Transcript Spinal Tumours Presentation – April 2104
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.