Benign or malignant lesions arising from the primary of the spine itself, the surrounding muscle tissues, ligaments, nerve cells and membranes in the spinal cord are called spinal cord tumors.
General characteristics of the disease and its incidence
Spinal tumors (OT) constitute approximately 10-25% of central nervous system tumors. Its prevalence in the community is 100000 / 2-10. The incidence of both vertebrae and spinal cord tumors varies according to the type and location of the tumor. For example, 95% of metastatic tumors that spread from another part of the body to the spine are located outside the spinal cord (extadural), while 4% are located inside the spinal cord (intradural). These metastatic tumors can rarely be located intramedullary within the spinal cord. Although it is not a general rule, tumors originating from inside the spinal cord and its membranes or the nerve itself are benign tumors.
Classification of spine and spinal cord tumors
1 – INTRADURAL SETTLEMENTS
2 – EXTRADURAL SETTLEMENTS
A: Primary spine tumors
B: Secondary (metastatic) spine tumors
Complaints and findings of spine and spinal cord tumors
Whether a spinal tumor is inside the spine or outside, depending on the location of the tumor, the leading complaint is specific to the doctor with pain in the form of back, back and neck pain. The pain initially increases with coughing, straining, and sneezing, which are maneuvers that increase intracranial pressure, and relaxes with rest. As the disease progresses, the pain cannot be relieved even with rest. Pain in metastatic spinal tumors usually occurs during rest at the beginning, but becomes continuous as the disease progresses. While the pain initially improves with medical painkillers, then they become continuous and resistant to medical drugs to the extent that they prevent the person’s activity. The physician who first sees the patient in this period perceives this pain complaint as benign degenerative diseases and plans a treatment. Secondly, sensory (paresthesia), motor (weakness), sphincter (urine, bladder) and autonomic complaints begin to occur depending on the size and location of the tumor. Here, complaints of half-incision or complete incision of the table spinal cord arise.
These tumors constitute 40% of all spinal tumors. 90% of these tumors are benign and 10% are malignant or metastatic tumors. 70% of intra dural tumors are benign tumors such as meningioma or schwannoma.
Spinal meningiomas are generally benign. Like meningiomas in the brain, they arise from the spinal cord membranes. They make up 25-48% of all spinal intradural tumors. They are most common between the ages of 50-60. They are more common in women and are seen at a rate of 4-5 / 1. Most frequently, they are located in the thoracic region 67-84%, 14-27% cervical (neck), 2-14% lumbar (waist). While they are generally intradurally localized, they may be localized in 3-9% extradural, 5-14% inradural and extradural. Pain is the most common complaint, followed by sensory, motor and sphincter complaints. Diagnosis of these tumors is quite easy and Magnetic resonance (MR), one of the advanced diagnostic methods of today, can be easily diagnosed. First of all, the physician conducting the examination should think of a pre-diagnosis of a spinal cord or spinal tumor. The treatment of these tumors is very easy, pleasant and successful. The purpose of surgical treatment is to remove the entire tumor from its origin. There are very rare types of malignant meningiomas. There is a risk of recurrence in these, and radiotherapy is added to them. Spinal meningioma surgery complications are very low according to the experience of the surgeon.
Schwannoma / Neurofibroma
Nerve sheath tumors are rare tumors in the general population, such as 100 000 / 0.3-0.5. It is common in 30-50 years old. The female to male ratio is the same. It chooses the cervical and lumbar region, the most common thoracic region. These tumors also grow slowly, like meningiomas, initially pain followed by motor weakness and sensory, sphincter, complaints. Diagnosis of these tumors is made very easily and quickly thanks to MRI, just like meningiomas. Its treatment is surgical removal. The most important issue in surgery is to correctly recognize the nerve root from which it originated and remove the entire tumor with this root. Recurrences are usually inevitable as a result of partial removal. Surgical success is closely related to the surgeon’s experience. The result is usually perfect.
Intradural- Intramedullary Tumors
45% of this group of spinal tumors are astrocytomas and 35% are ependymomas. Those in this location constitute 20-30% of all spinal tumors and 40-50% in children. These include other hemangioblastomas and residual tumors (dermoid, epidermoids, teratomas, lipomas) as well as neuronal tumors (oligodendroglioma, ganglogliomas) in this location. In these localized tumors, the initial complaint is pain followed by motor, sensory and sphincter complaints.
EpendymomasIt is the most common intramedullary tumor in adults and the second most common spinal tumor in children. It is common in 30-40 years of age. Male / female ratio is 2/1. While choosing the lumbo-sacral region most frequently, it is followed by the cervical and thoracic region. The initial complaint is pain, followed by sensory, sphincter and motor symptoms. These patients usually come to the clinic in advanced stages. The reason for this is that the patient cannot define his complaints well, a good spinal cord examination cannot be performed, and most importantly, an appropriate examination is not performed. Despite all these, these tumors are very easy to diagnose with today’s advanced MRI examination. Since spinal ependymomas have a pseudosapsule, it is possible to remove them completely, although there is no recurrence in those who undergo total resection, there is a risk of recurrence in those who have partial resection. They are sensitive to radiation therapy in ependymomas. Chemotherapy is used in some cases although it is controversial.
It is the most common intramedullary tumor in adults and the second most common spinal tumor in children. It is common in 30-40 years of age. Male / female ratio is 2/1. While choosing the lumbo-sacral region most frequently, it is followed by the cervical and thoracic region. The initial complaint is pain, followed by sensory, sphincter and motor symptoms. These patients usually come to the clinic in advanced stages. The reason for this is that the patient cannot define his complaints well, a good spinal cord examination cannot be performed, and most importantly, an appropriate examination is not performed. Despite all these, these tumors are very easy to diagnose with today’s advanced MRI examination. Since spinal ependymomas have a pseudosapsule, it is possible to remove them completely, although there is no recurrence in those who undergo total resection, there is a risk of recurrence in those who have partial resection. They are sensitive to radiation therapy in ependymomas. Chemotherapy is used in some cases, although it is controversial.
Metastatic Spinal Tumors
The spine is the most common site of metastasis. Primary cancers such as lung, breast, prostate, kidney, thyroid, gastrointestinal region and lymphoma spread to the spine. Metastatic tumors occur in 60% of men and 40% of women. It is the most common age between the ages of 40 and 60. Metastases are most common in the lumbar region, followed by thoracic and cervical regions. 95% of spinal metastases are located extradurally, 4% are intradural-extramedullary and 1% are intarmedullary. Patients’ complaints are usually short-lived and the most common complaint is pain. The nature of this pain is during rest and its distinctive feature from other spinal tumors is that pain complaints are followed very closely by pictures such as a half-cord cut or a complete cord cut. Treatment is primarily related to the survival of the primary tumor. The type and number of primary tumor involvement in the spine are decided according to the condition of the other body organs. Bone scintigraphy and the width of the PET-CT lesion should be considered in the treatment. Surgery, radiotherapy, and chemotherapy options are used alone or together in the treatment. In those undergoing surgery, only tumor decompression may not be sufficient, and stabilization of the spine should be planned in the same session.