Neurosurgery Dr. Stoforou

Spinal cord tumors or spinal column tumors.

Central Nervous System (CNS) cells usually grow in an organized and controlled manner. If for some reason this control is interrupted, the cells continue to divide and thus form a tumor (spinal cord tumors or spinal column tumors).


A tumor may be either benign or malignant.


Although a benign tumor may continue to increase, the cells are not removed from the original site and simply repulse the adjacent structures. In a malignant tumor, cells can invade and destroy the surrounding tissues, while at the same time they can spread to other parts of the CNS.


Spinal cord tumors or spinal column tumors are relatively rare.


Spinal cord tumors are grouped according to their localization into:


Intramyelinic tumors: These tumors are within the spinal cord. There are several different types of spinal cord tumors, but the most common are astrocytomas and ependymonas.
Intradural extramyelic tumors: These originate from the envelopes of the spinal cord, but outside the spinal cord itself. Meningioma and neuroma are the most common endoscleric extramyelic spinal cord tumors.
Extradural spinal tumors: Some tumors originate from the bones of the spinal column (primary bone tumors). There are several different types of primary bone tumors. Benign tumors include chordomas and osteomas. Malignant tumors include osteosarcomas, fibrosarcomas and chondrosarcomas.
Metastatic bone tumors: Some forms of cancer from another part of the body can spread to the bones of the spinal column. They are known as secondary bone sites. The most common forms of cancer that give metastases to the bones are cancers of the lung, breast, lymphoma, and prostate cancer. Multiple Myeloma is a cancer of the plasma cells, which usually affects the vertebrae.


Spinal cord tumors or spinal column tumors  – SYMPTOMS


The symptoms that a patient with spinal cord tumor may have depend on the position of the tumor in the spinal cord.


Spinal column tumors often cause symptoms due to pressure on the spinal nerves. Common symptoms include back and neck pain, numbness, tingling and / or weakness in either the hands or feet, or both.


Another symptom may be walking difficulty. Tumors in the lower part of the spinal cord can cause loss of bladder and bowel control (orthocystic disorders).


Spinal cord tumors or spinal column tumors – DIAGNOSTIC APPROACH

• CT (Computed tomography)
• MRI (Magnetic resonance imaging)
• MRI SPECT (Magnetic Spectroscopy)


Spinal cord tumors or spinal column tumors – TREATMENT

Treatment for a vertebral tumor depends on a number of parameters like the age and general condition of the patient, along with the location, size and type of tumor. Your treatment is usually scheduled by a team of experts that usually includes:


• Neurosurgeon
• Oncologist
• Radiotherapist
• Physiotherapist

The main therapeutic methods used are:


• surgery
• radiotherapy
• Chemotherapy
• steroids


Spinal cord tumors or spinal column tumors – Surgery

The goal of the surgery is to remove the tumor without disturbing the function of the spinal cord and the scope should be to decompress it and take samples for histopathological examination (biopsy). Sometimes this is feasible, especially when referring to extramyelic tumors of the meningioma or neuroma types. However, in cases of intramedullary tumors, this is more difficult and requires special surgical procedures combined with continuous electrophysiological testing to avoid a post-operative neurological deterioration.


Spinal cord tumors or spinal column tumors – Radiotherapy

Radiation uses high energy rays to destroy cancer cells. It is usually used as an adjunctive treatment in cases of tumors that can not be completely removed by surgery.


Spinal cord tumors or spinal column tumors – Chemotherapy


Drug treatment with chemotherapeutic agents or steroids (cortisone).
Chemotherapy is the use of cytotoxic drugs for the destruction of cancer cells. Chemotherapy is only occasionally used for certain types of spinal cord tumors.


Spinal cord tumors or spinal column tumors – Cortisone


Cortisone does not treat the tumor itself, but is very useful for improving the symptoms of patients. It can be used before or after surgery, or before, during or after radiation therapy.


Metastatic Disease in the Spinal Cord / Spinal Column

To a large extent the cause of a “simple” but persistent lumbago can be a metastatic tumor to the bones of the spinal column.

The treatment of these depends on the primary focus, i.e. the type of tumor. If pressure is exerted on the nerve structures in the spine, we may have a disorder in their functionality.

In these cases the treatment must be rapid, and includes:


• Surgical decompression (if appropriate)
• Administration of Steroids
• Radiotherapy
• Chemotherapy


The purpose of the treatment is to shrink the tumor and relieve the spinal cord or nerve roots from pressure.


Recent studies suggest that immediate surgery in combination with postoperative radiotherapy offers better results than radiation therapy only for patients with spinal cord pressure due to metastatic cancer.

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