spinal tumors

           SPINAL TUMOR 

"The vertebral column is  a curved rod,composed  of 33 vertebrae and 23 intervertebral  disc.  The  vertebral  column  is  made up of five  regions  :cervical  ,Thoracid, Lumbar  ,Sacral  and cocygeal regions."

-The  primary  and most  important  function of the  spinal column  is to protect  spinal cord and it's maningeal  covering. 

-It has two types of curves :-

    1 ) Primary curves:-Sacral  and thoracic curves (kyphotic  curves)

     2) Secondary  curves  :- Cervical  and  lumbar curves (lordotic  curves.

Spinal tumor:-

1) Definition :-

" The  spinal tumors are  neoplasm  or abnormal  mass  of  tissue  within  the  spinal  column  or  spinal  cord ,leads to pain,neurological  symptoms  and sometimes  lead to paralysis  also .Some  times  it becomes  life threatening  condition."

2)ETIOLOGY:-

-The exact etiology  of primary spinal tumor  is  unknown. 

-It may be due  to  environmental  agents like  certain  chemical  exposure or radiations.

-It may be hereditary 

-It may be  secondary  , that is spread to spinal column from other regions  like breast, kidney  ,thyroid etc.

I )CLASSIFICATION :-

1)On the basis  of  origin :-

A)  Primary tumors:-Origin in spinal column or spinal  cord. 

             1. Benign  tumor :-Hemangioma

                                             -Aneurysmal  bone cyst

                                             -Osteoid  osteomalacia

                                             -Osteochondromas

                                             -Giant cell tumor

    

              2.Malignant  tumor:- Multiple  myeloma /Plasmocytoma 

                                                -Chondroma

                                                -Osteosarcoma 

                                                - Chondrosarcoma 

B)Secondary tumor:-Metastasis  to spinal column or  cord from                                           other  site  of  cancer.

                     e.g:-Prostate  , Breasthe, Kidney etc.

2)On the  basis  of  location:-

1.Extradural  tumor:-Tunor outside  the  spinal  cord's outermost                                           layer that is dura mater.

                                  e.g:-Hemangioma  

                                        -Osteoid-Osteomalacia

                                         -Osteoblastoma

                                         -Giant cell tumor

2.Intradural-Extramedullary  Tumor:-Tumor  inside  the  dura                                                         but outside  the  Spinal cord.

                                              e.g:-Meningiomas 

                                                    -Nerve  sheath tumor.

3)Intermedullary  tumor:-Tumor  inside the spinal  cord.

                                           e.g:-Astrocytomas 

                                                  -Ependyomomas.

1)PRIMARY  SPINAL  TUMOR :-

"The  tumors arising  from  spinal cord,such  as by growing  in bone discs,nerves or  other components of  spinal cord.

-Hemangioma  are most common benign  primary  spinal tumor.

Types:-

A.Benign  Epidural  tumor:-

1) Hemangioma :-

-Most common benign  primary spinal tumor. 

-The  neoplasmic  growth of tissue  inside  the  blood  vessels  

Around  the  spinal  cord.

2)Osteoid  -Osteoma :-

-Small neoplasmic  growth in bone is called  Osteoid osteoma.

-Most common in children  and younger adults.

3)Osteoblastoma:-

-The  overgrowth  of cartilage  and  bone  that usually occurs at end  of  bone  near growth plate is called  osteoblastomas. 

4)Giant cell  tumor :-

-Neoplasmic  growth occurs  within the  Giant cells   is  called  giant cell tumor. 

-It is  most common tumors  of  spinal column. 

B.Benign  Intradural  Tumor:-

1)Meningiomas :- Tumors  of maningeal covering of brain and spinal cord. 

-It  most commonly  affect  the brain  but, may also affect spinal cord.

2)Nerve sheath tumor:-

-Tumors  affecting the  nerve  sheath cells like  schwan cells and other cells.

e.g:-Schwanomar

       Neurofibromas

3) Glial cells tumor:-

-The  glial cells are  non-neuronal  cells in CNS,That provide  support  for  the  insulation between  them.It includes Oligodendrocytes, Astrocytes, Schwan cells,Ependyomomas etc.

The  glial  cells tumor  sometimes  block the  flow  of  CSF  ,which increases  the  pressure  in brain.

It is  of  two types :-

1.Astrocytomas :- Most common  spinal cord  tumor in children.

                               It can be malignant and  benign.

2.Ependyomomas :-Affects  lining of passage  in brain and spinal cord. 

4) Hemangiomas :-A tumor  that arises  from blood  vessels  connected to CNS.

B)SECONDARY  SPINAL  TUMOR :-

-Tumor that have Metastasis to spinal cord  from other  neoplasmic region of body.

-Cancerous  cells from lung,kidney ,breast  can Metastasis  to spinal column or  cord. 

-According  to  researches  about 90% of spinal tumors are metastatic. 

INCIDENCE  AND PREVALENCE :-

-Overall incidence of spinal cord tumor  is  0.74/100,000 person per year.

-Intracranial tumors accounts for 85 to 90% of all primary  CNS tumors.

SYMPTOMS  OF  SPINAL  TUMOR :-

-The  symptoms  varies  from  individual  to  individual  depending  on  location ,type and severity of  tumor.

1)PAIN:-

-The  most common  and  initial  symptom  of  spinal  tumor  is neck pain if  cervical region is involved  and backnee pain if lumbar  or Sacral lregion is involved.

-The  differential  feature of these type  of pain is that the  pain aggravates  by  rest or lying position  in night.

-The  pain alsof aggravates  by  performing  activities. 

-The  pain may be due to neural  commpression  by tumor.or it may caused by changing  in alignment of spinal column .

-Pain may also occur due  Impaired  blood  supply to spinal structures. 

-The  pain may spread  beyond  the  back  to  hips  ,  legs  ,  feets and  arm .

2)NEUROLOGICAL  SYMPTOMS :-

-Impaired sensations.

-Reticulopathy 

-Myelopathy. 

-Paresthesia

-Bowel Bladder involvement 

-Muscular weakness 

3)SENSORY  SYMPTOMS :-

-Numbness  and  tingling  sensations. 

-Cold sensations   of  leg .

-Cold fingers  or hands  or coldness of other areas.

-Decrease  sensitivity  to pain ,heat  and cold.

-Decrease proprioception 

-Abnormal  sensations below level of lesion.

4)MOTOR  SYMPTOMS :-

-Muscle weakness on the  basis of which nerve  is  involved.

-Paralysis 

-Frequent  fall  due to  lower limb muscle  weakness ,Making walking difficult. 

5)Bladder Bowel  dysfunction 

6)POSTURAL  DISTURBANCE :-

-If the  tumor  grows large  enough  to shift the  spinal alignment  ,It may cause scoliosis,Kyphosis and  other deformaties. 

7)REFLEXES:-

-Hyperreflexia

- Hoffman  sign positive  in case of cervical  spine 

-Babinski sign  positive

-Clonus.

INVESTIGATION:-

1)CT-SCAN:-

-It is help to detect location of  tumor  .

-It also help  to detect swelling and bleeding .

2)MRI:-

-provide  better  picture of tumor  near  bone  than CT scan.

3)MYLOGRAM :-

-It is a specialist  x-Ray technique.

-A dye  is used  that absorb X-Ray which is injected into spinal cord.

The  dye outlines the spinal cord. 

4)Lumbar puncture:-

-Perform  to test abnormal  cells in CSF that may suggest  the spinal tumor .

5)Biopsy

TREATMENT :-

1)MEDICAL TREATMENT :-

1.NSAIDS :-For Inflammation. 

2.Corticosteroids :-Inflammation  and pain.

3.Opiods:-For pain.

4.Anti-epileptics :-For neuropathic pain

5.Osteoporosis  drugs:-To prevent bone density. 

2)Chemotherapy 

3)Radiation therapy 

4)Surgical treatment :-

-Decompression therapy 

-Embolization

-kyphoplasty

-Radiosurgery

-Spinal stabilisation 

COMPLICATIONS OF SPINAL SURGERY :-

1)Wound healing related issues 

2)Leakage  of CSF.

3)Pressure sores

4)Infections

5)Pulmonary complications 

6)Neurological  problems  like  paraplegia  or paralysis. 

7)Bladder Bowel  dysfunction. 

8)Sensory problems

physiotherapy management of spinal tumor