Spinal Cord Tumors

Pain is an early symptom, especially for extradural tumors. It is progressive, unrelated to activity, and worsened by recumbency. Pain may occur in the back, radiate along the sensory distribution of a particular dermatome (radicular pain), or both.

Neurologic deficits referable to the affected level of the spinal cord eventually develop. Common examples are spastic weakness, incontinence, and dysfunction of some or all of the sensory tracts at a particular level of the spinal cord and below. Deficits are usually bilateral.

Intradural extramedullary tumors may be painful when the nerve roots are compressed but can also develop painlessly if the spinal cord is directly compressed without involving the root.

Some patients with intradural tumors—most often meningiomas and neurofibromas—present with sensory deficits of the distal lower extremities, segmental neurologic deficits, symptoms of spinal cord compression, or some combination.

Symptoms of spinal cord compression can worsen rapidly and result in paraplegia and loss of bowel and bladder control.

Symptoms of nerve root compression are also common; they include pain and paresthesias followed by sensory loss, muscular weakness, and, if compression is chronic, muscle wasting, which occurs along the distribution of the affected roots.

Patients with segmental neurologic deficits or suspected spinal cord compression require emergency diagnosis and treatment.

The following symptoms and signs may suggest spinal tumors:

Diagnosis of spinal cord tumors is by MRI of the affected area of the spinal cord. CT with myelography is an alternative; it can help localize the tumor but provides less information than MRI.

Other spinal masses Spinal Cord Arteriovenous Malformations (AVMs) Arteriovenous malformations (AVMs) in or around the spinal cord can cause cord compression, ischemia, parenchymal hemorrhage, subarachnoid hemorrhage, or a combination. Symptoms may include... read more (eg, abscesses, arteriovenous malformations) and paravertebral tumors can manifest similarly to spinal tumors, but they can typically be distinguished on MRI scans.

Spinal x-rays, taken for other reasons, may show bone destruction, widening of the vertebral pedicles, or distortion of paraspinal tissues, especially if the tumor is metastatic.

Biopsy may be done to confirm the diagnosis.

If patients have neurologic deficits due to spinal cord compression Spinal Cord Compression Various lesions can compress the spinal cord, causing segmental sensory, motor, reflex, and sphincter deficits. Diagnosis is by MRI. Treatment is directed at relieving compression. (See also... read more , corticosteroids (eg, dexamethasone 100 mg IV, then 10 mg orally 4 times a day) are begun immediately to reduce spinal cord edema and preserve function. Tumors compressing the spinal cord are treated as soon as possible because deficits may quickly become irreversible.

Some well-localized primary spinal cord tumors can be excised surgically. Deficits resolve in about half of these patients. If tumors cannot be surgically excised, radiation therapy is used, with or without surgical decompression. Compressive metastatic extradural tumors are usually surgically excised from the vertebral body, then treated with radiation therapy. Noncompressive metastatic extradural tumors may be treated with radiation therapy alone but may require surgical excision if radiation therapy is ineffective. For metastatic prostate cancer to the spinal vertebrae, antiandrogenic chemotherapy may be used as an adjunct to focal radiation.