Spinal Tumours

Manoj Krishna, FRCSSpinal Surgeon.

www.spinalsurgeon.com

Incidence

• 5-15% of patients with cancer have spinal metastasis( spread to the spine)

• In autopsy studies 70% of cancer patients have spinal metastasis

• Risk of getting a primary spinal cord tumour is 1 in 140 for men and 1 in 180 for women.

Tumours in the Vertebra

• Spinal Metastases( commonest)

• Multiple Myeloma• Lymphoma

• Osteoid Osteoma( 10-25 yrs)

• Osteoblastome( 20-30 yrs)• Eosinophilic Granuloma• Haemangioma• Aneurysmal Bone Cysts• Sarcoma• Chordoma

Symptoms of early cord compression

• Heaviness in legs and arms• Altered sensation• ‘Water running down legs’• Loss of co-ordination when walking• Weakness• Changes in bladder function

3 types of pain in these cases

• Biological- from the inflammation around the tumour- described as a deep ache and is worse at night, eased on getting up and moving around.

• Radicular-from pressure on a nerve root• Mechanical- from bony destruction- worse on

loading the spine- eg lifting, bending , sitting.CAN MIMIC DEGENERATIVE SPINAL PAIN SO HIGH INDEX OF SUSPICION NEEDED.

Symptoms of hpercalcemia

• Thirst• Confusion• Loss of apetite• Nausea• Tiredness• Constipation

Investigations

• MRI is the investigation of choice- order brain and whole spine MRI with contrast if a tumour or cord compression is suspected

• Bone scan to check for skeletal spread• Chest X-ray• CT scan chest and abdomen– to look for a

primary once a spinal tumour is diagnosed• Biopsy

Blood tests

• FBC, ESR, CRP, U&E• Serum Electrophoresis- Myeloma• Bone Chemistry-look for elevated Alkaline

phosphatase in bone destruction, elevated calcium levels

• Thyroid levels• PSA – for prostate• CEA Antigen

Treatment Options

• Dexamethasone- to reduce cord oedema• Spinal cord tumours- usually need surgery• Spinal Metastasis: Surgical decompression and

stabilization if causing cord compression , radiotherapy with our without vertebroplasty if not.

• Chemotherapy in some cases as indicated.

T5 Metastatic TumourPatient in 60’s.

Sneezing episode

Got Mid-thoracic pain

Also reports some heaviness in legs

No loss of appetite or weight loss

O/E- Myelopathic gait, sensory level T6, tender D5/6

Walks like a drunk. Going off legs.

No known primary

20% of patients with tumors present with no known primary.

Treatment.T5 Trans-pedicular vertebrectomy +Bone Cement into Vertebra

Pain and cord compression symptoms resolved

Vertebroplasty for a spinal tumour

Dec 02 – Lifts heavy weight

LBP Since then

Getting Worse

Night Sweats x 6 weeks

ESR=73

Biopsy and Vertebroplasty - L2

Non-Hodgkins Lymphoma- now in remission after Chemotherapy

Neurofibroma causing Radicular Pain

Patient in 50’s.. Left buttock, and leg pain for 12 months.

No postural relief. Widespread Neurofibromatosis.

With Gadolinium

Intra-medullary Tumor- Schwannoma. Treated successfully by excision surgery

Post-GAD IMAGES.

Patient in 40’s6month history of abdominal painHad hernia repair- no betterHyper-sensitive to touch in abdomen T6-10 distribution.

BILATERAL POSITIVE HOFFMAN REFLEX