Transcript Tumours of the Spines (Spinal Tumours)

Tumours of the
Spines
(Spinal Tumours)
Tumours of the Spines
As in the brain, any space occupying
lesion around the soft encaged
spinal cord will produce the same
symptoms, signs and even
radiological appearance of a
tumour.
Spinal Tumours
 15 % of primary CNS tumors are intraspinal.
 Most of the primary CNS spinal tumors are
benign.
 Most present by compression rather than
invasion.
Sites of Spinal Tumours
A.Extradural
B.Intradural: which may be either:
I. Extramedullary (i.e. outside the cord)
II.Intramedullary (i.e. inside the cord, within the
substance of the cord)
Extradural Tumours:
 Pathological Types:
1.Metastatic tumours (secondary deposits)
2.Sarcoma
3.Chordoma
4.Neurofibroma
Metastatic tumours (secondary deposits)
• These are the most common tumours of the
spine, accounting for 98% of all spine lesions.
• Although metastatic lesions may be found in
each group, they are usually extradural.
• Areas involved in frequency are dorsal,
cervical, lumbar and sacral.
• These are also the commonest extradural
tumours.
Metastatic tumours (secondary deposits)
• The most common sites of origin usually from
the following organs in order of frequency:
a. Breast (21%)
b. Lung (14%)
c. Prostate (7.5%)
d. Renal (5%)
e. Gastrointestinal (5%)
f. Thyroid (2.5%)
Metastatic tumours (secondary deposits)
Methods by which metastatic disease spreads to
the spines:
a. Embolisation through the venous system (Batson's
plexus): this is the most frequent pathway.
b. Embolasation through the arterial system.
c. Direct extension.
d. Lymphatic spread.
Neurofibroma
• Neurofibroma may be "dumb-bell" in
shape, the smaller part lies within the
neural canal while the larger part
projects through an intervertebral
foramen and encroaches on the
thorax.
Clinical Features of Extradural
spinal tumours
• These tumours present with
symptoms and signs of irritation of
nerve roots preceding the signs of
pressure on the cord.
Differential diagnosis of Extradural
Spinal Tumours
• Prolapsed intervertebral disc in the
lumbar and less commonly in the
cervical regions, may produce
identical symptoms.
Intradural Tumours
• I. Intradural Extramedullary Tumours:
Pathological Types: the most important are
1.Meningiomas
2.Neurofibromas
Clinical Features of Extramedullary
Tumours
1. Sensory and motor weakness. The anterior or posterior
roots tend to be involved first; the proximal level of the
sensory and motor changes depends on the site of the
tumour.
2. Symptoms due to pressure on the cord itself occur later,
there may be the Brown-Sequard hemisection
phenomenon, with weakness and loss of vibration sense
on the same side as the lesion and loss of pain on the
opposite side. Paraplegia will follow if pressure is not
relieved.
Intradural Intramedullary tumours
Pathological types: Intramedullary tumours
are usually:
1.Ependymomas.
2.Astrocytomas (Gliomas).
Clinical features of Intramedullary Tumours
1. Cord signs present first, while root pains tend to
occur later.
2. Paralysis may occur on both sides, or sometimes
may be of the crossed type, where there is
anaesthesia on one side and paralysis and
hyperaesthesia on the other.
3. Dissociated sensory loss may occur.
4. Urinary incontinence usually appears early.
Investigations of Spinal Tumours
1. Plain X-ray of the spines should be done in
anteroposterior, lateral and oblique views.
• Erosion of bone or some other bony abnormalities is
seen nearly 50% of patients with spinal tumours.
2. CT scan and MRI of the spines will show the lesion
clearly.
3. Myelography has been largely superseded by CT scan
and MRI.
MRI
Treatment of Spinal Tumours
 Laminectomy is performed and if possible the
tumour is removed.
 Removal of the tumour and laminectomy help
in decompression of the cord.
 Acute paraplegia demands an emergency
operation.
Treatment of Spinal Tumours
 If the vertebral body pathology with anterior
compression, a corpectomy done with fusion
and fixation.
Intradural Tumour
Intradural Tumour
Intradural Tumour
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