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Spinal Cord Neoplasm

Spinal cord neoplasm can be either a primary central nervous system tumor (glial or nonglial) or secondary to metastases. Clinical features depend on the location of the tumor with regards to the level of the spinal cord, but some of the most common symptoms are localized pain, weakness, isolated sensory or motor dysfunction, as well as inadequate sphincter control. Magnetic resonance imaging (MRI) must be performed in order to make the diagnosis.


Presentation

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].

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]
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]
Suggestibility
  • Pain that progresses down the asymptomatic (or less symptomatic) limb caused by straight-leg raising may suggest cord compression.[emedicine.medscape.com]
  • […] knowledge to interpret spinal cord compression as myelopathy, and therefore follow index entry: Myelopathy (spinal cord) G95.9 - in (due to) - - neoplastic disease NEC (M8000/1) (see also Neoplasm) D48.9† G99.2* The NCCH agreed with this logic, and suggested[remote.health.vic.gov.au]
  • Skip lesions, "flip-flop" or lacking of contrast enhancement may suggest non-neoplastic disorders.[ci.nii.ac.jp]
  • If a neurological exam and review of symptoms suggest a spinal cord tumor, the doctor may order some of these additional tests: MRI or CT scan myelography blood and spinal fluid studies x rays of the spine biopsy radionuclide bone scan Treatment If the[medical-dictionary.thefreedictionary.com]
  • Surgery, radiation therapy, or both Sometimes chemotherapy Sometimes immediate corticosteroids If symptoms suggest that the tumor is compressing the spinal cord, corticosteroids (such as dexamethasone ) are immediately given in high doses to reduce the[merckmanuals.com]
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]

Workup

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].

Polyps
  • NIH: National Cancer Institute Biopsy - polyps (Medical Encyclopedia) Cherry angioma (Medical Encyclopedia) [ Read More ] Spinal Cord Diseases Your spinal cord is a bundle of nerves that runs down the middle of your back.[icdlist.com]

Treatment

  • Treatments often include medicines and surgery.[icdlist.com]
  • 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.[symptoma.com]
  • However, it is particularly important because of the good re sults of appropriate treatment and the unfortunate consequences should the diagnosis be missed.[books.google.com]
  • These patients require rapid diagnosis and treatment to prevent permanent complications (see Presentation, Workup, and Treatment.[emedicine.medscape.com]
  • 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]

Prognosis

  • 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]
  • Mortality correlates with the prognosis of the primary cancer. The severity of spinal cord compromise secondary to a tumor spans a wide range. Initially, symptoms may be limited to pain or minor sensory or motor disturbance.[emedicine.medscape.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]
  • Total excision in patients with good ambulation was associated with a good prognosis for post-operative mobility.[bmcresnotes.biomedcentral.com]
  • Overall the patient’s prognosis for recovery depends largely on the degree of ambulation at the time of diagnosis.[ispub.com]

Etiology

  • 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]
  • 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

  • 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]
  • 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]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • 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]

Prevention

  • 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]
  • High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults. Spine J. 2009;9:147-168. 2/17/2009 DynaMed's Systematic Literature Surveillance : Chou R, Fu R, et al.[cancercarewny.com]
  • 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]
  • These patients require rapid diagnosis and treatment to prevent permanent complications (see Presentation, Workup, and Treatment.[emedicine.medscape.com]

References

Article

  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.

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Last updated: 2019-07-11 21:10