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Spinal Neoplasm

Spinal neoplasms are rare in clinical practice, and more than 95% are recognized as metastatic tumors. A gradual onset of localized pain that is often present during the night and at rest is the typical symptom. The diagnosis can be made through imaging studies, such as computed tomography, magnetic resonance imaging, and bone scintigraphy. In addition, a biopsy is necessary to confirm the underlying subtype and assist in determining the tumor stage.


Presentation

Tumors of the spine are predominantly diagnosed as metastatic deposits of a range of malignant diseases, including breast, lung, prostate, kidney, GI tract and thyroid cancer [1] [2]. In fact, up to 97% of spinal neoplasms are secondary tumors, whereas numerous benign and malignant (chordomas, osteosarcomas, multiple myelomas, lymphomas) primary spinal tumors are rare clinical entities [1] [3]. Neoplasms can develop at virtually any location in the spine, and studies have shown variable data regarding the age of onset [1] [3] [4]. Primary tumors are more commonly reported in the pediatric population [4], while metastatic spinal neoplasms are diagnosed in late adulthood [1] [3] [5]. In terms of clinical presentation, localized pain is the hallmark of a spinal neoplasm [1] [4] [5] and the pain is usually gradual in onset and becomes particularly unpleasant at night. Many patients report that the pain becomes constant later [1] [4]. The pathogenesis of pain involves several theories, including pathological fractures, nerve damage, and cortical expansion as a result of bone remodeling [1] [4]. Additional symptoms that might be encountered in spinal neoplasms are waist and back pain, a kyphotic posture if a fracture has occurred, as well as aggravation of symptoms during standing or walking, fever, weight loss, and associated neurologic complaints [1] [5].

Sneezing
  • Valsalva maneuvers, such as coughing, sneezing, or straining, may exacerbate radicular back pain from cord compression, but this occurs with other causes of mechanical back pain as well.[emedicine.medscape.com]
Gingival Pain
  • Pain (gum pain): 1 person, 25.00% Dizziness: 1 person, 25.00% Emphysema (chronic respiratory disease - over inflation of the air sacs (alveoli) in the lungs): 1 person, 25.00% Exposed Bone In Jaw: 1 person, 25.00% Fall: 1 person, 25.00% Fever: 1 person[ehealthme.com]
Back Pain
  • Additional symptoms that might be encountered in spinal neoplasms are waist and back pain, a kyphotic posture if a fracture has occurred, as well as aggravation of symptoms during standing or walking, fever, weight loss, and associated neurologic complaints[symptoma.com]
  • Valsalva maneuvers, such as coughing, sneezing, or straining, may exacerbate radicular back pain from cord compression, but this occurs with other causes of mechanical back pain as well.[emedicine.medscape.com]
  • References: Acute low back pain. EBSCO DynaMed website. Available at: . Updated November 22, 2013. Accessed November 26, 2013. Bratton RL. Assessment and management of acute low back pain. Am Fam Physician. 1999;60:2299-2309. Chronic 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]
  • People older than 50 years are more likely to experience back pain secondary to a metastatic tumor. Certain CNS tumors, such as neuroblastoma, occur almost solely in pediatric patients.[emedicine.medscape.com]
Spine Pain
  • Pain mainly when you sit or stand usually means that the tumor is causing weakness or instability in the bones of your spine. Pain primarily at night or in the early morning that gets better as you move is often the first symptom of a tumor.[mskcc.org]

Workup

The diagnosis of a spinal neoplasm may be difficult to attain without an obvious clinical presentation, which is why physicians must conduct a thorough physical examination and obtain a detailed patient history in order to raise clinical suspicion. The patient's age, history of malignant disease, and both the course and progression of symptoms should be covered during the patient interview [1] [4] [5]. Imaging studies, however, are the cornerstone for achieving the diagnosis of a spinal neoplasm, with plain radiography being a useful initial method, as up to 80% of benign and 40% of metastatic tumors can be seen on spinal X-rays [1]. Because of its limited efficacy, it is now considered as a useful adjunct to more superior studies, primarily computed tomography (CT) and magnetic resonance imaging (MRI) [1] [4] [6]. These two procedures are able to identify the exact location of the tumor, define the extent of local tissue destruction, and provide key information for obtaining a biopsy sample, which is vital for determining the exact tumor type [1] [5] [6]. In addition to CT and MRI, bone scintigraphy and positron emission tomography (PET) are also regarded as potentially useful tools in the diagnostic workup of spinal neoplasms [1].

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

  • We present an overview of the clinical outcome and surgical treatment of 197 benign spinal tumours carried out in our centre from 1980 to 1999.[ncbi.nlm.nih.gov]
  • Treatments often include medicines and surgery.[icdlist.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]
  • We have rehabilitation and pain management experts ready to assist you after treatment. We can help you with the pain, numbness, weakness, and loss of mobility that may result from a spine tumor or its treatment.[mskcc.org]

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]
  • . - Metastatic Tumors of the spine: - carcinoma of the breast, kidney, or multiple myeloma may have relatively good long term prognosis; - metastatic carcinoma of the prostate or lung may have poor 1 year survival; - patients w/ combination of spinal[wheelessonline.com]
  • Almost all attempt to guide decision-making by predicting survival prognosis [ 12 – 17 ]. In addition to prognosis, other key factors require consideration, including spinal stability.[ro-journal.biomedcentral.com]

Etiology

  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.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]

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]
  • The prevailing patterns of care and neurosurgical challenges in the treatment of spinal tumors are best determined by local epidemiological data in conjunction with wider population based analyses.[scitechnol.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]
  • Generalizability was enhanced by a multicenter, international group of oncologists who reviewed cases that represented the established epidemiological profile of metastatic spine disease.[ro-journal.biomedcentral.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]

Prevention

  • What they found adds to... [ Read Full Story ] May 10, 2019 If your provider is ordering nebulizers and the drugs used in them for their patients here are things in the documentation that will help prevent a resubmission to Medicare and ease medical coding[coder.aapc.com]
  • These patients require rapid diagnosis and treatment to prevent permanent complications (see Presentation, Workup, and Treatment.[emedicine.medscape.com]
  • 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]
  • […] most common primary tumor of spine) - chordoma - osteosarcoma - hemangioma - giant cell tumor of bone : sacrum; - eosinophilic granuloma - produces vertebra plana on lateral x-ray; - observe unless it causes a deficit - low dose xrt may be helpful to prevent[wheelessonline.com]
  • Magnetic resonance imaging or myelography with computed tomography Sometimes a biopsy Compression of the spinal cord by a tumor must be diagnosed and treated immediately to prevent permanent damage.[merckmanuals.com]

References

Article

  1. Ciftdemir M, Kaya M, Selcuk E, Yalniz E. Tumors of the spine. World J Orthop. 2016;7(2):109-116.
  2. Choi D, Crockard A, Bunger C, Harms J, Kawahara N, Mazel C, Melcher R, Tomita K. Review of metastatic spine tumour classification and indications for surgery: the consensus statement of the Global Spine Tumour Study Group. Eur Spine J. 2010;19:215–222.
  3. Clarke MJ, Mendel E, Vrionis FD. Primary spine tumors: diagnosis and treatment. Cancer Control. 2014;21(2):114-123.
  4. Kelley SP, Ashford RU, Rao AS, Dickson RA. Primary bone tumours of the spine: a 42-year survey from the Leeds Regional Bone Tumour Registry. Eur Spine J. 2007;16(3):405-409.
  5. Slipman CW, Patel RK, Botwin K, et al. Epidemiology of spine tumors presenting to musculoskeletal physiatrists. Arch Phys Med Rehabil. 2003;84(4):492-495.
  6. Patnaik S, Jyotsnarani Y, Uppin SG, Susarla R. Imaging features of primary tumors of the spine: A pictorial essay. Indian J Radiol Imaging. 2016;26(2):279-289.

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Last updated: 2019-07-11 21:49