Tumours of the Spine

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Tumours of the Spine

  1. 1. Tumours of the Spine Brad Hoffmann MBBCh FRCS(Eng) FRCS(SN) FCS(SA) Neurosurg
  2. 2. Spinal Tumours  15% of primary CNS tumours are in the spine  Most are benign  Mostly present with compression rather than invasion
  3. 3. 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
  4. 4. 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
  5. 5. Differential diagnosis  Intradural extramedullary Meningiomas Neurofibromas Lipomas (also intramedullary) Metastatic (only 4%)
  6. 6. Differential diagnosis  Intramedullary Astrocytoma-30% Ependymoma-30% Miscellaneous Malignant glioblastoma Dermoid Epidermoid Teratoma Lipoma Haemangioblastoma
  7. 7. 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
  8. 8. Intramedullary tumours- Treatment  Surgery  Radiotherapy (rare-glioma group)  Observation (“masterly inactivity”)
  9. 9. Intramedullary tumours
  10. 10. Intramedullary tumours
  11. 11. Intramedullary tumours
  12. 12. Spinal tumours-miscellaneous
  13. 13. Spinal tumours-miscellaneous
  14. 14. Spinal tumours-miscellaneous
  15. 15. Spinal tumours-miscellaneous
  16. 16. Spinal tumours-miscellaneous
  17. 17. Spinal tumours-miscellaneous
  18. 18. Thoracic meningioma
  19. 19. Thoracic meningioma
  20. 20. Spinal lipoma
  21. 21. Spinal lipoma
  22. 22. Intradural, extramedullary…
  23. 23. 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
  24. 24. 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
  25. 25. Spinal metastases  Most severe group- about 75% have abnormal Xrays: Pedicle erosion Pedicle widening Compression fracture Scalloping of vertebral body Sclerosis, osteoblastic changes
  26. 26. Spinal metastases  Further Ix: MRI +/- contrast Rarely myelogram Isotope bone scan +ve in 66% Metastatic work-up
  27. 27. Spinal metastases  Treatment Individualised Usually palliative Radiotherapy most common Surgery Dexamethasone Pain control
  28. 28. 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
  29. 29. “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
  30. 30. “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)

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