Spinal Neoplasms
Similar to intracranial tumors but involving the spinal cord or its roots, untreated spinal neoplasms can eventually cause paralysis. As primary tumors, they originate in the meningeal coverings, the parenchyma of the cord or its roots, the intraspinal vasculature, or the vertebrae. They can also occur as metastatic foci from primary tumors, but death usually results from the primary condition.
Primary tumors of the spinal cord may be extramedullary (occurring outside the spinal cord) or intramedullary (occurring within the cord). Extramedullary tumors may be intradural (meningiomas and schwannomas) or extradural (metastatic tumors from breasts, lungs, prostate, leukemia, or lymphomas). Intradural extramedullary tumors account for about 60% of all primary spinal cord neoplasms. Extradural extramedullary tumors account for about 25% of these neoplasms.
Intramedullary tumors, or gliomas (astrocytomas or ependymomas), are comparatively
rare and account for only about 10% of spinal neoplasms.
rare and account for only about 10% of spinal neoplasms.
Pediatric pointerIn children, these lesions are low-grade astrocytomas.
Spinal cord tumors are rare compared with intracranial tumors (ratio of 1:4). They occur with equal frequency in men and females except for meningiomas, which occur more often in females. Spinal cord tumors can grow anywhere along the cord or its roots.
The prognosis depends on tumor control and the extent of residual neurologic deficit.
Causes
Little is known about the cause of spinal cord tumors. They have been associated with central von Recklinghausen’s disease.
Complications
Motor and sensory deficits range from weakness to paralysis as the disease progresses. They may lead to loss of sphincter control and subsequent bladder and bowel dysfunction.
In late stages of disease, especially with paralysis, complications of immobility such as skin breakdown may occur. Other complications depend on the tumor’s location. For example, respiratory problems occur in high cervical tumors, whereas chronic urinary tract problems are associated with tumors lower in the spine.
Assessment
Because the spinal cord adjusts to a slow-growing tumor, a tumor may grow for several years and produce minimal neurologic signs. The patient’s history, however, may reveal pain described as most severe directly over the tumor and radiating around the trunk or down the limb on the affected side. The patient may report that few measures relieve the pain, not even bed rest. Some patients also complain of constipation.
In the early stages, the patient may express difficulty in emptying the bladder or notice changes in the urinary stream. If you suspect a spinal cord tumor, ask the patient about bladder emptying because many patients overlook or dismiss this sign.
In later stages, urine retention is an inevitable sign of spinal cord compression. If the patient has a cauda equina tumor, he may report bladder and bowel incontinence, usually resulting from flaccid paralysis.
On inspection and palpation, you may find symmetrical spastic weakness, decreased muscle tone, exaggerated reflexes, and a positive Babinski’s sign. If the tumor is at the cauda equina level, you may notice muscle wasting. Palpation may reveal muscle flaccidity, wasting, weakness, and progressive diminution in tendon reflexes.
Neurologic examination may disclose contralateral loss of sensation to pain, temperature, and touch (Brown-Séquard’s syndrome). These losses are less obvious to the patient than functional motor changes. Caudal lesions invariably produce parasthesia in the nerve pathways of the involved roots.
Diagnostic tests
