In the examination and evaluation of any patient presenting with back or leg symptoms the possibility of spinal tumor must always be considered. Clues as to the existence of a tumor are:
- Pain which is worse at night.
- Unexplained weight loss.
- Neurologic examination showing a sensory level above the typical l3-S1 pattern.
- Neurologic exam showing clonus, Babinski (or other long tract signs).
In today’s world the most effective means of tumor diagnosis is a high resolution MRI (Magnetic Resonance Imaging) scan.
Intradural Spinal Cord Tumors
4-20% of all primary central nervous system tumors are intradural. Astrocytomas and ependymomas account for 80-90% of all intramedullary tumors while nerve sheath tumors (neurofibroma and schwannoma) and meningioma account for 80% of all intradural extramedullary tumors.
These tumors are typically benign and, in the majority of cases, can be surgically removed. In the case shown below a standard MRI examination shows the tumor mass arising from the cauda equina. A digitally enhanced MRI better demonstrates the solid and cystic characteristics. Tumor was completely excised and patient experienced no post-operative problems.
Typically benign and well delineated from adjacent nerve tissue. In this case the meningioma was identified with a myelogram. Operative photo shows the well-defined tumor separate from the spinal cord (which has become markedly attenuated). The histologic pattern was that of a psammomatous meningioma. Patient experienced a complete recovery with no further problems.
Extradural Spinal Column Tumors
Lymphoma is a cancer of the lymph glands divided into Hodgkins and non-Hodgkins types. The nature of the tumor is described as Type 1-4. Spinal lymphomas are usually secondary to tumors elsewhere in the body. Following surgical decompression and pathologic review radiotherapy and chemotherapy are usually the initial forms of therapy.
In the case shown above the thoracic lymphoma produced spinal cord compression. Surgical decompression was followed by radiation and chemotherapy.
Shown to the left is a lymphoma involving the pelvic rim (ileum) and the sacro-iliac joint. This tumor was responsive to both radiation and chemotherapy.
Mass Lesions Imitating Spinal Cord Tumors
Synovial Cysts and Chondromas
These entities are mass lesions often acting just like tumor. They are totally benign masses produced by facet joint degeneration. The mass is similar to a “ganglion” of the wrist joint but in a “bad” location. Although benign these masses may compress spinal nerves or the spinal cord. In the example shown the mass (at the thoracic 11-12 level) required surgical removal. This mass presented clinically much like a spinal cord tumor.
Shown immediately above is a L4-5 level synovial chondroma which was complicating a Grade 1 degenerative spondylolisthesis and an associated central spinal stenosis. The post-operative specimen is on the right and was acting very much like a tumor.