A spinal neoplasm is anyone of many tumor types that are similar to intracranial tumors and involve the spinal cord or its roots. If untreated, they can eventually cause paralysis.
Primary spinal neoplasms 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.
Primary spinal cord tumors may be extramedullary (occurring outside the spinal cord) or intramedullary (occurring within the cord itself). Extramedullary tumors may be intradural (meningiomas and schwannomas), which account for 60% of all primary spinal cord neoplasms, or extradural (metastatic tumors from breasts, lungs, prostate, leukemia, or lymphomas), which account for 25% of these neoplasms.
Intramedullary tumors, or gliomas (astrocytomas or ependymomas), are comparatively rare, accounting for only about 10% of tumors. In children, they're low-grade astrocytomas.
Spinal cord tumors are rare compared with intracranial tumors (ratio of 1:4).
Signs and symptoms
Extramedullary tumors produce symptoms by pressing on nerve roots, the spinal cord, and spinal vessels; intramedullary tumors, by destroying the parenchyma and compressing adjacent areas. Because intramedullary tumors may extend over several spinal cord segments, their symptoms are more variable than those of extramedullary tumors.
The following clinical effects are likely with all spinal cord neoplasms:
Several tests aid in diagnosis:
Spinal cord tumors usually require decompression or radiation. Laminectomy is indicated for primary tumors that produce spinal cord or cauda equina compression; it's not usually indicated for metastatic tumors.
If the tumor is slowly progressive, or If it's treated before the cord degenerates from compression, symptoms are likely to disappear, and complete restoration of function is possible. In a patient with metastatic carcinoma or lymphoma who suddenly experiences complete transverse myelitis with spinal shock, functional improvement is unlikely, even with treatment, and his outlook is ominous.
If the patient has incomplete paraplegia of rapid onset, emergency surgical decompression may save cord function. Steroid therapy minimizes cord edema until surgery can be performed. Partial removal of intramedullary gliomas, followed by radiation, may alleviate symptoms for a short time.
Metastatic extradural tumors can be controlled with radiation, analgesics and, in the case of hormone-mediated tumors (breast and prostate), appropriate hormone therapy.
Transcutaneous electrical nerve stimulation (TENS) may control radicular pain from spinal cord tumors and is a useful alternative to narcotic analgesics. In TENS, an electrical charge is applied to the skin to stimulate large-diameter nerve fibers and thereby inhibit transmission of pain impulses through smalldiameter nerve fibers.
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