Spinal cord tumors are abnormal growths within the spinal canal or the vertebrae. They can be classified as intramedullary (within the spinal cord), extramedullary (within the membranes around the spinal cord), or extradural (outside the dura mater). The most common spinal tumors include meningiomas, nerve sheath tumors (schwannomas and neurofibromas), and gliomas (astrocytomas and ependymomas). Also spinal cord tumors can be malignant as following:
Primary Malignant Spinal Cord Tumors:
- Astrocytomas: These are the most common type of glioma found in the spinal cord and can vary in malignancy.
- Ependymomas: Typically located in the central canal of the spinal cord and can be either slow-growing or aggressive.
- Oligodendrogliomas: Rarer than astrocytomas and ependymomas, these arise from the cells that produce the myelin sheath.
Secondary (Metastatic) Malignant Spinal Cord Tumors: breast, lung, prostate, renal, thyroid cancers spread to the spine and may cause lytic or blastic lesions.
Symptoms of spinal tumors vary but often include back pain and/or radiating pain (the most common symptoms), loss of sensation, muscle weakness, and difficulty with bowel or bladder function. These symptoms result from the tumor pressing on the spinal cord (known as myelopathy) or nerve roots (known as radiculopathy). Symptoms depend on the localisation of the tumor and usually progress by spreading to the opposite side and affecting wider areas.
Diagnostic Workout:
Imaging Studies:
- MRI (Magnetic Resonance Imaging): The gold standard for visualizing spinal cord tumors. It provides detailed images of the spinal cord, surrounding tissues, and can detect intramedullary (within the spinal cord) and extramedullary (outside the spinal cord but within the dura) tumors.
- CT (Computed Tomography): Sometimes used in conjunction with MRI, especially if bone involvement is suspected or to guide a biopsy procedure.
Biopsy:
- Surgical Biopsy: The definitive method for diagnosing the type of spinal cord tumor. A tissue sample is obtained either through open surgery or using a needle guided by CT or MRI imaging.
Additional Tests:
- Blood Tests: To identify markers that might suggest certain types of tumors.
- CSF (Cerebrospinal Fluid) Analysis: Can provide information about cancer cells in the spinal fluid.
Differential Diagnosis:
- It’s crucial to differentiate between spinal cord tumors and other conditions that can cause similar symptoms, such as degenerative spinal diseases or multiple sclerosis.
Management typically involves a combination of surgery, radiation therapy, chemotherapy, or other medications. The approach depends on the type of tumor, its location, and whether it is benign or malignant.
Indications for surgery include neural compression, radioresistant tumors, failure of radiation therapy, spinal instability, and intractable pain unresponsive to non-operative management.
A clinical case might involve a young patient presenting with progressive back pain and neurological deficits. Imaging studies such as MRI could reveal an intradural extramedullary tumor compressing the spinal cord. Surgical resection would be considered if the tumor is accessible and the patient’s overall health allows for surgery.
References:
1 link.springer.com
2 merckmanuals.com
3 teachmesurgery.com
4 musculoskeletalkey.com
Одобрено от Dr. Petya Stefanova
