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Spinal Cord Tumor

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]
  • […] changes or confusion Parietal lobe problems with reading or writing loss of feeling in part of the body difficulty with spatial awareness, e.g. telling left from right, locating objects Occipital lobe loss of all or some vision Spinal cord back and neck[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]
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]
Sciatica
  • Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Syst Rev. 2010;(6):CD007612. Hagen KB, Hilde G, et al. Bedrest for acute low back pain and sciatica.[cancercarewny.com]
Polyneuropathy
  • These can produce: a subacute cerebellar syndrome; polyneuropathy; myoneural junction disease (weakenss); or confusional state. 28-14. What is the most common cause of tumors of the spine? Answer 28-14.[dartmouth.edu]

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].

Treatment

  • 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]
  • 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]
  • NYU Langone’s Rusk Rehabilitation has a team of physical and occupational therapists who can help you regain your mobility and sensation after treatment for a spinal cord tumor.[nyulangone.org]
  • Consequently, treatment is similar to that for intracranial tumors with a similar histology.[ncbi.nlm.nih.gov]

Prognosis

  • However, plans of care must factor account for prognosis and medical co-morbidities for maximal improvement in outcomes. DOI: 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]
  • Malignant Astrocytomas generally have a poor prognosis, with an average survival of two (2) years.[neurosurgerydallas.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]
  • Certain factors affect prognosis (chance of recovery). The prognosis (chance of recovery ) depends on the following: Whether there are any cancer cells left after surgery. The type of tumor. Where the tumor is in the body. The child's age.[cancer.gov]

Etiology

  • Subsequent histopathological examination and immunohistochemistry testing will be able to provide the answer to the etiology of the tumor.[symptoma.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]
  • 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]
  • In some instances, however, the symptoms are specific to the etiology. Hemorrhage, which can be parenchymal or extra-axial is the most common cause of intracranial mass lesions and is discussed in Chapter 27.[dartmouth.edu]

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]
  • 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]
  • However, if caught early and treated aggressively, it may be possible to prevent further loss of function and regain nerve function. Depending on its location, a tumor that presses against the spinal cord itself may be life-threatening. Dec. 28, 2017[mayoclinic.org]

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