Neoplastic diseases of the spinal cord are broadly categorized into two main groups - primary and secondary [1] [2]. Primary tumors of the spinal cord comprise approximately 2-4% of all central nervous system (CNS) malignancies [1], and are further divided into intradural intramedullary (where glial tumors, such as ependymomas, hemangioblastomas, and astrocytomas are the main subtypes) and intradural extramedullary (tumors of nonglial origin) [1] [2] [3]. Conversely, metastatic tumors and lymphomas in the epidural space are the main secondary tumors of the spinal cord [2] [4]. The clinical presentation somewhat varies on the location of the tumor, but the principal features are progressively worsening localized pain (usually in the neck or back ) that may further spread to the lower extremity (radicular pain) [3] [4]. The pain is described as constant and is most severe when lying on the side (recumbent position) [3]. In addition, patients frequently report weakness, spasticity, and poor motor control if a nerve root is damaged by the tumor, and both sensory input and sphincter control might also be affected [2] [3]. Neurological deficits (either sensory, motor or both) caused by a spinal cord neoplasm will frequently present in a bilateral fashion while sparing the head and the face [3]. Some authors describe hydrocephalus as a rare, but significant complication of spinal cord neoplasms, affecting 1-8% of patients [3] [5] [6]. Unfortunately, the diagnosis of spinal cord neoplasms is frequently delayed (hemangioblastoma is confirmed after a mean period of 3 years), which may profoundly reduce the efficacy of treatment [1] [2] [3].

• Collapse

  Patient with metastatic breast cancer; plain radiograph shows L4 vertebral collapse. MRI of plain film above showing intrusion of tumor and vertebral collapse into spinal canal. [emedicine.medscape.com]

  An injury, cancer, or osteoporosis may cause vertebrae to collapse, compressing the spinal cord. [ispub.com]

  Anterior decompression and stabilization of the spine as a treatment for vertebral collapse and spinal cord compression from metastatic malignancy. Clin Orthop. 1988;233:177. Peabody TD, Gibbs CP Jr, Simon MA. [uscspine.com]

  Surgery for stabilisation is indicated in myelomas of the spine when destruction of the vertebral body exists to such an extent that collapse and possible kyphosis with canal compromise could result. [patient.info]

• Hypotension

  Effect of intraoperative hypotension and hypothermia on IOM In our study, six false positive MEP cases were with intraoperative hypotension and/ or hypothermia. [omicsonline.org]

• Back Pain

  When to see a doctor There are many causes of back pain, and most back pain isn't caused by a tumor. [mayoclinic.org]

  Lumbar disc disorders and low-back pain: Socioeconomic factors and consequences. J Bone Joint Surg Am. 2006;88 Suppl 2:21. Patel AT, Ogle AA. Diagnosis and management of acute low back pain. [cancercarewny.com]

  Symptoms Back pain (new onset back pain is most common presenting symptom) Worse at rest, lying supine May awaken patient at night Later changes Weakness (75%) Autonomic or sensory symptoms (50%) Urinary Incontinence VII. [fpnotebook.com]

  […] in the top of the spinal column can cause pain radiating from the arms or neck; a tumor in the lower spine may cause leg or back pain. [medical-dictionary.thefreedictionary.com]

  A rare but serious problem that exists is the formation of an inflammatory mass at the catheter tip of the pain pump. We report the case of a 67-year-old female patient with failed back syndrome who presented with sensory complaints and back pain. [ncbi.nlm.nih.gov]

• Neck Pain

  What others are saying Regular chiropractic care - Increasingly, the public is becoming more aware of the benefit of chiropractic care for neck pain. AxizPhysio is registered Sports Injury and Rehab Clinic in Mississauga. [pinterest.co.uk]

  Some common signs of spinal tumors may include: Pain (back and/or neck pain, arm and/or leg pain) Muscle weakness or numbness in the arms or legs Difficulty walking General loss of sensation Difficulty with urination (incontinence) Change in bowel habits [cancercenter.com]

  Symptoms Neck pain is the most common presenting symptom of patients with a cervical spine tumor. Patients often have unrelenting pain, as well as night pain, that is not relieved by rest or traditional measures. [uscspine.com]

  pain numbness or tingling in the arms or legs clumsiness or difficulty walking loss of bowel or bladder control (incontinence) Cerebellum coordination and balance problems uncontrolled eye movement stiff neck dizziness difficulty speaking (staccato speech [cancervic.org.au]

• Muscular Atrophy

  Other spinal cord problems include Tumors Infections such as meningitis and polio Inflammatory diseases Autoimmune diseases Degenerative diseases such as amyotrophic lateral sclerosis and spinal muscular atrophy Symptoms vary but might include pain, numbness [icdlist.com]

  They can result in painful scoliosis, muscular atrophy, radicular pain and gait disturbances secondary to pain and splinting. [patient.info]

• Low Back Pain

  Lumbar disc disorders and low-back pain: Socioeconomic factors and consequences. J Bone Joint Surg Am. 2006;88 Suppl 2:21. Patel AT, Ogle AA. Diagnosis and management of acute low back pain. [cancercarewny.com]

• Meningism

  Brain and spinal cord tumours can also start in the cells of the meninges. The meninges are the membranes that cover the brain and spinal cord. These tumours are called meningiomas. [cancer.ca]

  D42.0 Neoplasm of uncertain behavior of cerebral meninges D42.1 Neoplasm of uncertain behavior of spinal meninges D42.9 Neoplasm of uncertain behavior of meninges, unspecified D43 Neoplasm of uncertain behavior of brain and central nervous system D43.0 [icd10data.com]

  Meninges – Both the brain and spinal cord are surrounded by thin layers of protective tissue (membranes) called the meninges. [cancercouncil.com.au]

  Most primary spinal cord tumors originate in cells next to the spinal cord, such as those of the meninges—the layers of tissue that cover the spinal cord (see figure How the Spine Is Organized). [merckmanuals.com]

• Tingling

  When the tumor presses on the spinal cord, symptoms may begin with numbness or tingling in the arms or legs. Next, patients may experience clumsiness, not knowing where their feet are, and difficulty with buttons or keys. [cancercenter.com]

  Pressure on spinal nerve roots can cause pain, numbness, tingling, and weakness in areas supplied by the compressed nerve root. Pain may radiate along the nerve whose root is compressed. If compression continues, the affected muscles may waste away. [merckmanuals.com]

  This can cause neurologic symptoms, including: weakness, tingling, or numbness in both legs or arms difficulty walking or balancing sensory problems loss of bowel and bladder control Back to top Arrow (up) icon. [mskcc.org]

• Stroke

  Resources Organizations National Institute of Neurological Disorders and Stroke. P.O. Box 5801, Bethesda, MD 20824. (800) 352-9424. http://www.ninds.nih.gov/index.htm. [medical-dictionary.thefreedictionary.com]

  (National Institute of Neurological Disorders and Stroke) Spinal cord tumors, while rare, can leave patients severely impaired neurologically. [neurosurgerydallas.com]

  Occasionally, a rapidly growing neoplasm causes sudden loss of function clinically suggestive of a stroke. [dartmouth.edu]

• Hyperreflexia

  As spinal cord compromise advances, hyperreflexia and Babinski reflexes are typically present. Lax rectal sphincter tone is a late sign of spinal cord dysfunction. [emedicine.medscape.com]

  Neurologic Exam (Motor Exam) Symmetric motor weakness In Epidural Spinal Cord Compression, motor deficits are more common than sensory Pain on Vertebra l body compression Early changes Flaccidity Hyporeflexia Later changes Cauda Equina Syndrome Spasticity Hyperreflexia [fpnotebook.com]

• Hyporeflexia

  Signs: Neurologic Exam (Motor Exam) Symmetric motor weakness In Epidural Spinal Cord Compression, motor deficits are more common than sensory Pain on Vertebra l body compression Early changes Flaccidity Hyporeflexia Later changes Cauda Equina Syndrome [fpnotebook.com]

The role of an adequate clinical workup is pivotal in making a presumptive diagnosis of an ongoing process in the spinal cord. Physicians must perform a full physical examination, with an emphasis on the neurological exam with sensory and motor testing, and obtain a complete patient history regarding the course, progression, and duration of symptoms. Imaging studies, however, are vital for recognizing lesions of the spinal cord and determining their exact location [2] [3] [7]. Magnetic resonance imaging (MRI) is the gold standard, particularly for intramedullary neoplasms, and many studies have emphasized its high rate of success in identifying a spinal cord tumor [7]. Some tumors exhibit specific features on MRI - ependymomas and astrocytomas will be either hypo or isointense on T1-weighed imaged and hyperintense on T2-weighed images, while both tumors are enhanced by the use of contrast [3]. However, MRI might not be always able to differentiate between the exact subtypes of spinal cord neoplasms based on imaging criteria, as certain studies showed a 70% success with histological findings from the tumors [2]. For this reason, a definite diagnosis can only be made after obtaining a sample of the tumor either by performing a biopsy or after surgical resection [2] [3] [7]. Subsequent histopathological examination and immunohistochemistry testing will be able to provide the answer to the etiology of the tumor [2].

Treatment for children is usually different than treatment for adults. (See the PDQ summary on Adult Central Nervous System Tumors Treatment for more information about the treatment of adults.) [cancer.gov]

Side effects of treatment in children Children can have long term side effects after treatment for a spinal tumour. The more severe the symptoms of weakness or paralysis before treatment, the more likely these may carry on after treatment. [cancerresearchuk.org]

Your radiotherapy team use this scan to plan your treatment. At the beginning of each treatment session, you lie in the same position but under the radiotherapy machine. The treatment itself only takes a few minutes. [macmillan.org.uk]

Downloadable PDFs Download free PDFs of our adult brain and spinal cord tumors information About and Key Statistics Causes, Risks, Prevention Detection, Diagnosis, Staging Treatment and Side Effects Next Steps After Treatment More Resources Read more [cancer.org]

If they can not be, radiation and chemotherapy treatments may be effective. Treatment also may include pain relievers and cortisone drugs to lessen swelling around the tumor, and ease pressure on the spinal cord. [medical-dictionary.thefreedictionary.com]

Key message: Ependymomas are a group of CNS tumours with moderately good prognosis, though higher grade tumours have slightly poorer survival. The prognosis for spinal ependymomas is better than that for cerebral tumours. [ncin.org.uk]

However, plans of care must factor account for prognosis and medical co-morbidities for maximal improvement in outcomes. DOI: https://doi.org/10.5430/cns.v1n2p14 Refbacks There are currently no refbacks. [sciedupress.com]

Prognosis Early diagnosis and treatment can produce a higher success rate. Long-term survival also depends on the tumor's type, location, and size. [medical-dictionary.thefreedictionary.com]

The prognosis depends on whether the tumour can be resected completely. The location and size at presentation often mean that incomplete resection only is possible. [patient.info]

Total excision in patients with good ambulation was associated with a good prognosis for post-operative mobility. [bmcresnotes.biomedcentral.com]

Subsequent histopathological examination and immunohistochemistry testing will be able to provide the answer to the etiology of the tumor. [symptoma.com]

If there is no focal cord expansion or considerable mass effect, non-neoplastic etiologies should be considered first. Cysts can be tumoral or nontumoral. [appliedradiology.com]

Despite more common etiologies of squamous cell carcinoma, this case report highlights the importance of being mindful of rare diseases. Statement of Ethics The authors have no ethical conflicts to disclose. [karger.com]

Etiology The clinically evident symptoms of spinal cord compression are caused by this cycle of increasing pressure (compression) on the spinal cord and nerves. [ispub.com]

Epidemiology Epidural Spinal Cord Compression occurs in 5% of cancer patients III. Causes: Benign Primary spinal tumors IV. Causes: Malignant Primary spinal tumors Sarcoma Multiple Myeloma (most common in adults) V. [fpnotebook.com]

Epidemiology Frequency United States Metastatic lesions that involve the spinal cord affect about 5-10% of patients with cancer. [3] Approximately 15% of all primary CNS lesions arise from the spinal cord, with an estimated incidence rate of 0.5-2.5 cases [emedicine.medscape.com]

Pathophysiology The pathophysiology of spinal cord compression is vascular in nature. This has been demonstrated in animal models. Initially there is venous compression which causes increase in venous permeability and interstitial edema. [ispub.com]

Pathophysiology Metastatic spinal cord compression usually follows hematogenous dissemination of malignant cells to the vertebral bodies, with subsequent expansion into the epidural space. [emedicine.medscape.com]

Prompt intervention may prevent paralysis. [medical-dictionary.thefreedictionary.com]

Causes, Risk Factors, and Prevention Learn about the risk factors for brain and spinal cord tumors and if there are things that you might be able to do to help lower your risk. [cancer.org]

These exercises can help prevent falls and other injuries and speed recovery from treatment. Occupational therapists can help you resume everyday activities such as bathing, going to the bathroom, and getting dressed. [nyulangone.org]

The cause of most brain tumors is unknown, as is any way to prevent them. How common are they? Brain and spinal cord tumors are rare, occurring in fewer than six in 100,000 U.S. children and teens. [ohsu.edu]

High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults. [cancercarewny.com]

1. Grimm S Chamberlain MC. Adult primary spinal cord tumors. Expert Rev Neurother. 2009;9(10):1487-1495.
2. Koeller KK, Rosenblum RS, Morrison AL. Neoplasms of the spinal cord and filum terminale: radiologic-pathologic correlation. Radiographics. 2000;20(6):1721-1749.
3. Samartzis D, Gillis CC, Shih P, et al. Intramedullary Spinal Cord Tumors: Part I—Epidemiology, Pathophysiology, and Diagnosis. Global Spine J. 2015;5(5):425-435.
4. Vaillant B, Loghin M. Treatment of spinal cord tumors. Curr Treat Options Neurol. 2009;11(4):315-324.
5. Mirone G, Cinalli G, Spennato P, Ruggiero C, Aliberti F. Hydrocephalus and spinal cord tumors: a review. Childs Nerv Syst. 2011;27(10):1741–1749.
6. Cinalli G, Sainte-Rose C, Lellouch-Tubiana A, et al. Hydrocephalus associated with intramedullary low-grade glioma. Illustrative cases and review of the literature. J Neurosurg. 1995;83(3):480–485.
7. Arima H, Hasegawa T, Togawa D. et al. Feasibility of a novel diagnostic chart of intramedullary spinal cord tumors in magnetic resonance imaging. Spinal Cord. 2014;52(10):769–773.