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Tumours of the Spine

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    Tumours of the Spine Tumours of the Spine Presentation Transcript

    • Tumours of the Spine Brad Hoffmann MBBCh FRCS(Eng) FRCS(SN) FCS(SA) Neurosurg
    • Spinal Tumours
      • 15% of primary CNS tumours are in the spine
      • Most are benign
      • Mostly present with compression rather than invasion
    • Spinal tumours-types
      • Extradural-55% (probably higher) Arise in bone or extradural tissues.
      • Intradural extramedullary-40%.
      • Intramedullary-5%. Affect white matter tracts and grey matter
    • Differential diagnosis
      • Extradural
        • Metastatic-lymphoma, lung, breast, prostate
        • Primary spinal tumours- chordomas, osteoid osteoma, osteoblastoma, aneurysmal bone cyst, vertebral haemangioma
        • Occasionally extradural- meningiomas, neurofibromas, chloromas, angiolipoma
    • Differential diagnosis
      • Intradural extramedullary
        • Meningiomas
        • Neurofibromas
        • Lipomas (also intramedullary)
        • Metastatic (only 4%)
    • Differential diagnosis
      • Intramedullary
        • Astrocytoma-30%
        • Ependymoma-30%
        • Miscellaneous
          • Malignant glioblastoma
          • Dermoid
          • Epidermoid
          • Teratoma
          • Lipoma
          • Haemangioblastoma
    • Intramedullary tumours-Presentation
      • Pain- radicular/ non radicular. Local pain/stiffness.NB- pain with recumbency. Often bilateral
      • Motor disturbance
      • Other sensory disturbance
      • Sphincter disturbance
      • Other-scoliosis, cutaneous stigmata, visible mass
      • Usually insidious, progressive
    • Intramedullary tumours-Treatment
      • Surgery
      • Radiotherapy (rare-glioma group)
      • Observation (“masterly inactivity”)
    • Intramedullary tumours
    • Intramedullary tumours
    • Intramedullary tumours
    • Spinal tumours-miscellaneous
    • Spinal tumours-miscellaneous
    • Spinal tumours-miscellaneous
    • Spinal tumours-miscellaneous
    • Spinal tumours-miscellaneous
    • Spinal tumours-miscellaneous
    • Thoracic meningioma
    • Thoracic meningioma
    • Spinal lipoma
    • Spinal lipoma
    • Intradural, extramedullary…
    • Spinal epidural metastases
      • Suspect if history of cancer
      • NB-pain at rest/ recumbency
      • Occurs in 10% of cancer patients
      • 80%-lung, breast, GI, prostate, melanoma, lymphoma
      • Routes-haematogenous
      • Thoracic>cervical>lumbar
      • Pain is first symptom in 95%, followed by neurological symptoms/ signs
    • Spinal metastases
      • Primary site can be unknown/asymptomatic
      • 15% present with paraplegia, but up to 75% have weakness at diagnosis
      • Symptoms to diagnosis-2 months
      • Patients “triaged” according to severity of symptoms/signs
    • Spinal metastases
      • Most severe group- about 75% have abnormal Xrays:
        • Pedicle erosion
        • Pedicle widening
        • Compression fracture
        • Scalloping of vertebral body
        • Sclerosis, osteoblastic changes
    • Spinal metastases
      • Further Ix:
        • MRI +/- contrast
        • Rarely myelogram
        • Isotope bone scan +ve in 66%
        • Metastatic work-up
    • Spinal metastases
      • Treatment
        • Individualised
        • Usually palliative
        • Radiotherapy most common
        • Surgery
        • Dexamethasone
        • Pain control
    • Other conditions to consider..
      • Osteoporotic fractures
      • Disc lesions
      • Infection-intra-osseous, epidural..
      • Haematomas-AVM, anticoagulation..
      • Facet joint cysts
      • Demyelination, transverse myelitis
      • Abdominal, renal, vascular pathology
      • Paget’s disease
      • Psychological factors
    • “Red flags”
      • Cancer or infection
        • Age >50 or <20
        • Hx of cancer
        • Unexplained weight loss
        • Immunosuppression
        • Drug abuse
        • UTI-fever, chills
        • Pain not relieved by rest
    • “Red flags”
      • Fracture
        • Significant trauma
        • Prolonged use of steroids
        • Age >70
      • Cauda Equina Syndrome
        • Acute urinary incontinence, saddle anaesthesia
        • Faecal incontinence, decreased anal tone
        • Global / progressive weakness and numbness in legs (+ pain)