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HOW ARE SPINAL CORD TUMORS DIAGNOSED?

A spinal cord tumor is an abnormal mass of tissues grown inside the spinal column, it may be present in the lining of the spinal cord (dura) or within the spinal cord. These tumors may be benign (non-cancerous) or malignant (cancerous) in nature. They are classified into two main groups i.e. primary and secondary. Primary spinal cord tumors are those which originate within it however secondary tumors are those that are metastasized from cancer from another body part i.e. lungs, breast etc.

The initial diagnosis is made by a thorough medical examination, including general physical and neurological exams and laboratory tests mainly radiological tests. These tests include X-ray, CT scan, biopsy, bone scan, MRI etc. Multiple tests are done in order to attain accurate results and to identify the actual type and location of the tumor.

  • MAGNETIC RESONANT IMAGING (MRI):

MRI is usually preferred for accurate results, as it shows a clear image of the spinal cord and the surrounding tissues. It uses a contrast agent to highlight the affected area that is injected through a vein into your body. It provides a three-dimensional image that includes all the degenerations, tumors, or any other abnormalities.

  • X-ray:

X-ray is done to see the bony structure of the spine and its outline. However, they are not considered very reliable.

  • CT SCAN:

Ct scans are done in order to evaluate the size and shape of the spinal canal, it is also useful to visualize the bony structures and the contents inside the spinal canal.

  • Bone Scan:

Technetium-99 is used in the bone scan. It is used to identify bony tumors and infections.

These tumors can be treated by surgical or non-surgical methods. This decision depends on the age and overall health of the patient as well as the outcome goals.

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HOW SERIOUS ARE SPINAL CORD TUMORS?

Spinal cord tumors originate within the spinal cord or in the lining (dura) of it enclosed in the bony structure of the vertebral column. The purpose of the spinal cord is to conduct sensory and motor sensations from the brain to the body and vice versa. Hence, any impairment in the spinal cord directly affects the sensations all over the body.

Any abnormal growth in the spinal cord compresses the nerve fiber band in the areas of its pathway i.e. cervical, thoracic, lumbar, and sacral will result in damage. This damage depends on the location and size of the tumor. The tumor’s location determines which part of the body is most likely to be affected. While its size may indicate the extent of the damage and the level of the injury. Any kind of abnormal growth may lead to pain and discomfort.

Spinal cord tumors can result in various levels of impairment including mild to severe damage. The impairments may include pain, numbness, discomfort, and neurological disorders and may even lead to paralysis. The overall understanding of the symptoms and the level of injury depends on the time of diagnosis (the early the diagnosis the better the prognosis), the level of injury, and the nature of cancer. It also depends on whether the compression of the spinal cord is present or not, if present then what is the extent. It is also dependent on the age and overall health of the patient and whether the tumor is benign or malignant.

Even if the tumor is treated, the healing depends on the patient’s health and wellness. The surgical treatment also has some side effects such as infection at the site of surgery, systematic disorders, and infections. There may also be chances of deep vein thrombosis.

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WHAT ARE THE CAUSES OF SPINAL CORD TUMORS?

The spinal cord is a long tubular band of nerve fibers enclosed in the bony structure called the vertebral column. The tumors that occur within this enclosed structure are called spinal cord tumors. These tumors may be benign or malignant in nature. Most of these tumors are metastasized from other body parts.

Following are the various causes of spinal cord tumors briefly explained by the best neurosurgeon Dr. Kalyan Bommakanti.

1.Genetic mutation:

Genetic defects may be a cause of the origin of the tumors in the spinal cord. Usually, these mutations have been seen in particular families so it is supposed that it runs in the families. These mutations may be congenital or may develop with time. In some cases, spinal cord tumors may occur with the occurrence of some genetic diseases i.e. neurofibromatosis and Von Hippel-Lindau disease.

2. Exposure to cancerous substances:

Direct or indirect exposure to cancerous chemicals or substances may lead to the cause of spinal cord tumors. These substances may transfer by air or by physical contact. These substances may be present in the environment.

3. Weak immune system:

A compromised immune system may lead to spinal cord tumors as it increases the prevalence of spinal cord lymphomas. These lymphomas affect the immune cells i.e. lymphocytes.

4. Metastasized tumors:

Secondary tumors, also known as metastasized tumors, are a common cause of spinal cord tumors. These tumors are spread to the spine from elsewhere in the body. Usually, they spread by entering the systems that are responsible for the exchange of fluids around the body such as the lymphatic system or the bloodstream. These systems transfer the cancer cells with the fluid they are already supplying. Spinal tumors may also develop from the primary tumor present nearby such as in the liver, lungs, abdomen, and bones.

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What are Intradural-extrmedullary and extradural spinal cord tumors?

Spinal cord tumors are the tumors inside or in the lining of the spinal cord enclosed in the vertebral column. These tumors may be benign or metastatic. These tumors are classified on the basis of their location and size.

In this article, the best spine surgeon Dr. Kalyan Bommakanti has explained the Intradural-extramedullary and extradural spinal cord tumors.

  1. Intradural-extramedullary tumors:

The outermost layer of the spinal cord is the dura sheath. The tumors developed in this sheath but outside the spinal cord are the intradural-extramedullary tumors. Usually, these tumors are benign. The symptoms may include weakness and pain.

Intradural-extramedullary tumors are further divided into the following sub-types:

i. Meningiomas:

These spinal tumors are formed in the membranes covering the spinal cord. These tumors are more common in women than men and appears usually in the back in the upper portion. They may be cancerous or not, but usually, they are not cancerous. As the tumor grows, symptoms like pain, weakness, numbness, or bowel/bladder incontinence can be seen.

ii. Neurofibroma:

A Neurofibroma occurs in the outer layering and the nerves of the spine. Usually, it accompanies a condition called neurofibromatosis. This condition is responsible for causing spinal tumors. The growth rate of these tumors is slow.  

iii. Schwannoma:

This type of spinal cord tumor is caused by Schwann cells, these cells produce myelin sheath for the protection of the nerves. It may be congenital. In most cases, they are non-cancerous however they may grow in size and put pressure on the spinal cord. It may result in symptoms like pain, weakness, or numbness.

2. Extradural tumor:

A tumor that is formed outside the dura is known as the extradural tumor. Usually, they are metastatic and have spread from any other part of the body. These tumors also involve the vertebral column. Almost 55% of the spinal cord tumors occur in this part of the spine.

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What are the intramedullary spinal cord tumors?

The spinal cord is a tube consisting of nerve bundles running along the spinal canal, carrying messages from the brain to the body and vice versa. The formation of a tumor in or around the spinal canal is called a spinal cord tumor. These tumors may be benign (localized) or malignant (can transfer to other body parts). Whether malignant or benign, these tumors can compress the nerve bundles passing nearby causing numbness, pain, and loss of sensations in the affected area.

The best spine surgeon in India Dr. Kalyan Bommakanti has classified the various sub-types of intramedullary spinal cord tumors according to their size and location.

  1. Intramedullary tumors:

Spinal cord tumors that grow inside the spinal cord are called intramedullary tumors. Usually, they appear in the cervical/neck region. These tumors are further classified into sub-types such as:

i. Ependymoma:

Ependymal cells are located in the spinal cord and act as a lining to the central canal while helping in regulating the fluid flow within the spinal canal. The tumor of these cells is called Ependymoma – the most common type of spinal cord tumors. These tumors spread at a slow rate and can cause symptoms like nausea, vomiting, and bowel and bladder incontinence.

ii. Astrocytoma:

Astrocytes are star-shaped cells (gliomas) located in the spinal cord and the brain that regulates the proper functioning of the nerve cells. A tumor of astrocytes is called astrocytoma. Astrocytomas are usually found in the thoracic region. They may cause weakness in the legs and gait problems. This type of spinal cord tumor is most common in children.

iii. Lipomas:

Lipomas are congenital and are very rare. They arise in the fat tissue present in the middle of the back i.e. cervicothoracic region.

iv. Hemangioblastoma:

This type of tumor is usually non-cancerous and can occur in any area of the spinal cord. They arise in the blood vessels lining the spinal cord and the brain. It may cause disturbance in the balance and weakness in various parts.

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WHAT ARE THE SYMPTOMS OF SPINAL CORD TUMORS?

A spinal cord tumor is a tumor within the spinal cord enclosed by the spine. An uncontrolled cell growth results in the tumor. It may be benign or malignant depending on the root cause of it. Spinal cord tumors can seriously compromise the body’s functioning according to the level of the damaged neurons.

The symptoms caused by it depend upon the growth of the tumor. Here are the symptoms of spinal cord tumors explained by Dr. Kalyan Bommakanti – the best neurosurgeon in India.

1. Back pain:

Back pain is a common early and non-mechanical symptom of the tumors of the spine. The pain is not associated with any injury or trauma. However, it remains consistent and may increase with increased activity and even at night while lying down. The pain may also radiate to other body parts such as hips, feet, legs, arms, or chest.

2. Muscle weakness or sensations loss:

The damage to the nerve bundles passing across the spinal cord may result in numbness and complete/partial loss of sensations in several body parts. The affected areas may experience less sensitivity to several environmental factors such as hot or cold. This may also result in weakness of the muscles in the affected areas, especially the legs and arms.

3. Loss of bowel and bladder function:

The normal functioning of the bowel and bladder may also be affected if the associated nerves are damaged. It may cause incontinence of the bowel and bladder or complete loss of control in extreme cases.

4. Difficulty in walking:

The person experiences difficulty in walking as his balance and coordination may also be affected. It becomes so persistent that sometimes he ends up trembling or even falling.

5. Paralysis:

In extreme cases of nerve damage, the body may go into paralysis. Its intensity and location depend upon the level of injury.

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