SPINAL CORD TUMORS
Spinal cord tumors account for ~20% of neuraxial tumors and are classified according to their location as—(a) intramedullary, (b) extramedullary, and (c) extradural tumors.
TABLE 18.37: D/D intra vs extra-medullary spinal tumors
| Feature | #8739;#8739;#8725;ml | EML |
| Back pain | Rare | Presenting |
| Root pains | Rare | Common |
| Paresthesia | Below the lesion | Segmental |
| LMN signs | At the lesion | Segmental |
| UMN signs | Below the lesion | Uncommon |
| Sphincters | Early | Late |
| MRI | Fusiform swelling | Circular indentation |
IML: Intramedullary, EML: Extramedullary
Intramedullary tumors commonly develop in cervical region as slow-growing astrocytoma, presenting with:
• LMN signs at the site of lesion,
• UMN signs and sensory loss below the lesion,
• Spastic bladder involvement,
• Fusiform swelling of cord on MRI.
Extramedullary tumors are usually benign, arising from neural crest tissue, e.g.
neurofibroma and presenting with:• Severe back pain/stiffness (Tripod posture),
• Root pains,
• Segmental weakness,
• Circular indentation of cord on MRI (neurofibroma) Extradural tumors are usually metastatic, e.g. neuroblastoma, lymphoma, etc., which present with:
• Flaccid paraplegia,
• Urinary retention and patulous anus,
• Raised ICP with elevated CSF proteins due to obstruction of spinal CSF flow by tumor (Froin syndrome),
• Brown-Sequard syndrome, i.e. ipsilateral weakness, spasticity, ataxia with contralateral loss of pain and temperature sense in some cases.
• Spinal block on MRI.
Diagnosis of spinal tumors rest on MRI, though plain spinal skiagrams may show variable abnormalities, e.g. widening of interpediculate distance, destruction of vertebral bodies and widening of vertebral foramen. Important clinical differences between intramedullary and extramedullary tumors are shown in Table 18.37.
Treatment: Surgery is the treatment of choice in all cases, with best results for extradural tumors.
18.17