What Are the Most Common Spinal Cord Problems?

Spinal cord tumor (tumor of spinal cord) is also called intraspinal tumor, which refers to the primary and secondary tumors that grow in the spinal cord and tissues close to the spinal cord, including nerve roots, dura mater, blood vessels, spinal cord, and adipose tissue. Can be divided into spinal and extraspinal tumors. Primary spinal tumors account for 2.5 / 10 million new cases each year, which is about 1/10 of the incidence of brain tumors. In histogenesis, it can be divided into ependymal and glial origins from the spinal cord ectoderm, such as gliomas, schwannomas, etc., which occur in the mesenchymal mesenchyma of the spinal cord, such as meningioma. There are tissues surrounding the spinal canal that directly invade the spinal canal. Clinically common tumors include schwannomas, meningiomas, gliomas, congenital tumors (epidermoid cysts, dermoid cysts, teratomas), cavernous hemangioma, angiocytoma, metastases, and granulation Swelling and so on. More common in 20-40 years old, more men than women, but meningiomas are more common in women.

Basic Information

nickname: Spinal tumor
English name: tumor of spinal cord
Visiting department: neurosurgery
Multiple groups: Meningiomas are more common in women, and meningiomas are more common in men

Common locations: Thoracic spinal cord
Common causes: Closely related to genetics, trauma and environment
Common symptoms: Pain and paresthesia, followed by loss of sensation, muscle weakness and atrophy

Causes of spinal tumors

Pathogenesis: Only 10% of benign spinal tumors originate from nerve cells in the spinal cord, 2/3 are meningioma and Schwann cell tumor, both of which are benign tumors. Malignant spinal tumors include gliomas and sarcomas and originate from connective tissue. Neurofibromas are a type of Schwann cell tumor that can develop from Schwann cells and other surrounding support cells. The most common spinal metastases usually originate from lung, breast, prostate, kidney, and thyroid. Lymphoma can also extend to the spinal cord.

Clinical manifestations of spinal cord tumors

1. Stimulation period (nerve root pain period)

Symptoms of nerve root irritation can appear early in the disease, manifested as electrocautery, acupuncture, stabbing or traction-like pain, cough, sneezing, and increased abdominal pressure at the time of inducing or exacerbating pain. Nocturnal pain and supine pain are special spinal tumor Symptoms.

2. Partial compression of the spinal cord

Presented as ipsilateral limb dyskinesia and contralateral limb sensory disturbance below the compression plane. The sensory plane of the spinal cord tumor develops from top to bottom, and the extramedullary tumor develops from bottom to top.

3. Fully compressed spinal cord

It is manifested as complete loss of movement, sensation, and sphincter function below the compression plane, and it cannot be recovered.

4. Examination

Full body examination, pay attention to cardiopulmonary function, whether chest breathing exists; somatosensory disturbance plane; muscle atrophy and bedsores.

Spinal Tumor Examination

Cerebrospinal fluid examination

Lumbar penetrating cerebrospinal fluid pressure measurement and laboratory examination.

2.X-ray

Understand the secondary changes of the vertebrae, such as the absorption and destruction of the vertebral body, the increase of the pedicle spacing, and the enlargement of the intervertebral foramen.

3.CT and MRI

MRI is the most commonly used examination method for spinal tumors. It can clearly show the extent and characteristics of the lesion. Combined with enhanced scanning, it can directly observe the tumor shape, location, size, and relationship with the spinal cord.

4. Spinal lipiodol contrast

For those who do not have an MRI examination or cannot be examined due to the presence of metal foreign bodies in the patient, spinal lipiodol imaging is feasible.

5. Spinal angiography

For the consideration of vascular malformations, angiography of spinal vascular malformations has qualitative diagnostic value.

Spinal Tumor Diagnosis

Based on clinical symptoms, signs, imaging examination, combined with laboratory examination, the diagnosis can be basically located. For the nature of the tumor, it may depend on postoperative pathological confirmation.

Differential diagnosis of spinal cord tumors

Spinal arachnoiditis

The course of disease is long and there is a history of fever or trauma before onset. The condition may have ups and downs and the symptoms may be intermittently relieved. Most have broader root pain, dyskinesias are more severe than sensory disorders, and deep sensory disorders are more pronounced than shallow sensory disorders. The plane is not constant and asymmetric. Autonomic function usually appears later. Cerebrospinal fluid examination showed a slight increase in the number of cells and a significant increase in protein. The C-ray was normal. Examination of the spinal cord with lipiodol showed that the contrast medium was bead-shaped and there was no obvious obstruction plane, which could be distinguished from the tumor.

2. Spinal tuberculosis

Often secondary tuberculosis in other parts or a history of tuberculosis, kyphotic deformities of the spine, clinical manifestations are diverse, and it is not easy to distinguish from other spinal canals. The X-ray bone is mostly damaged, the intervertebral space is narrowed or disappeared, and a cold abscess shadow may be present near the vertebra.

3. Transverse myelitis

The disease usually has a history of infection or poisoning, onset quickly, and may have pioneer symptoms such as fever. Paraplegia can occur quickly a few days after the onset of illness. The number of cerebrospinal fluid cells increased, and lumbar puncture and neck tests were mostly non-obstructive, which facilitated the identification of spinal cord tumors.

4. Epidural abscess

Sudden onset, a history of purulent infection, fever, increased white blood cell count, increased erythrocyte sedimentation, etc. The pain is sudden and severe pain, and the spinous process of the lesion has obvious tenderness. The disease progresses rapidly, and spinal shock may occur in a short time. However, chronic epidural abscesses and spinal cord tumors are often difficult to distinguish. The number of cerebrospinal fluid cells and protein increased. If the abscess is located in the waist, pus may flow from the lumbar puncture. Lesions often expand within the spinal canal and involve long segments.

5. Intervertebral disc herniation

In particular, cervical spondylotic myelopathy is accompanied by disc herniation, or atypical chronic development of lumbar disc herniation. The condition of spinal cord compression is similar to that of spinal cord tumors, with root pain at an early stage, and symptoms of spinal cord compression gradually appear.

6. Cervical Spondylosis

It is a degenerative disease of the cervical spine, which mostly occurs in middle-aged and elderly people, but has a younger trend. Early symptoms are mostly numbness in one side of the upper extremity, neck pain, and limited movement. A few cervical spondylotic myelopathy is difficult to distinguish from tumors. Generally, the symptoms can be relieved by traction. X-ray film shows cervical hyperplasia and narrowing of intervertebral space.

Spinal Tumor Treatment Principles

The only effective treatment for spinal tumors is surgical resection. Tumors were removed under the microscope to achieve the greatest degree of protection for nerves and blood vessels.

1. benign tumor surgery

(1) For those who do not involve spinal stability, microsurgical resection and laminar reduction;

(2) For those who cause spinal instability, microsurgical resection plus spinal internal fixation.

2. Surgical treatment of malignant tumors

Tumor resection and laminectomy decompression; malignant spinal tumors that affect spine stability can be surgically resected and spinal internal fixation to relieve symptoms and maintain spinal stability, providing a basis for postoperative radiotherapy and chemotherapy or other treatments.

3. Non-surgical Therapy

(1) The patient's general condition does not allow surgery, and can be treated with radiation.

(2) Patients with limb dysfunction should undergo neurological rehabilitation after surgery.