Spinal Tumours Manoj Krishna, FRCS Spinal Surgeon. .
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Transcript of Spinal Tumours Manoj Krishna, FRCS Spinal Surgeon. .
Spinal Tumours
Manoj Krishna, FRCSSpinal Surgeon.
www.spinalsurgeon.com
Incidence
• 5-15% of patients with cancer have spinal metastasis( spread to the spine)
• In autopsy studies 70% of cancer patients have spinal metastasis
• Risk of getting a primary spinal cord tumour is 1 in 140 for men and 1 in 180 for women.
Tumours in the Vertebra
• Spinal Metastases( commonest)
• Multiple Myeloma• Lymphoma
• Osteoid Osteoma( 10-25 yrs)
• Osteoblastome( 20-30 yrs)• Eosinophilic Granuloma• Haemangioma• Aneurysmal Bone Cysts• Sarcoma• Chordoma
Symptoms of early cord compression
• Heaviness in legs and arms• Altered sensation• ‘Water running down legs’• Loss of co-ordination when walking• Weakness• Changes in bladder function
3 types of pain in these cases
• Biological- from the inflammation around the tumour- described as a deep ache and is worse at night, eased on getting up and moving around.
• Radicular-from pressure on a nerve root• Mechanical- from bony destruction- worse on
loading the spine- eg lifting, bending , sitting.CAN MIMIC DEGENERATIVE SPINAL PAIN SO HIGH INDEX OF SUSPICION NEEDED.
Symptoms of hpercalcemia
• Thirst• Confusion• Loss of apetite• Nausea• Tiredness• Constipation
Investigations
• MRI is the investigation of choice- order brain and whole spine MRI with contrast if a tumour or cord compression is suspected
• Bone scan to check for skeletal spread• Chest X-ray• CT scan chest and abdomen– to look for a
primary once a spinal tumour is diagnosed• Biopsy
Blood tests
• FBC, ESR, CRP, U&E• Serum Electrophoresis- Myeloma• Bone Chemistry-look for elevated Alkaline
phosphatase in bone destruction, elevated calcium levels
• Thyroid levels• PSA – for prostate• CEA Antigen
Treatment Options
• Dexamethasone- to reduce cord oedema• Spinal cord tumours- usually need surgery• Spinal Metastasis: Surgical decompression and
stabilization if causing cord compression , radiotherapy with our without vertebroplasty if not.
• Chemotherapy in some cases as indicated.
T5 Metastatic TumourPatient in 60’s.
Sneezing episode
Got Mid-thoracic pain
Also reports some heaviness in legs
No loss of appetite or weight loss
O/E- Myelopathic gait, sensory level T6, tender D5/6
Walks like a drunk. Going off legs.
No known primary
20% of patients with tumors present with no known primary.
Treatment.T5 Trans-pedicular vertebrectomy +Bone Cement into Vertebra
Pain and cord compression symptoms resolved
Vertebroplasty for a spinal tumour
Dec 02 – Lifts heavy weight
LBP Since then
Getting Worse
Night Sweats x 6 weeks
ESR=73
Biopsy and Vertebroplasty - L2
Non-Hodgkins Lymphoma- now in remission after Chemotherapy
Neurofibroma causing Radicular Pain
Patient in 50’s.. Left buttock, and leg pain for 12 months.
No postural relief. Widespread Neurofibromatosis.
With Gadolinium
Intra-medullary Tumor- Schwannoma. Treated successfully by excision surgery
Post-GAD IMAGES.
Patient in 40’s6month history of abdominal painHad hernia repair- no betterHyper-sensitive to touch in abdomen T6-10 distribution.
BILATERAL POSITIVE HOFFMAN REFLEX