Spinal Tumours

Manoj Krishna, FRCS Spinal 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 Tumour

Patient 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 With Gadolinium

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

No postural relief. Widespread Neurofibromatosis.

Intra-medullary Tumor Schwannoma. Treated successfully by excision surgery Patient in 40’s 6month history of abdominal pain Had hernia repair- no better Hyper-sensitive to touch in abdomen T6-10 distribution.

BILATERAL POSITIVE HOFFMAN REFLEX Post-GAD IMAGES.