Spinal Tumors
Cell types similar to intracranial tumors. Arise from cord parenchyma, nerve roots, meninges, intraspinal blood vessels, sympathetic nerves, vertebrae.
Intramedullary (10%), extramedullary (90%; intradural or extradural). Intramedullary more common in children; extramedullary in adults.
Most common primary tumors with spine metastases: lung, breast, prostate.
Table 63.1 Relative Frequency of Different Types of Spinal Tumors | ||||||||||||||||
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Frequency
Much less prevalent than intracranial tumors (1:4). Relative frequency of tumor types: see Table 63.1. Most in young or middle-aged adults. Meningioma more common in women; ependymoma in men. Most common site: thoracic.
Pathophysiology
Extramedullary: compression of nerve roots or spinal cord, occlusion of spinal blood vessels. Intramedullary: direct interference with intrinsic structures (mass effect, edema, syringomyelia).
Clinical Manifestations
Extramedullary Tumors
Either intradural or extradural (= epidural). Usually involve multiple adjacent segments.
Nerve root compression: focal pain, paresthesias followed by sensory loss, weakness, atrophy in distribution of affected roots.
Spinal cord compression: usually late syndrome. Pathways at cord periphery affected first. Early findings: (a) spastic weakness below lesion; (b) impaired cutaneous and proprioceptive sensation below lesion; (c) urinary incontinence; (d) overactive tendon reflexes, Babinski signs, loss of abdominal reflexes. If untreated, syndrome may progress to complete transection of spinal cord: wasting and atrophy of muscles at level of lesion with paraplegia or quadriplegia below.
Spinal vessel occlusion: myelomalacia, cord necrosis; symptoms similar to those of intramedullary lesion.
Anterior spinal artery occlusion: segmental lower motor neuron signs at level of occlusion; bilateral loss of pain and temperature sensation and upper motor neuron signs below. Posterior columns spared.
Spinal Metastasis
Epidural Spinal Cord Compression
Onset: neck or back pain; relentless, persists when patient supine. Limb weakness, paresthesias in distribution of nerve root, sphincter dysfunction: neuro-oncologic emergency.
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