One in ten primary tumors of the central nervous system are intrathecal. Most of these primary spinal tumors are benign, which is not true of intracranial tumors.
Types of spinal and intrathecal tumors
There are three groups of spinal and intrathecal tumors, classified:
- Extradural: these account for more than half of all tumors. They originate in the vertebral bodies or in the epidural space, which means that they appear outside the spinal cord and in the dura (the covering). Most tumors located in this area are metastatic, meaning that their origin is in a primitive, malignant tumor elsewhere in the body. The most frequent are lymphoma, lung, breast and prostate. In these cases, the prognosis depends on being able to apply a resolutive treatment of the primitive process.
- Intradural – extramedullary: these are less than half, arising in the leptomeninx or nerve roots. Most are meningiomas and neurinomas, both of which are benign and can be cured if removed in their entirety.
- Intramedullary: these occur in less than one in ten cases and originate in the nerve tissue of the medulla itself. The most frequent are astrocytomas, which are usually located in the most eccentric part, and ependymomas, which occupy the most central location in the spinal cord tissue.
Symptoms of spine and spinal cord tumors
Patients showing this pathology may have different symptoms. The most common is pain, which may be local to the affected area or radiate elsewhere in the form of radiculopathy. Another symptom that may occur is loss of strength or sensibility in the trunk and extremities, as well as difficulties in urination or bowel movements due to damage to the bladder and rectal sphincter.
These symptoms can be so severe that they can end up condemning the patient to a wheelchair and total incontinence of feces and urine.
How to diagnose spine and spinal cord tumors
The most important test in the diagnosis of spinal and intrathecal processes is spinal MRI.
If it is an extradural tumor, an involvement of the vertebrae and/or the extradural space and the possible compression of the spinal cord will be seen. If it is an intradural-extramedural tumor, a homogeneous and regular mass will be seen that displaces the spinal cord within the dura mater or meningeal covering that surrounds it. If the tumor is intramedullary, what will be observed is an intrinsic lesion of the spinal cord, not as homogeneous or regular as those in the previous section.
Treatment for spine and spinal cord tumors
The most commonly used treatment in this field is surgery, which is considered urgent when there is a considerable loss of strength in the extremities, as well as alteration of the bladder or rectal sphincters.
In the intervention, the surgical microscope is used to have a good illumination and magnification of the field, which facilitates the maneuvers and allows to act with more precision. This avoids causing unnecessary damage to the bone or nerve structures. The ultrasonic aspirator is used to remove the tumor in many cases, since it allows it to be fragmented by ultrasound and aspirated without pulling on the nerve structures.
Radiotherapy and chemotherapy will be used in all those tumors that are sensitive to these treatment modalities, either as initial therapy, in case surgery has been discouraged, or as adjuvant therapies.
Prognosis in spine and spinal cord tumors
The prognosis in patients with spinal and intrathecal tumors, given the wide variety of processes that can be found in this field, will depend on the histological nature of these and the degree of resection achieved of the tumor process. Normally, well-localized benign tumors with total surgical excision have an excellent prognosis. Malignant tumors, which are diffuse and have partial surgical excision, will have a poor prognosis with short life expectancy and important and disabling sequelae.