Tumours of the spine and spinal cord represent nearly 15% of primary CNS tumours. Most of them are benign and they tend to constrict rather than invade surrounding structures.
Based on the compartment involved they can be subdivided into three groups:
- Extradural [ED]
- Intradural extra-medullary [ID-EM]
- Intramedullary spinal cord tumours [IMSCT]
Extra-Dural Spinal Cord Tumors
They represent 55% of all CNS spinal cord tumors and they arise outside cord in epidural tissue or vertebral bodies and may be subdivided in:
Secondary spinal tumours (more common)
Osteolytic metastatic tumours
- Carcinoma (lung, breast, prostate)
- Lymphoma
- Plasmacytoma
- Multiple myeloma
Metastatic tumours that may be osteoblastic
- Prostate carcinoma
- Breast carcinoma
Primary spinal tumours (very rare)
Benign
- Osteoma osteoid and osteoblastoma
- Osteochondroma
- Vertebral hemangiomas
- Aneurysmal bone cyst
- Giant cell tumours (AKA osteoclastoma)
- Eosinophilic granuloma (AKA Unifocal Langerhans cell hystiocytosis)
Malignant
- Chordomas
- Osteosarcoma
- Chondrosarcoma
- Ewing’s sarcoma
- Plasmacytoma
- Multiple myeloma
- Lymphoma (very rare, more frequent represents spread of systemic disease)
Intra-Dural Extra-Medullary Spinal Cord Tumors
They constitute 40% of all CNS spinal tumours and arise in leptomeninges or roots and include:
- Meningiomas (40%)
- Neurinomas and neurofibromas (50%)
Symptoms, diagnosis and treatment
- Pain is the most common symptom at onset, followed by other symptoms and signs according to level and extent involvement of spinal cord;
- MRI is the gold standard for diagnosis;
- Elective treatment is surgical excision with different approach (anterior, lateral, posterior) based on level of involvement. Recurrence rate depends on tumour histotype (e.g. meningioma recurrence rate is approximately 7% within a minimum of 6 years).
Intra-Medullary Spinal Cord Tumors
They are the less common CNS spinal tumour of which they represent only 5% and arise in spinal cord substance and invade tracts and grey matter
They consist of:
- Ependymoma (45%)
- Astrocytoma (30%)
- Miscellaneous
- Dermoid and epidermoid
- Hemangioma
- Hemangioblastoma
Symptoms, diagnosis and treatment
- Pain is the most common symptom at onset, followed by other symptom and signs according to level and extent involvement of spinal cord;
- MRI is the gold standard for diagnosis;
- Elective treatment is surgical excision for low grade tumours whereas it is not useful in case of high grade tumours (e.g. astrocytomas WHO grade III, glioblastomas (IV)) due to marked invasion of the spinal cord.
Authors
Fabio Paio, MSMedical Student |