Spinal cord tumors- Treatment and outcome

Spinal cord tumor refers to tumours within the spinal cord. These tumours are the rarest of spine tumours, but cause significant disabilities, decreased functions, impairment in the quality of life and even death. As most of such tumours occur in the young productive age groups, they cause significant loss of function and increased dependency. Even though the tumours are not cancerous, but they can cause severe problems like paralysis and loss of control over urinary bladder and bowel function.

To understand the types of spine tumours and to know how spinal cord tumours are different than other types of spine tumours, read these other blogs.
Spinal tumours- Symptoms and diagnosis
Spine tumour surgery- Meningiomas and Neurofibromas

What are the symptoms of spinal cord tumors?

Symptoms from the spinal cord tumours is dependent on a lot of factors like rate of growth of tumour, location of tumour, extent of involvement of tumour and size of the spinal bony canal.
Pain is the most common presentation. The pain is constant, deep aching, burning kind of a pain which is more worse at night or lying down. The pain starts at the site of spinal level but may go down to the arms or legs.
Tingling or abnormal sensations are also very common presenting feature. progressive symptoms of such nature needs evaluation.
Difficulty in walking or muscle weakness, which keeps on gradually worsening is caused by involvement ad impairment of function of the motor nerves in the spinal cord. Sometimes, even muscles of respiration may get involved to cause breathing difficulties. Difficulty in walking is also caused by impairment of sensations which help in balancing our body without our consciousness.
Urinary voiding difficulties may occur over time and cause impairment in normal functioning of the urinary bladder.

What are the types of spinal cord tumors?

The intra-medullary or spinal cord tumours are sub classified based on their cellular structure seen on examination of tumour under microscope. Gliomas are the most common spinal cord tumour which comprise around 80 % of tumours in this category and Hemangioblastomas are the second most common tumour seen in this location.
Gliomas are further subdivided into Astrocytomas and Ependymomas.

What causes spinal cord tumors?

Even though no cause can be found in most cases of intra-medullary or spinal cord tumours, there are certain genetic predispositions to these tumours. Two common associations are with Neurofibromatosis and Von Hippel-Lindau disease.
Neurofibromatosis is a genetic disorder with very high association with tumours arising from nerve layers all over the body. Neurofibromatosis has two types, type 1 and type 2. It is speculated that one in every five patients with Neurofibromatosis type 1 also known as Von Reckinghausen disease may get affected with an intramedullary or spinal cord tumour over the lifetime. Neurofibromatosis type 2 has a slightly less frequent association with these tumours.
Von Hippel Lindau disease is very commonly associated with occurrence of Hemangioblastomas.

How are spinal cord tumors diagnosed?

The basis of diagnosis starts with the clinical history and examination findings which may be quite suggestive. Subsequently to confirm the diagnosis, the doctor may order MRI with contrast administration, which is the gold standard for the diagnosis of these tumours. MRI will reveal the site of the tumour, and help rue out some medical conditions that may mimic the spinal cord tumour symptoms.
In some patients where MRI can not be done like in cases with pacemakers, then CT pyelography is done to look for site of expansion of the spinal cord caused by the spinal cord tumour.

What is the treatment of spinal cord tumors?

The treatment of spinal cord tumours is dependent on a number of factors. In tumours like ependymoma, and hemangioblastomas, which are well defined and have a clear demarcation with the normal cord tissue, surgery is possible to remove the tumour completely with good long term outcomes. On the other hand, Astrocytomas are diffuse and can not be surgically removed completely. So after a biopsy, other treatment modalities are considered like Radiotherapy.


How is the outcome of spinal cord tumors after surgery?

Tumours that are removed completely like Ependymomas and Hemangioblastomas, do not require any further intervention. Regular follow up for clinical examination is required and such tumours carry and excellent long term outcome.

How is the surgery done for spinal cord tumors?

Surgery for spinal cord tumours is complex and is usually carried out at specialised centres with advanced Neurosurgical facilities. The patient is under general anaesthesia. Now facilities are available to monitor function of spinal cord during surgery, called Neurophysiological monitoring. Monitoring functions help a surgeon to remove maximum tumour without causing any significant worsening of function like muscle weakness. The most commonly used functional monitoring is for motor function using, Motor evoked potentials or MEP.
Spinal cord tumours are approached from the back with removal of bone to expose the spinal canal. Once the spinal canal is open, the covering layer os spinal cord, Duramater is opened and the cord expanded by the tumour can be easily identified. The spinal cord is then opened under operating microscopes and tumour is identified by its colour difference with the normal cord tissue. The tumour is removed using special instruments, looking at the neurophysiological monitoring to guide the extent of resection. As previously mentioned, in cases of Ependymomas and Hemangioblastomas, complete excision is possible because of the clear interface with the normal spinal cord tissue.
Once the excision is achieved satisfactorily, Duramater is closed with sutures. Muscles and skin are also approximated in a standard fashion.
Post-operative course including need for admission into an intensive care unit or ICU depends on the level of spinal cord involved and the neurological problems before the surgery. All patients with cervical cord or high thoracic cord tumours spend at least one night in the ICU for observation of the respiratory parameters. Physiotherapy and rehabilitation is stared as soon as possible after the surgery.

Which surgeon does surgery for spinal cord tumors?

Surgery for Intra spinal cord tumours is done by trained neurosurgeons. Neurosurgeons are familiar with the anatomy, techniques and skills required for surgery of spinal cord tumours.

Author- This blog has been written by Dr. Harnarayan Singh.  He is a Neurosurgeon practising in Gurugram, India with special interests in Minimally Invasive spine surgery.

Disclaimer- This article is for the general awareness of the patients and cannot replace expert medical advice. Patient treatments need to be individualised and that can be decided based on clinical examination and evaluation by a trained physician.

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