Where are spinal
Spine tumors can
involve the structures of the spine or the spinal column. Cervical
(neck), thoracic (back) and lumbosacral (low back) areas can all
be locations for these tumors. They can arise from nerve or bony
structures that make up the spine. And they can originate from the
spine or come from elsewhere in the body.
Typical Symptoms and Signs
Pain is the usual presentation and this is classically thought
to be worse when the patient is supine or flat. Pain usually
radiates to the part of the body (arm or leg) because theses
nerves in the cord are being pressed on by the tumor mass.
Eventually weakness and abnormal sensations will follow and the
tumor advances and finally the bladder and bowel will begin to
lose normal function. During this time walking will become
difficult and paralysis may then rapidly occur.
What Tests can be Done?
Some or all of the following tests maybe needed
to determine the extent and location of the tumor. It is also
important to determine if there are other locations of tumor both
within the spine or from other organs or tissues.
|Plain Spinal X-rays |
|CTS with and without contrast dye |
|MRI with and without
contrast dye |
|MRA or MRI- angiogram |
|Electrical conduction tests - usually used
during surgery |
|Lumbar puncture |
Once diagnosed a Neurosurgeon will need to
assess whether this is an operable tumor. If surgery is indicated
the goal will be to remove as much tumor safely and to preserve
the neurological function that is present prior to surgery. Many
factors go into this decision and the risks must be considered but
once surgery is agreed upon. Even with a successful outcome there
is still a possibility of reoccurrence which will usually require
lifelong monitoring with MRIs. Radiation therapy and chemotherapy
are usually of little help with most tumors of the spine but some
treatment protocols are offered.
Spinal tumors can be divided into extradural,
intradural extramedullary, and intradural intramedullary.
|Extradural- Those tumors outside the dural
covering of the spinal cord. |
|Intradural extramedullary - Those tumors
inside the dural covering but not within the spinal cord itself.
|Intradural intramedullary - Those tumors
inside the dural covering and within the spinal cord itself.
The cell types of these tumors are the same are
those of the brain (See
list of tumor types). And many tumors from other parts of the
body can metastasize or travel to the spinal cord and cause
compression. Listed below are the common occurrence rates of the
following tumors that can occur within the spinal cord.
|Ependymoma (56%) The most common intrinsic
spinal cord tumor |
|Astrocytoma (29%) These lesions are more
common in children than in adults. |
|Oligodendroglioma (3%) |
|Developmental tumors (3%) |
|Hemangioblastoma (3%) |
|Lipoma (2%) |
|Others (4%) |
|Spinal tumors approximately 1.1 case per
100,000 persons. |
|Approximately 15-20% of all central nervous
system (CNS) tumors occur in the spine. |
| They occur in both the pediatric and adult
|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
|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
The possible risks from spinal cord tumor
surgery will be reviewed with you and your family prior to
surgery. But this type operation is obviously very serious and
risks verses benefits must be considered. The risk of paralysis,
loss of bladder, bowel or sexual function can occur but are rare
in most cases. Spinal fluid leaks, due to the fact that the dural
or outer sac around the spinal cord may be open, are more common
and are treated with either prolong bed rest or a spinal fluid
drain after surgery. Recovery after this type surgery may include
aggressive physical therapy in order to regain lost function due
to the tumor compression. Cord swelling after surgery is not
unusual and symptoms may be worse for a time. Often medications
such as steroids are used to decrease nerve tissue swelling. As
with any operation events such as infection, blood clots and
pneumonia can occur following this type of surgery.
Complaint: This is a 25
year old man who originally complained of mid to low back pain
while working in July, 2001. He was treated with conservative
therapy and his symptoms worsen with pain radiating into his
legs. MRI which showed a spinal cord tumor at the end portion of
the spinal cord.
Discussion: The symptoms
and signs of spinal tumors are usually slow to develop but often
persist and worsen despite treatment.
Further review showed the spinal tumor at the level of T12 to L2
in the spinal canal. It was intradural and intramedullary and up
against the conus medullaris or the tail of the spinal cord. It
is homogenously enhancing and had the appearance of an ependymoma.
He was examined and found to have decreased strength in his legs.
He was explained the risks and benefits of the recommended
Due to the consistent (same) appearance of the tumor throughout
its structure on an enhanced MRI, it was believed to be a benign
ependymoma tumor. Physical examination showed weakness of the
patients legs most likely from the enlarging mass of the tumor
pressing on the nerves as they exited the spinal cord to the legs.
The risks of surgical intervention, including but not limited to,
weakness, numbness, paralysis, and/or loss of bowel or bladder
function are always discussed in great detail.
The surgery consisted of T12 to L2 laminectomies
and opening of the dural sac surrounding the cord. (See above left
picture) The tumor was identified and resected from off of the
nerve roots very carefully. The tumor could then be removed. (See
above right picture)
The description above is minimal compared to the actual surgery
involved. This is a very intricate operation that requires great
skill and patience. The operating room microscope is used and
throughout the entire operation electrical monitoring is used to
monitor nerve function.
The operation was a success and the patient recovered completely
and was discharged home 3 days after the surgery. The patient
complained of some incisional pain but his leg symptoms and
strength had returned to normal. Post-operative MRI examination
prior to hospital discharge showed no residual tumor.
The results are typical but as with any operation results can
vary. This patient would be able to resume most activities in 1
to 2 months, including work activity. This type tumor can reoccur
and therefore follow-up MRIs are recommended annually.
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Updated: August 26, 2007