Tumors of the spinal cord and back pain

Spinal cord can develop in the parenchyma of the spinal cord (intramedullary), directly damaging the tissues, or outside the spinal cord (extramedullary), causing compression of the spinal cord and roots. Symptoms include progressive back pain and a neurological deficit corresponding to the affected area of the spinal cord or roots. Diagnosis - MRI. Treatment may include corticosteroids, surgical removal and radiation therapy.

Tumors of the spinal cord can be intramedullary (inside the parenchyma of the spinal cord) and extramedullary (outside the parenchyma). Most often intramedullary tumors are represented by gliomas (eg, ependymomas, low-grade astrocytomas). Extramedullary tumors can be intradural and extradural. Most intradural tumors are benign, usually meningeomas and neurofibromas, which are often primary. Most extradural tumors are metastatic, usually from lung, breast, prostate, kidney, thyroid, or lymphoma carcinoma (eg, Hodgkin's lymphoma, lymphosarcoma, reticular cell sarcoma).

Intramedullary tumors infiltrate and destroy the parenchyma of the spinal cord and can spread over several spinal segments; Intramedullary tumors can lead to the appearance of syringomyelitis cavities. Intradural and extradural tumors cause neural damage, squeezing the spinal cord or roots. Many extradural tumors cause bone destruction before compressing the spinal cord.

Symptoms of tumors of the spinal cord

Symptoms and Diagnosis

• Constant back pain, which does not diminish as the body changes
• Night pain; weight loss
• Electrophoresis of blood proteins (myeloma)
• PSA> 10ng / ml
• MPT; CT; Radiography is informative 65%
• Isotope scintigraphy is informative in osteoblastic tumors

The earliest symptom is pain. It progressively increases, does not depend on activity, and increases in lying position. Pain can be localized in the back, irradiated over the dermatome (radicular pain), or both. In the future there is a neurological deficit. The most typical spastic paresis, incontinence of urine and feces, dysfunction of some or all of the sensory tracts, in particular at the level of the affected segments of the spinal cord and below. Deficiency is usually bilateral.

Most patients with extramedullary tumors complain of pain, but in some, the first clinical symptoms may be sensory disorders in the distal parts of the lower extremities or segmental neurologic deficits and spinal cord compression. Symptoms of compression of the spinal cord tend to be rapid weighting, because most extradural tumors are metastatic. Symptoms of compression of nerve roots are also frequent, they include pain and paresthesia following a decrease in sensitivity, muscle weakness and, with prolonged compression, patient exhaustion that corresponds to the duration of the pain syndrome.

Favorable

• Osteoid osteoma
• Osteoblastoma

Malignant

• Myeloma
• Osteosarcoma
• Chondrosarcoma
• Metastases in the skeleton

Malignant

• 75% of all cases in patients older than 50 years
• In 30% of cases in history, oncological pathology
• Less than 1% of all back pain cases

Causes

• 2/3 metastases
• The most common primary tumor is myeloma
• Extrinsic tumors: pancreas, kidney, retroperitoneal lymphomatosis
• Metastatic tumors

The most common causes are in descending order:

• Lungs
• Breast
• Prostate
• Kidneys
• Unknown origin
• Sarcoma
• Lymphoma
• Colon
• Thyroid
• Melanoma

Localization of metastases

• Neck department 6 - 19%
• Thoracic department - 49%
• Lumbar department - 46%

Diagnosis and treatment of spinal cord tumors

Suspicion of a spinal tumor occurs in the presence of progressive, non-curable or nocturnal pain or radicular pain, segmental neurologic deficit or neurologic deficit of an unclear genesis, indicative of a lesion of the spinal cord or roots. Suspicion also occurs with unspecified back pain in patients with a tumor of the lung, breast, prostate, kidney, thyroid or lymphoma. Diagnosis consists in carrying out an MRI of the affected area of the spinal cord. CT is an alternative method, but less informative. Patients with segmental neurologic deficits or suspected compression of the spinal cord require urgent diagnosis and treatment.

If MRI did not detect a spinal tumor, other volumetric processes (eg, abscess, arterio-venous malformation) and paravertebral tumors should be considered. Radiography of the spine, carried out for other indications, can show bone destruction or lesion of paraspinal tissues in metastatic tumors.

For patients with neurological deficits, corticosteroids (eg, dexamethasone 50 mg intravenously, then 10 mg orally 4 times daily) should be given immediately to reduce spinal cord edema and preserve function. A tumor that squeezes the spinal cord should be treated as quickly as possible. Some tumors of favorable localization can be surgically removed.

Deficiency disappears in about yr of these patients. Tumors that can not be surgically removed are treated with radiotherapy with or without surgical decompression. Metastatic extradural tumors that compress the spinal cord are usually surgically removed, followed by radiotherapy. Extradural metastases that do not cause compression of the spinal cord can be treated only by radiotherapy, but removal may be required if radiotherapy is ineffective.

[1], [2], [3], [4]