Diseases

Tumors of the spinal cord (OT) account for approximately 10-25% of tumors of the central nervous system. The incidence in the general population is 100000/2-10. The incidence of both spinal and spinal cord tumors varies depending on the type and location of the tumor. For example, 95% of metastatic tumors that spread to the spine from another part of the body are located outside the spinal cord (extadural), while 4% are located within the spinal cord (intradural). Very rarely, these metastatic tumors may be located intramedullary in the spinal cord. Although there is no general rule, tumors originating from the spinal cord and its membranes or from the nerve itself are benign tumors.

Classification of tumors of the spine and spinal cord

1 - INTRADURAL INHABITANTS

A: Intradural-extramedullary

B: Intradural-ectramedullary

2 - EXTRADURAL LOCALIZATIONS

A: Primary spine tumors

B: Secondary (metastatic) spine tumors

Symptoms and signs of spine and spinal cord tumors

Whether a spinal tumor is located inside or outside the spine, depending on the location of the tumor, the leading complaint is pain in the lower back, back and neck. Initially, the pain increases with coughing, straining, sneezing, maneuvers that increase intracranial pressure and is relieved with rest. As the disease progresses, the pain is not relieved even with rest. Pain in metastatic spinal tumors, on the other hand, usually occurs initially at rest, but becomes persistent as the disease progresses. While the pain is initially relieved with medical painkillers, it then becomes persistent and resistant to medical drugs, to the extent that it interferes with the activity of the person. The physician who first sees the patient in this period usually perceives this pain complaint as benign degenerative diseases (lumbar, herniated disc) and plans treatment. Secondly, depending on the size and location of the tumor, sensory (paresthesia), motor (weakness), sphincter (urinary, bladder) and autonomic complaints begin to emerge. In this case, the picture is that of a semi-incision or full incision of the spinal cord.

 

Intradural-extramedullary tumors

These tumors account for 40% of all spinal tumors. 90% of these tumors are benign and 10% are malignant or metastatic. 70% of intra dural tumors are benign tumors such as meningiomas or schwannomas.

Meningiomas

Spinal meningiomas are usually benign. Like meningiomas in the brain, they originate from the spinal cord membranes. They account for 25 to 48% of all spinal intradural tumors. They are most common at the age of 50-60 years. They are more common in women, with a ratio of 4-5/1. They are most commonly localized in the thoracic (67-84%), cervical (14-27%) and lumbar (2-14%) regions. While they are usually located intradurally, 3-9% may be extradural, 5-14% may be intradural and extradural. Pain is the most common complaint, followed by sensory, motor and sphincter complaints. These tumors are very easy to diagnose and can be easily diagnosed by Magnetic resonance imaging (MRI), one of the most advanced diagnostic methods of today. First of all, the examining physician should think of a spinal cord or spine tumor. The treatment of these tumors is quite easy, satisfying and successful. The aim of surgical treatment is to remove the tumor completely from its source. There are very rare types of malignant meningiomas. There is a risk of recurrence and radiotherapy is added to these. Complications of spinal meningioma surgery are quite low depending on the experience of the surgeon.

Schwannoma/ Neurofibroma

They are nerve sheath tumors and are rare, occurring in the general population of 100 000/ 0.3-0.5. It is common in 30-50 years of age. The female to male ratio is the same. The most common site is the thoracic region, followed by the cervical and lumbar regions. Like meningiomas, these tumors grow slowly and initially cause pain followed by motor weakness and sensory, sphincter and sphincter complaints. Just like meningiomas, these tumors can be diagnosed very easily and quickly by MRI. The treatment is surgical removal. The most important point in surgery is to correctly identify the nerve root from which it originates and to remove the entire tumor together with this root. Recurrences are usually inevitable as a result of partial removal. Surgical success is closely related to the experience of the surgeon. The result is usually excellent.

Intradural- Intramedullary Tumors

Of this group of spinal tumors, 45% are astrocytomas and 35% ependymomas. These constitute 20-30% of all spinal tumors and 40-50% in children. In addition to these, hemangioblastomas and residual tumors (dermoid, epidermoids, teratomas, lipomas), as well as neuronal tumors (oligodendrogliomas, ganglogliomas) are also seen in this location. The initial complaint in these tumors is pain followed by motor, sensory and sphincter complaints.

Epandimomas

 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. The male/female ratio is 2/1. The most common site is the lombo-sacral region, followed by the cervical and thoracic regions. The initial complaint is pain followed by sensory, sphincter and motor findings. These patients usually present to the clinic in advanced stages. This is due to the patient's inability to describe their complaints well, the lack of a good spinal cord examination and most importantly, the lack of appropriate testing. Despite all this, these tumors are very easy to diagnose with today's advanced MRI scans. Since spinal ependymomas have a pseudocapsule, total resection is possible, but there is a risk of recurrence in partial resections. Ependymomas are sensitive to radiotherapy. Although chemotherapy is controversial, it is used in some cases.

Metastatic Spinal Tumors

The spine is the most common site of metastasis. Primary cancers such as lung, breast, prostate, kidney, kidney, thyroid, gastrointestinal and lymphoma can spread to the spine. Metastatic tumors occur in 60% men and 40% women. The most common age of onset is between 40 and 60 years. Metastases are most common in the lumbar region, followed by the thoracic and cervical regions. While 95% of spinal metastases are extradural, 4% are intradural-extramedullary and 1% are intramedullary. Patients' complaints are usually of short duration and the most common complaint is pain. The distinctive feature of this pain is that it occurs at rest and is closely followed by half cord incision or complete cord incision. Treatment is closely related to the survival of the primary tumor. The type of the primary tumor, the type and number of involvement in the spine are decided according to the condition of other body organs. Bone scintigraphy and PET-CT should take into account the extent of the lesion. Surgery, radiotherapy, and chemotherapy are used alone or in combination. In surgical cases, only tumor decompression is not sufficient and stabilization of the spine should be planned in the same session.