Our spine is made of a column of bones. It has 33 vertebrae. Each vertebral segment creates a bony circle, called the spinal canal, that protects the spinal cord and nerves.
Tumour is an abnormal growth of cell mass. Spinal tumours can grow outside the spinal cord covering i.e. duramater & are called extradural. They can grow from bones surrounding the spinal cord i.e. vertebra, muscles, nerve roots, duramater. Examples include metastasis, aneurysmal bone cysts, ewing’s sarcoma, lymphoma, neurofibroma.
Intradural extramedullary tumours grow inside the duramater but outside the spinal cord. They cause direct compression of the spinal cord. Here tumours can grow from nerve roots, duramater. Examples include neurofibroma, schwannoma, meningiomas, dermoids, epidermoids, lipomas, teratomas.
Intramedullary tumours grow inside the spinal cord substance. Examples include ependymomas, astrocytomas, hemangioblastomas, cavernomas.
The majority of tumours are benign.
Clinical presentation depends on the location of tumours in the spinal canal, size & severity of compression caused by the tumour.
Local Pain – especially in Extramedullary Tumours
Paresis & Numbness
Sensory & Motor deficits
Bladder / Bowel involvement
Many a times, the symptoms of spinal tumours may be confused with those of prolapsed intervertebral disc or simple low backache or neck pain.
Diagnostic workup includes detailed history and neurological examination of the patient. Investigations include MRI spine with contrast; MRI brain and CT scan of spine may be required on a case to case basis. Uroflowmetry and urodynamic studies may be required in some cases where bladder seems to be involved.
Management of spinal tumours includes surgical excision without compromising neurologic function. Radiotherapy and/ or chemotherapy may be required in some cases. Neurophysiological monitoring should also be used in cases where the borders of the tumour are not well defined.
Microscope, neuromonitoring, high speed drill, CUSA, irrigation cautery systems and microneuro instruments further enhance safety in spinal tumour surgeries.
Surgery should be done as early as possible in symptomatic & large tumours
RAPID IDENTIFICATION AND INTERVENTION OF MALIGNANT SPINAL TUMORS, OFTEN CAUSING SPINAL CORD COMPRESSION, IS KEY TO MAINTAINING QUALITY OF LIFE IN PATIENTS