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
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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
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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 TumorSchwannoma. 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.