Spinal tumors – mechanism of development, symptoms, treatment
From the pathologic point of view, the spinal tumor is benign or malignant neoplasms of the spinal cord of a private matter of the brain. But the statistics of the tumor, emerging directly from the brain substance, it makes up only 10% of the total number of cancer tumors of the spinal cord.
There are primary and secondary tumors of the spinal cord. Called primary tumors of the nervous tissue and meninges, and secondary, those which have metastasized from malignant tumors located in other organs. Most often metastases penetrate into the spine, lung cancer, stomach or esophagus.
1) tumors of the nervous tissue of the spinal cord (ependymomas, oligodendrogliomas, medulloblastoma, glioblastoma);
2) tumors of the meninges (meningioma);
3) tumors of the vessels (angiomas, hemangiomas, hemangiopericytoma);
4) tumors of spinal roots (Sanoma, neurofibromas, neurinomas);
5) tumors of the connective tissue (sarcoma);
6) tumor of fat tissue (lipoma);
- tumors of the cervical;
- tumors of the thoracic;
- tumors of the lumbar;
- the tumor region of brain cone;
- the tumor region of the horse's tail
- extradural (or epidural) tumours (mainly secondary);
- intramurally (or subdural) tumor:
a. intramedullary (intracerebral):
- cavernous angiomas;
b. extramedullary (extra):
The clinical picture is characterized by progressive undulating course with increasing neurological syndromes due to lesions of spinal roots and the gradual squeezing of the spinal cord with a progressive tumor.
The symptoms extramedullary tumors:
When extramedullary tumors appear earlier radicular pain is to identify the sensitivity disorders in the immediate area of the affected roots reduced or completely disappear tendon, periosteal and cutaneous reflexes, identifies local paresis, accompanied by atrophy of the muscles corresponding to the innervation of the affected roots. With the gradual growth of the tumor, increases the degree of compression of the spinal cord, so join conductor pain syndromes and paresthesias, with characteristic sensitivity disorders. Over time, a syndrome of cross-compression of the spinal cord, resulting in paraparesis or paraplegia. Muscle weakness and impaired sensation are first determined in the distal parts of the body, gradually rising to the level of the affected nerve roots.
Syndromes intramedullary tumors:
- the absence of radicular pain;
- sensitivity disorders are dissociated;
- conduction disorders spread gradually from top to bottom;
- severe muscle atrophy;
- over time, the manifestation of the syndrome complete transverse lesion of the spinal cord.
When extramedullary tumors during percussion or pressure on the spinous process corresponding to the affected nerve root occur typical radicular pain and possible conductor paresthesia, which is not observed in case of intramedullary tumors.
Syndromes metastatic tumors:
- conduction disorders (first, flaccid paraparesis andparaplegia, spastic later appear the elements);
- due to the compression by the tumor of the spinal cord is compression of the anterior spinal artery which can cause ischemia of the spinal cord;
- the level of inconsistency of the location of the tumor and sensitivity.
Symptoms for tumors of the cervical spinal cord:
- early radicular syndrome in the neck area (shooting pain) and limited mobility of the cervical spine;
- dyspnoea (due to paralysis of the diaphragm);
- intracranial hypertension (if craniospinal tumors);
- bulbar syndromes (with the defeat of the nuclei of the medulla oblongata);
- Central paraparesis progressing to paraplegia of the lower extremities.
Symptoms for tumors of the thoracic spinal cord:
- thoracic radicular syndrome (radicular pain along the intercostal nerves);
- cardiac abnormalities (when the tumor was at the level of DIV – DVI segments of the spinal cord);
- pain in the abdominal region (at the location of the tumor in the lower thoracic segments of the spinal cord).
Symptoms for tumors of the lumbosacral spinal cord (LI-SII):
- the decrease or absence of knee reflexes while enhancing the heel of the reflexes (the location of the tumor in the upper sections of the lumbar enlargement);
- preservation of the knee reflexes and the loss of heel reflexes (localization of the tumor in the lower portion of the lumbar enlargement);
- paralysis of the muscles of the lower extremities from distal to the knees and above;
- loss of sensation of the lower extremities from distal to the knees and above;
- flaccid paralysis of the peroneal and gluteal muscles with preservation of the knee and loss of heel reflexes.
When the tumor in the cervical, thoracic and lumbosacral spinal cord are characterized by violation of functions of pelvic organs through the Central type, i.e. the delay of urination and defecation.
Symptoms for tumors in the region of the cerebral cone:
- pain in the anogenital area and on the rear surface of the gluteal region;
- dysfunction of the pelvic organs via peripheral type (sexual weakness, urinary incontinence and fecal incontinence, loss of anal reflex).
Symptoms for tumors in the region of the horse's tail:
- sharp steady pain in the sacrum, anus and lower extremities, worse in the horizontal position;
- disorders of the sensory and motor roots;
- dysfunction of the pelvic organs via peripheral type (first partial and then complete incontinence of urine and feces).
Methods of diagnosis:
- neurological research;
- radiography of the spine;
- computed tomography;
- magnetic resonance imaging
- radical surgery;
- ultrasonic aspiration of the tumor;
- radiation therapy;
- stereotactic radiosurgery;
- stereotactic radiotherapy.
The success of surgical treatment of spinal tumors depends on the stage of disease, type of tumor, its localization and the age of the patient.
Despite the fact that the best method of surgical treatment is recognized, it is not always possible for several reasons. So, the secondary (metastatic) tumor is inoperable. For some tumors before radical removal of the used embolism of tumor vessels.
When the infiltrative growing tumor resort to decompression or laminectomy. In the future, carry out a course of radio - or chemotherapy.
An alternative method of treatment
In recent years, began to practice the treatment of tumor of the spinal cord without pain, scalpel and blood. This is an alternative treatment is called stereotactic radiosurgery or stereotactic radiotherapy. 100% fitstreatment of inoperable in the medical concepts of the tumors.
The essence of the procedure is that one high dose of gamma or x-ray radiation purposefully destroys the tumor without damaging healthy body tissues. Like conventional radiation therapy, stereotactic radiosurgery does not destroy literally the tumor and destroys the DNA of tumor cells, which consequently lose their ability to divide and reproduce. Practically this procedure is carried out in several stages, especially if the tumor is of large size. If held from 3 to 5 treatments, it is called fractionated stereotactic surgery. If held for more than five fractions, called this method of treatment stereotactic radiotherapy.
The benefits of stereotactic radiotherapy:
- continuous delivery of beams of radiation in a 3D projection in real time;
- minimum exposure of the body;
- continuous delivery of radiation dose exactly to the tumor without breath hold;
- automatic correction of the minimum displacement of the patient or of the tumor;
- maximizing, submillimeter accuracy in achieving the goal.