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Spinal Tumor

Introduction:

Spinal cord tumors are rare but can leave patients neurologically and functionally impaired. Recently, improved testing, such as MRI and CTS, has allowed these lesions to be diagnosed earlier and intervention can proceed sooner. Microsurgical techniques and other specialized treatments can help to minimize these potentially devastating types of tumors.

This website will provide an overview about spinal cord tumor types, treatments and also a unique collection of surgical video to give you a neurosurgeon's view of how these tumors are resected.

To Learn More About Dr. El Kadi and Tri-State Neurosurgical Associates -UPMC

phone # 412-630-7640 or 1-877-635-5234

Where are spinal tumors?

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 are?

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
	Myelogram
	Electrical conduction tests - usually used during surgery
	Angiogram
	Lumbar puncture

Treatment Options?

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.

Types of Tumors:

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%)

Occurrence:

	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 population.
	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 problems.
	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 injuries)

Surgical Risks:

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.

Case Study:

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.

MRI Results: 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 surgery.

Discussion: 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.

Surgery: 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)

Discussion: 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.

Operation: 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.

Discussion: 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.

Call, toll-free, at 412-630-7640 or 877-635-5234 to learn more.

Disclaimer:

Every effort has been made by the author (s) to provide accurate, up-to-date information. However, the medical knowledge base is dynamic and errors can occur. By using the information contained herein, the viewer willingly assumes all risks in connection with such use. Neither the author nor UPMC shall be held responsible for errors, omissions in information herein nor liable for any special, consequential, or exemplary damages resulting, in whole or in part, from any viewer(s)' use of or reliance upon, this material.

CLINICAL DISCLAIMER:

Clinical information is provided for educational purposes and not as a medical or professional service. Person(s) who are not medical professionals should have clinical information reviewed and interpreted or applied only by the appropriate health professional(s).

For questions or comments, please contact: bostj@msx.upmc.edu

Updated: August 26, 2007

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SpineTumor.org

09/18/07

Spinal Tumor

Where are spinal tumors?