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BLOG&NEWS Sciatica and key hole spine surgery

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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BLOG&NEWS Sciatica and key hole spine surgery

WHAT ARE THE THINGS THAT AGGRAVATE SCIATIC PAIN?

Sciatic pain is caused by the impingement or inflammation of the sciatic nerve in the lumbar spine. It may cause pain, numbness, or muscle weakness in the lower back, legs, or foot. The intensity of pain may vary among individuals, and proper care and precautions must be taken to minimize the symptoms.

The best neurosurgeon Dr. Kalyan Bommakanti has explained different factors that may aggravate the sciatic pain:

1.Being obese:

Being overweight may be a cause of many health problems. The more the weight is, the more the strain and pressure are put on the body, especially the musculoskeletal system. Bones and joints are affected mostly by this, as they need to carry a heavy load hence resulting in weakness. The lower back is the place that is usually affected by it a lot, as there is a shift in the center of gravity due to excessive weight, resulting in putting pressure on the lumbar spine and causing disc herniation. It may eventually compress the sciatic nerve. To manage it or prevent it, it is advised to maintain a healthy weight.

2. Wearing uncomfortable shoes:

Wearing the wrong shoe may seriously disturb the biomechanics of gait pattern, unequal weight distribution, increased stress on the lower back, and aggravates the symptoms of sciatica. The increase of pressure in the lower back directly compresses the sciatic nerve.

3. Excessively loaded back pocket:

When you continue to sit for a prolonged time with an excessively loaded back pocket, it exerts direct pressure on the piriformis muscle under which the sciatic nerve runs.

4. Lifting weight with your back:

While lifting loads, the bending posture puts a lot of pressure on the lumbar discs. Due to excessive load, the vertebral discs may bulge out causing disc herniation ultimately compressing the sciatic nerve.

5. Pregnancy:

In pregnant women, it is common to experience piriformis syndrome due to the increasing fetus that results in the anterior shift of the pelvis resulting in the tightening of the piriformis muscle. Sciatic occurs as a secondary symptom of this syndrome.

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BLOG&NEWS Sciatica and key hole spine surgery

WHAT ARE THE VARIOUS TYPES OF SCIATIC NERVE PAIN?

Sciatica is a term used to describe pain caused by impingement or inflammation of the sciatic nerve. The sciatic nerve is the longest in the body. It originates from the lumbosacral vertebrae and travels along the route through the hips, buttocks, down each leg, and foot. The impingement of the sciatic nerve causes pain or numbness in any part where it supplies. Some people may experience pain in one part and numbness in another. It also supplies the muscles of these areas and may also cause muscle weakness and difficulty in movement.

These are various types of sciatica explained by the best neurosurgeon Dr. Kalyan Bommakanti:

1. Acute sciatica:

Acute sciatica has a sudden onset and the pain lasts for about 4-8 weeks. The intensity of pain is not severe and can be managed by self-treatment and gentle stretches at home. Usually, there is no need for medical treatment. But if ignored for a long period, acute sciatica may recur and may convert into chronic sciatic nerve pain.

2. Chronic sciatica:

This type of sciatica lasts for more than 8 weeks and the pain type is persistent.  Chronic sciatica cannot be cured by self-medication and you need to seek medical help. According to the severity and nature of the pain, either surgical or non-surgical interventions are made. It depends upon the pain type and the patient’s health status.

3. Alternating sciatica:

Usually, sciatica involves only one leg but sometimes it may affect both legs alternatively. This may indicate a degenerative disorder in the sacroiliac joint (the joint that connects the spine to the hips) such as sacroiliac arthritis.

4. Bilateral sciatica:

Bilateral sciatica is rare and affects both legs simultaneously when there is an impingement of both ends of the sciatic nerve. It may be caused by some degenerative changes in the vertebral discs or the vertebra. The intensity of pain in both legs may be variable. It may also be caused by the Cauda equina syndrome.

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BLOG&NEWS Sciatica and key hole spine surgery

WHAT WILL HAPPEN IF SCIATICA IS LEFT UNTREATED?

Sciatica is a term used to describe pain caused by irritation or impingement of the sciatic nerve. The sciatic nerve is believed to be the longest nerve in the human body. In the lumbar spine, it may be compressed due to disc herniation or spinal stenosis, resulting in affecting the areas where it supplies. It runs through the buttocks, hips, legs, and feet. The nerve damage can cause pain and discomfort in the affected areas, as well as sensory impairment. This condition is experienced by over 40% of the population worldwide.

If left untreated, it may cause several serious complications as follows:

1.Irreparable nerve damage:

Permanent nerve damage can cause serious complications, the sensory or motor loss may occur. The nerve damage can increase the intensity of pain. The pain may become unbearable and the intake of medications will be increased. Eventually, there will be a time, when the medication stops responding resulting in the worst conditions. As the sensory system of diabetic patients is already compromised, they are at great risk for this.  

2. Loss of motor and sensory control:

When the condition becomes worse, the patient may suffer a sensory and motor loss in the affected areas. You may feel a constant numbness and tingling because the nerve is being damaged continuously. It may also cause muscle weakness and difficulty in movement in the areas that are supplied by it.

Prolonged damage gradually decreases and then diminishes the sensations causing irreparable nerve dysfunction that can result in the amputation.

3. Bowel and bladder incontinence:

In extreme cases, it may also affect the control of bowel and bladder movements. It may be a temporary loss but can become permanent if left untreated for long period. The nerves become completely compromised and the damage is irreversible.  

4. Cauda Equina syndrome:

It can be caused by damage to the nerve root bundle present at the lower end of the spinal cord. This condition is characterized by extreme low back pain. Sensory impairment and incontinence may also occur. Cauda Equina syndrome may also cause permanent paralysis.

These are some of the complications explained by brain tumor surgeon Dr.Kalyan Bommakanti, M.Ch.

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