluating head and neck patients with radiologically confirmed spinal metastases. We included time interval from primary diagnosis to SM development, presentation of SM, presence of other distant metastases and overall survival (OS).
Results: Between 2016 and 2024, 28 patients meeting the above criteria were identified, with strong male preponderance (7:1). Sixty-eight percent of patients developed metastases to the thoracic spine (n=19), 32% to the lumbar spine (n=9), 21% (n=6) to the cervical spine & sacral spine respectively( n = 6) , with multiple sites affected in 28% (n=8). The most common sites presenting with disease were oropharynx (n=9), thyroid (n=6), followed by unknown primary (n=4). Presentations ranged from completely asymptomatic to acute spinal cord compression. The median overall survival was 8.6 months from development of SM, which was not significantly different whether one or more sites involved. Those who received immunotherapy trended towards longer survival.
Conclusion: Spinal metastases in head and neck cancer patients carries a grim prognosis, though immunotherapy may increase OS compared with other treatment methods.