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Spinal Tumours

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

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Spinal Tumours

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  1. Spinal Tumours Manoj Krishna, FRCS Spinal Surgeon. www.spinalsurgeon.com

  2. 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.

  3. Tumours in the Vertebra OsteoidOsteoma( 10-25 yrs) Osteoblastome( 20-30 yrs) EosinophilicGranuloma Haemangioma Aneurysmal Bone Cysts Sarcoma Chordoma • Spinal Metastases( commonest) • Multiple Myeloma • Lymphoma

  4. 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

  5. 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.

  6. Symptoms of hpercalcemia • Thirst • Confusion • Loss of apetite • Nausea • Tiredness • Constipation

  7. 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

  8. 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

  9. 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.

  10. 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.

  11. Treatment. T5 Trans-pedicularvertebrectomy +Bone Cement into Vertebra Pain and cord compression symptoms resolved

  12. 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

  13. Neurofibroma causing Radicular Pain With Gadolinium Patient in 50’s.. Left buttock, and leg pain for 12 months. No postural relief. Widespread Neurofibromatosis.

  14. Intra-medullaryTumor- Schwannoma. 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.

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