spinal tumors

Different types

Tumors of the column

These tumors affect the bones of the spine. The majority of tumors of the spine are metastatic. That is, the primary or primary tumor developed in another organ and spread to the spine, usually through the bloodstream. The most common metastatic spinal tumors in women are breast and lung. In humans, metastatic spinal cord tumors most often originate in the prostate and lung. Tumors from vertebral bone and cartilage cells are also present in the spine. Examples of such primary spinal tumors include osteoid osteoma, osteoblastoma and giant cell tumor, which are benign, and osteogenic sarcoma, chordoma, chondrosarcoma, and Ewing's sarcoma, which are malignant bone tumors.

Intra-dural and extra-medullary tumors

These tumors are located inside the dura mater but outside the substance of the spinal cord. Meningitis and tumors of the nerve sheath (schwannomas and neurofibromas) constitute the vast majority. The meningiomas come from the dura mater, the thin membrane that surrounds the cerebrospinal fluid and the spinal cord. Meningiomas are more common in middle-aged women. These tumors are usually benign. Schwannomas and neurofibromas come from the nerve roots that leave the spinal cord. Like meningiomas, tumors of the nerve sheath are usually benign. Ependymomas of the filum terminale appear just below the spinal cord. Almost all are benign. These tumors can be bulky and adhere to many nerves, which sometimes makes it difficult to eliminate them completely.

Intramedullary tumors

Intramedullary tumors are located inside the substance of the spinal cord. These tumors usually come from glial cells (support cells) of the spinal cord. Astrocytomas and ependymomas account for the majority and occur at approximately equal frequency, although astrocytomas are more common in children and ependymomas are more common in adults. Hemangioblastomas, tumors of the blood vessels, are less common and occur as part of Von Hippel Lindau disease (VHL). VHL is an inherited disorder in which patients are likely to develop cysts and tumors in the kidneys and other organs. Intramedullary tumors occur most often in the cervical spinal cord.

Symptoms

Tumors in the spine can cause symptoms that vary in type, location, and growth rate. the most common sign is pain in the tumor (neck or back), followed by neurological problems such as weakness / numbness in the arms or legs, or bowel or bladder problems. In patients already diagnosed with cancer in another part of the body, the recent onset of spinal pain may indicate a fracture of the spine caused by a metastatic tumor that has weakened the vertebra. Tumors that appear inside the dura are usually benign and slow growing. Patients with these tumors may experience pain for years before a neurological problem occurs.

Diagnostic

The assessment includes a complete medical history, a physical and neurological examination and a radiographic study of the spine. The most accurate imaging study is magnetic resonance imaging of the spine, with and without intravenous gadolinium (a contrast enhancer that allows some tumors to brighten up). These scans give an adequate image of the spinal cord and its associated nerves. On an MRI, the details of the spine bone are not as good as with CT-scan. However, bone details are usually sufficient with MRI and MRI scans are able to show details of the spinal cord, whereas CT scans are not. Other radiographic studies such as CT scan and myelography associated (CT scan after radiographic contrast injection into cerebrospinal fluid) or standard x-rays of the spine may be required depending on the type, location and impacts of the tumor.

Treatment

Tumors of the column
Some tumors of the spine are primary bone tumors, but most tumors of the spine are metastatic tumors. In the case of metastatic tumors, removing the tumor from the spine will not cure the cancer. However, advances in treatments such as radiosurgery, separation surgery and chemotherapy have significantly improved the prognosis for patients with metastatic tumors. There are many treatments available to reduce the tumor or slow down or stop its growth, relieve the pain or neurological signs caused by the tumor and maintain the stability of the spine. Radiation therapy, either conventional or stereotaxic radiosurgery, is an option that often significantly reduces spinal pain. This treatment uses highly focused rays to disrupt tumor cells and shrink the tumor. Radiation therapy can be used to treat painful tumors if they do not compress the spinal cord or destabilize the spine. Surgical treatment may be beneficial for tumors that compress the spine or destabilize the spine. Most benign tumors and many malignant spinal tumors can often be completely eliminated with advanced surgical techniques. Decompression surgery involves removing the part of the vertebra implicated in the tumor. When decompression surgery or the tumor itself destabilizes the spine, an arthrodesis with bone graft and material may be proposed.


Intra-dural and extra-medullary tumors
Most intradural-extramedullary tumors are treated by total resection and patients generally report little or no neurological problems after surgery. However, ependymomas of large filum terminales are often impossible to eliminate completely because they adhere to many spinal nerves. Postoperative radiotherapy can improve the results in these cases.


Intramedullary tumors Intramedullary tumors
(such as astrocytomas, ependymomas, and hemangioblastomas) appear in the very substance of the spinal cord. The usual treatment of these tumors is surgical excision. The goal of the surgery is to completely remove the tumor while preserving maximum neurological function. For most operations on or near the spinal cord, surgeons use careful monitoring using neurophysiological techniques such as SSEPs (somatosensory evoked potentials) and MEPs (motor evoked potentials). These techniques allow surgeons to monitor the functioning of the spinal cord during surgery, to ensure that it responds safely. Intramedullary ependymomas and hemangioblastomas are generally well differentiated from the surrounding spinal cord and can often be removed completely. Patients may have temporary neurological problems after surgery. On the other hand, intramedullary astrocytomas can mix with the surrounding spinal cord and can be difficult to completely and safely eliminate. Since these tumors tend to grow slowly, patients can still benefit significantly from incomplete elimination. Tumors that can not be completely eliminated and have aggressive characteristics are often treated with post-operative radiotherapy.