Spinal Cord Neoplasms

Question 1

Primary spinal cord tumors arise from the different elements of the CNS:

Answer 1

1. Neurons.
2. Supporting glial cells.
3. Meninges.

Question 2

Additionally, neoplasms of the spinal cord may be classified according to …?

Answer 2

Compartment of origin, either INTRAMEDULLARY (inside the cord) or EXTRAMEDULLARY (outside the cord).

Question 3

Met lesions cause …% of the cases of neoplastic spinal cord compression

Answer 3

85%.

Question 4

Metastatic spinal cord compression usually follows …?

Answer 4

Hematogenous dissemination of malignant cells to the vertebral bodies, with subsequent expansion into the epidural space.

Question 5

Spread into the epidural space may occur by means of …?

Answer 5

Tumor extension through the INTERVERTEBRAL FORAMINA or HEMATOGENOUS SPREAD by way of the BATSON venous plexus.

Question 6

Most frequently, met seeding appears in the …?

Answer 6

THORACIC spine (70%).

Lumbar next (20%).

Cervical (10%).

==> Multiple spinal levels (30%).

Question 7

Systemic cancer with a tendency for spinal cord metastasis:

Answer 7

1. Breast.
2. Prostate.
3. Renal.
4. Lung.
5. Lymphoma.
6. Sarcoma.
7. MM.

==> GI + pelvic ==> Lumbosacral spine.

==> Lung + breast ==> Thoracic.

Question 8

Intramedullary or extramedullary mets are more common?

Answer 8

EXTRA.

Question 9

Intramedullary mets - Signs/symptoms tend to simulate those of …?

Answer 9

Epidural compression.

However, the associated motor weakness is more likely to be UNILATERAL.

Question 10

Principles of treating intramedullary cancer are similar to those for …?

Answer 10

Epidural spinal cord compression.

Question 11

Leptomeningeal mets spread by means of …?

Answer 11

Diffuse or multifocal seeding of the meninges from systemic cancer (eg lung or breast cancer, melanoma, lymphoma).

==> Consequent signs and symptoms may be referable to the spine or spinal cord.

Question 12

Evidence of spinal compromise may include:

Answer 12

Lower extremity weakness, paresthesias, reflex asymmetry, and spinal pain.

Question 13

Most primary intramedullary spinal cord tumors are:

Answer 13

1. Astrocytomas.

2. Ependymomas.

Question 14

INTRADURAL extramedullary tumors include:

Answer 14

1. Schwannomas.
2. Neurofibromas.
3. Meningiomas.

==> Affect the paravertebral area may spread and compress the cord through expansion.

***An enlarged cancerous lymph node may compress the cord.

Question 15

Hemangiomas:

Answer 15

Usually discovered incidentally + asymptomatic.

==> Symptoms emerge if pathologic vertebral fractures or epidural extension occurs.

Question 16

Nerve tracts most vulnerable to mechanical pressure include:

Answer 16

1. Corticospinal.
2. Spinocerebellar.
3. Posterior columns.

Question 17

Neoplasms may compromise the …?

Answer 17

Vascular supply, causing edema or ischemia.

Question 18

Less frequently, tumors may induce …?

Answer 18

1. Cyst formation.

2. Cavitation within the spinal cord.

Question 19

Frequency - USA:

Answer 19

0.5-2.5 /100,000.

Metastatic lesions that involve the spinal cord affect about 5-10% of pts with cancer.

Question 20

Approx …% of all primary CNS lesions arise from the spinal cord.

Answer 20

15%.

Question 21

Mortality/morbidity - Most primary spinal cord cancers …?

Answer 21

Do NOT disseminate widely through the CNS or body.

==> Consequent disability relates to the degree of cord impairment and anatomic level of cord.

Question 22

Metastatic tumors that cause epidural cord compression and dysfunction are …?

Answer 22

MCC of oncologic CNS injury.

**mortality correlates with the prognosis of the primary cancer.

Question 23

The severity of the spinal cord compromise 2 to a tumor spans a wide range:

Answer 23

Initially, symptoms may be limited to pain or minor sensory or motor disturbance.

==> As the compression progresses, neurologic abnormalities become more pronounced, advancing to disability.

==> PARTIAL cord compression, such as Brown-Sequard syndrome, may evolve.

==> In the advanced stage of compression, complete transverse sensory and motor paralysis with bowel and bladder incontinence occurs.

Question 24

Best predictor of ultimate disability in pts with epidural cord compression:

Answer 24

The disability of the pt at the initiation of therapy serves as the best predictor of ultimate disability in pts with epidural cord compression.

==> Early detection of cord compression and early intervention is the goal.

Question 25

Sex:

Answer 25

A SLIGHT male predominance for primary spinal cord tumors.

+

Symptomatic hemangiomas occur most frequently in the thoracic region of teenaged girls.

Question 26

Age:

Answer 26

> 50 ==> More likely to experience back pain 2o to a metastatic tumor.

==> The incidence of primary spinal cord tumors peaks in people aged 30-50 years.

Question 27

Certain CNS tumors, such as neuroblastoma, occur almost solely in …?

Answer 27

Pediatric patients.

Question 28

Clinical syndromes produced by intramedullary tumors vary depending on the age of the individual:

Answer 28

In children ==> Gait disturbances prevail, with pain reported infrequently.

==> Spinal cord neoplasms may manifest as scoliosis or torticollis in younger pts.

==> Pain is the MC early complaint of adult pts with spinal cord neoplasms, followed by the insidious progression of spinal cord dysfunction.