Spine and Spinal cord Tumors

1. Spine and Spinal cord Tumors

2. Benign , primary malignant , and metstatic tumors Spine tumors

3. Sign and symptoms: • Cord compression and n. deficit • Mechanical instability • Structural change like scoliosis • Pain ( persistent , at rest and at night) • Local pain or mechanical pain • Local tenderness and muscle spasm • Radicular symptoms due to neural foramen involvement

4. 15% of primary CNS tumors are intraspinal • Most primary CNS spinal tumors are benign • Most present by compression rather than invasion

5. Primary Skeletal Neoplasms Cell of origin Osseous Cartilagenous Fibrous Benign Malignant Neoplasms Neoplasms Osteoid osteoma Osteosareoma Osteoblastoma ( and variants Osteochondroma Enchondroma Chondroblastoma Chondromyxoid- fibroma Chondrosarcoma Primary, secondary Fibrosarcoma Malignant fibrous Histiocytoma Fibroma

6. Marrow Other Ewing’s sarcoma Multiple myeloma Lymphoma Metastasis Giant cell tumor Hemangioma Related lesions Eosinophilic-Granuloma Aneurysmal-Bone cyst

7. Osteoidosteomas • first discovered by Jaffe in 1935 . • May be seen in the spine. • Osteoidosteomas involve males more commonly than females. • men to women is 2:1

8. Osteoid osteomasare seen predominantly in childen or young adults from 10 to 25 years of age .

9. Osteoid Osteomas • Have a strong predilection for the posterior • elements of the vertebra (lamina, pedicle, most • frequent sites). • Neural arch is affected in about • 75%, articular facets in about 18%, • vertebral bodies in only 7%.

10. Osteoid Osteomas Are slightly more common in the lumbar area, followed by the cervical, thoracic, sacral regions.

11. OsteoidOsteomas All patients will present with back pain & usually is the primary complaint and is not relieved by rest or heat .

12. Pain is worse at night and with recumbency and is frequently relieved by aspirin or other nonsteroidal drugs.

13. More commonly the patients will present with scoliosis, osteoid osteoma is the most frequent cause of painful scoliosis in adolescents .

14. Osteoid osteoma is often diagnosed late with the delay reported being between 18 & 27 months.

15. Early in its courses, plain X-Ray films are negative

16. Any back pain of greater than 6 weeks, duration in children and young adults should be studied by a technetium bone scan.

17. The bone scan will show increased radionuclide uptake at the site of the lesion .

18. Radiologically , the lesion is characterized by a radiolucent area with a central nidus and surrounding sclerosis (a lesion about 1.5 cm diameter ).

19. Treatement is surgery when lesions involved the posterior elements, they can usually be completely remove through a posterior approach.

20. If the lesion has been completely removed , recurrence is unlikely.

21. Osteiod osteomas constitute about 2.6% of all excised primary tumors of bone and about 12.1% of all benign tumors .

22. Location Between 7% and 18% of all osteoid osteomas are located in the spine. Lumbar 40% , thoracic 30%, and cervical 30%.

23. Osteeoblastoma Osteoblastoma : is a rare benign neoplasm of bone that accounts for 3% of all benign bone tumors. Pathogenesis of tumor is unknown.

24. osteoblastoma The major clinical symptom of osteoblastoma is dull aching, localized pain over the involved bone.

25. Pain is insidious in onset and may have a duration of months to years before diagnosis.

26. As opposed to osteoid osteoma, pain of an osteoblastomais less severe, not nocturnal, and not relieved by salicylates

27. Osteoblastoma located in the lumbar spine may be associated with pain radiation into the legs.

28. Pain may be aggravated by activity, was the presenting symptom in 81% and radicular pain was in 29% of patients with spinal involvement.

29. Osteoblastoma appear during the second or third decade of life

30. Osteoblastoma has a predilection for the spine, approximately 40% are located in the axial skeleton.

31. Male to female ratio is 2.5 to 10

32. In the past osteoblastoma has been referred to as an osteogenic fibroma, giant osteoid osteoma,

33. Physical examination may demonstrate local tenderness on palpation with mild swelling over the spine .

34. A positivestraight leg raising test is present in bout 25% of patients .

35. Osteoblastoma associated with spinal cord compression with result in abnormalities on sensory and motor examination of the lower extremities.

36. Radiographics evaluation of osteoblastoma are variable and nonspecific.

37. In the spine lesions are most commonly located in the posterior elements of the vertebrae (pedicles, lamina, transverse, & spinous processes).

38. Osteoblastoma is locted in the sacrum or lumbar spine in 40% of the lesions, in the cervical spine in 36%, and in the thoracic spine in 24%

39. In x-ray osteobastoma is expansile, with well-circumscribed margins and homogeneous ossification.

40. CT.may provide better localization of the tumor particularly when when the lesion is obscured on plain roentgenograms.

41. MRI. is better than CT. in demonstrating the extension of the bone sclerosis.

42. Osteochondroma Is a common benign tumor of bone that occurs in single or multiple location in the skeleton .

43. Osteochondromas represent up to 36% of all benign bone tumors

44. Approximately 60 % of patients develop the lesion between the second and third decade of life ( in multiple lesions before 20 years )

45. Pathogenesis of osteochondroma is postulated to be related to an abnormality of cartilage growth .

46. 1% to 2% of osteochondromas are located in the spine

47. 50% in the Lumbosacral 30% in the thoracic 20% in the cervical

48. Osteochondroma is frequently asymptomatic and is discovered only as a painless prominence of bone.

49. If pain is present, it is mild, deep , pain may increase with activity.

50. Osteochondromasattached to the spinal column have been associated with kyphosis and spondylolisthesis