Spinal Cord Tumors

Primary spinal cord tumors arise from the different elements of the central nervous system (CNS), including neurons, supporting glial cells, and the meninges (coverings of the nerves). Anatomically, tumors of the spinal cord may be classified according to the compartment of origin, either intramedullary (inside the cord) or extramedullary (outside the cord).

Tumors
Inside the Spinal Cord	Outside the Spinal Cord

Spinal cord tumors are tumors that arise from the tissues of the spinal cord. The term spine tumor refers to tumors that arise from the coverings of the spine including the vertebral bones. Spinal cord tumors are relatively rare, as are most spine tumors other than metastatic tumors. Spinal metastases occur in more than 10 percent of patients with cancer.

The most common tumors of the spine are metastatic tumors: tumors that have spread from somewhere else in the body. While metastatic lesions are not actually spinal cord tumors, they are included in this discussion because vertebral metastases cause 85% of the cases of spinal cord compression and clinical presentation tends to be indistinguishable from primary cancer of the spinal cord.

Symptoms

PAIN: The most common symptom of a spinal cord or spine tumor is pain. The pain can be located near the level of the tumor or it may radiate around the side, down the arm or down the leg. This is usually a gradually worsening back pain and is seen in about 90% of affected adult patients.

Pain usually precedes other symptoms associated with spinal cord compression by 2-4 months.

FUCNTIONAL LOSS: Emergence of leg weakness (usually bilateral and often prominent when climbing stairs), paresthesias (tingling) in the legs are common symptoms. The latter complaints are related to pressure on the nerve roots that come off of the spinal cord, or stretching of the pain fibers within the cord. Symptoms may be very similar to a disc herniation. Eventually, weakness or paralysis can occur, either partially or completely.

SENSORY LOSS is also common. In the case of an intramedullary tumor, there is loss of sensitivity to pain and temperature below the tumor but preserved sensitivity to light touch.

Loss of bowel and or bladder control are important signs of pressure on the spinal cord or the lower spinal nerves (called the cauda equina).

The evolution of pain may be slow and insidious, however, once symptoms other than pain appear, symptom progression may be rapid.

General Information

The disability of the patient upon initiating therapy serves as the best predictor of ultimate disability in patients suffering a spinal cord tumor. The spinal cord is not a very forgiving structure. That is, lost function is often not regained. Therefore, early detection of cord compression and early intervention is the goal.

The peak incidence of primary spinal cord tumors is in a patient’s fourth and fifth decade.

Spinal tumors occur in approximately 1 case per 100,000 persons per year.

Approximately 15-20% of all central nervous system (CNS) tumors occur in the spine.

They occur in both the pediatric and adult population.

They are found most frequently in the thoracic cord but can also occur in the cervical spine to the tail of the spine.

A tumor can arise from any component of the spinal cord.

90% are benign and therefore a surgical "cure" is possible.

Many are slow growing and take years to cause problems.

These tumors are occasionally missed in their early stages because of their tendency to mimic other conditions. (i.e.. back pain from strains or other traumatic injuries)

Diagnosis

As always, a careful history and physical examination are the first steps in diagnosis. The diagnosis of a spinal cord tumor may be slow because back pain is so common and spinal cord tumors are rare. It is not unusual for some time to pass before a diagnosis is made. The invention of the MRI scanner has made it much easier to diagnose spinal cord and spine tumors. Frequently an MRI is the only test necessary to make a diagnosis. In some cases, however, a CT scan and or a nuclear medicine bone scan may be helpful.

Imaging Studies

Magnetic resonance imaging (MRI)

An MRI of the affected area provides the best definition of spinal lesions and is the procedure of choice. With an MRI, the entire spine may be visualized rapidly (sagittal images), and images may be obtained in multiple planes for best definition of the lesion, the vertebrae, the epidural space, and the spinal cord. Usually, an MRI is able to differentiate a collapsed vertebra secondary to osteoporosis or trauma from malignant disease. The intervertebral space usually is not involved in tumors of the spine. When the disc space is obliterated, infection is more likely.

Treatment

Because the majority of these tumors are slow growing and locally contained, surgical removal, where possible, is the treatment of choice. In some cases of primary bone tumors, all that be needed is observation. In most cases of intramedullary, extramedullary and metastatic tumors more aggressive intervention will be indicated. Metastatic tumor treatment depends on the state of the cancer, the neurological condition of the patient and the appearance of the imaging studies. In some cases, treatment may consist of steroid medication and radiation therapy. In cases where severe compression of the spinal cord or spinal nerves exists, decompression along with stabilization (fusion) may be necessary. Each case must be evaluated on an individual basis.

Surgical removal of a spinal cord tumor often takes several hours, meticulous dissection and sophisticated surgical equipment. These tumors are usually ideal for the use of the surgical laser, ultrasonic aspirator, and the image guided stereotactic system.

With primary spinal cord tumors, the need for radiation and chemotherapy is made on an individual basis by the surgical and medical team of doctors.

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