Spinal neoplasms
A spinal neoplasm is any one 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.
Causes
Primary spinal cord tumors may be extramedullary (occurring outside the spinal cord) or intramedullary (occurring within the cord itself). Extra-medullary 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). They occur with equal frequency in men and women, with the exception of meningiomas, which occur most often in women. Spinal cord tumors can occur anywhere along the length of the cord or its roots.
Signs and symptoms
Extramedullary tumors produce symptoms by pressing on nerve roots, the spinal cord, and spinal vessels; intra-medullary 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:
Pain is most severe directly over the tumor, radiates around the trunk or down the limb on the affected side, and is unrelieved by bed rest.
Motor signs and symptoms include asymmetrical spastic muscle weakness, decreased muscle tone, exaggerated reflexes, and a positive Babinski’s sign. If the tumor is at the level of the cauda equina, muscle flaccidity, muscle wasting, weakness, and progressive diminution in tendon reflexes are characteristic.
