Spinal Tumours Manoj Krishna, FRCS Spinal 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 Tumour Patient 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 With Gadolinium Patient in 50’s.. Left buttock, and leg pain for 12 months. No postural relief. Widespread Neurofibromatosis. Intra-medullary TumorSchwannoma. Treated successfully by excision surgery Patient in 40’s 6month history of abdominal pain Had hernia repair- no better Hyper-sensitive to touch in abdomen T6-10 distribution. BILATERAL POSITIVE HOFFMAN REFLEX Post-GAD IMAGES.