Tumor of the spinal cord: symptoms, diagnosis, treatment

The tumor of the spinal cord is a neoplasm located in the region of the spinal cord. The tumor can be benign and malignant. This insidious disease can be manifested by signs characteristic of other diseases or even remain invisible until the tumor grows to considerable size. Symptoms of a tumor of the spinal cord are very diverse, which is associated with the location of the tumor, the nature and rate of its growth, the peculiarities of the histological structure. The most informative method for diagnosing tumors of the spinal cord is magnetic resonance imaging (MRI) with contrast enhancement. The main method of treating tumors of the spinal cord is surgical removal, however, chemotherapy and radiotherapy can be used in the complex. In this article, the main information about the types, symptoms, methods of diagnosis and treatment of tumors of the spinal cord is collected.

According to statistics, tumors of the spinal cord constitute 10% of the total number of tumors of the central nervous system.

What are the tumors of the spinal cord?

There are several ways to classify tumors of the spinal cord. All of them are based on different principles and have their significance in terms of diagnosis and treatment.

First of all, all tumors of the spinal cord are divided into:

• primary: when the tumor cells in their origin are actually nerve cells or cells of the meninges;
• secondary: when the tumor is only located in the region of the spinal cord, and in itself is a metastatic process, that is, it is a "scion" of the tumor of another localization.

In relation to the spinal cord itself, tumors can be:

• intramedullary (intracerebral): account for 20% of all tumors of the spinal cord. Located directly in the thickness of the spinal cord, usually composed of cells of the spinal cord;
• extramedullary (extra-cerebral): they account for 80% of all tumors of the spinal cord. They arise from shells of nerves, from rootlets and a number of disposed tissues. And they are located directly near the spinal cord and can grow into it.

Extramedullary tumors, in turn, are divided into:

• subdural (intradural): located between the dura mater and the brain substance;
• epidural (extradural): located between the dura mater and the vertebral column;
• subepidural (intra-extradural): germinating in both directions with respect to the dura mater.

Concerning spinal (spinal canal) tumor can be:

• intravertebral: located inside the canal;
• extravertebral: grow outside the canal;
• Extraintravertebral (tumor by the type of hourglass): half of the tumor is located inside the canal, the other - outside.

The length of the spinal cord is distinguished:

• craniospinal tumors (spread from the cranial cavity to the spinal cord or in the opposite direction);
• cervical tumor;
• swelling of the thoracic region;
• tumors of the lumbosacral department;
• tumors of the medulla cone (lower sacral segments and coccygeal);
• tumors of the horse's tail (roots of the four lower lumbar, five sacral and coccygeal segments).

The histological structure is distinguished by: meningiomas, schwannomas, neurinomas, angiomas, hemangiomas, hemangiopericytes, ependymomas, sarcomas, oligodendrogliomas, medulloblastomas, astrocytomas, lipomas, cholesteatomas, dermoids, epidermoids, teratomas, chondromes, chordomas, metastatic tumor. The most common of these are meningiomas (arachnoidendoteliomas) and neurinomas. Metastatic tumors are the daughter most often in relation to tumors of the breast, lung, prostate, kidneys and bones.

Symptoms of a tumor of the spinal cord

A tumor of the spinal cord is an additional tissue that occurs in a place where there is already something: the nerve root, the membrane, the vessel, the nerve cells. Therefore, when there is a tumor of the spinal cord, the functions of those formations that are subjected to compression begin to suffer. This is what manifests itself in various symptoms.

Any tumor of the spinal cord is characterized by a progressive course. The rate of progression depends on several factors, including the location of the tumor, the direction of growth, the degree of malignancy. It can not be said that a single symptom testifies to the presence of a tumor of the spinal cord. All manifestations need to be evaluated in a comprehensive manner, only in this case it will be possible to avoid an incorrect diagnosis.

All signs of a tumor of the spinal cord are divided into several groups:

• radicular-shell symptoms (due to compression of the nerve roots and spinal cord envelopes);
• segmental disorders (the result of compression of individual segments of the spinal cord);
• conductor disorders (a consequence of compression of nerve wires that form the white matter of the spinal cord in the form of longitudinal cords).

Radicular-shell symptoms

These symptoms appear first in extramedullary tumors and last in intramedullary tumors.

Nerve roots are front and back. The front roots are considered motor, the back are sensory. Depending on which root is involved in the process, this is the symptomatology. And there are two phases of damage to the root:

• the phase of irritation (when the rootlet is not yet strongly compressed and its blood supply is not violated);
• the phase of loss (when the compression reaches a significant degree, and it can not perform its functions).

The phase of irritation of the sensitive root is characterized by pain, which can spread to the entire innervation zone of the root, that is, it is felt not only in the place of irritation, but also at a distance. With extramedullary tumors, the pain increases in the supine position, because the spine is even more affected by the tumor, and decreases in the standing position. Pain will not necessarily be permanent, its duration may range from a few minutes to several hours. Characteristic is the increased pain when the head is tilted forward, which is called the "bow" symptom. Also, the pain increases with pressure (tapping) on ​​the spinous process of the vertebra at the level of the location of the tumor.

Also, the phase of irritation of the sensitive root is accompanied by increased sensitivity in the zone of its innervation (for example, a simple touch feels like pain) and the appearance of paresthesias. Paresthesias are unpleasant involuntary sensations of tingling, numbness, crawling, chills, and the like.

The phase of prolapse for the sensitive spine is characterized by a decrease in sensitivity, and then its complete absence. For example, a person ceases to feel a touch to the skin, to catch the difference between a cold and hot object when applied to the skin.

The phase of irritation of the motor spine can be characterized by an increase in reflexes closing at the level of tumor localization. This can only be checked and evaluated by a doctor. The phase of loss, in turn, is manifested by a decrease, and then a loss of the corresponding reflexes.

In addition to the above described radicular symptoms, with tumors of the spinal cord, so-called shell symptoms can be noted. For example, a symptom of "liquor thrust". It consists in the following. When pressing on the jugular veins in the neck, for a few seconds, the root pain arises or intensifies. This is because the flow of blood from the brain worsens when the jugular veins are squeezed. As a result, intracranial pressure, i.e., pressure in the subarachnoid space, increases. The cerebrospinal fluid rushes down to the spinal cord (along the pressure gradient) and, as it were, "pushes" the tumor, which is accompanied by a tension of the nerve root and increased pain. By a similar mechanism, pain can be exacerbated by coughing and straining.

Segmental violations

Each segment of the spinal cord is responsible for a separate area of ​​the skin, part of the internal organs (or organ) and some muscles. The doctor knows exactly the relationship of individual segments with innervated structures.

If a tumor of the spinal cord affects (squeezes) some segments, then there are violations in the activity of internal organs, muscles, the sensitivity changes in certain areas of the skin. By registering changes in all these structures and comparing them, the doctor can determine the location of the tumor in the spinal cord.

In each segment of the spinal cord there are anterior and posterior horns, and in some - lateral. When the posterior horns are affected, sensitive disturbances of a different nature arise (for example, loss of pain sensitivity, sensation of touch, cold and heat in a separate part of the body). When the anterior horn is affected, reflexes are lost (reduced), involuntary muscular twitching (only in those groups muscles that are innervated by the affected segment), and with time, weight loss of such muscles occurs and a decrease in strength (paresis) and tone in them. This should be understood correctly: if a person falls all reflexes and there are muscle twitches in the whole body, then this is clearly not a symptom of the tumor of the spinal cord. But if these changes arise locally, and their segmentary innervation coincides, in this case it is worthwhile to think about a possible tumor process in the spinal cord.

When the lateral horns are compressed, vegetative disturbances occur. In this case, the food (trophic) of the tissues is disrupted, which is manifested by a change in skin temperature, color, sweating, or vice versa, by dry skin, peeling. Again, these changes occur only in the corresponding area of ​​the skin, for which the affected segment is responsible. In addition, in some lateral horns there are specific vegetative centers responsible for the work of individual organs (for example, the heart, the bladder). Their compression is manifested by specific symptoms. For example, the appearance of a tumor in the region of the 8th cervical segment and the 1st thoracic segment is accompanied by the development of the lower eyelid lowering, the narrowing of the pupil and the occlusion of the eye apple (Claude-Bernard-Horner syndrome), and formation in the region of the brain cone causes disorders of urination and defecation (urinary incontinence and chair).

Conducting violations

The compression of the spinal cord leads to the development of paresis.

Nerve wires that run along the entire spinal cord carry different information: both ascending and descending. Each of the conductors has a clear arrangement, for example, in the side cords (poles), downward conductors pass, carrying impulses from the brain to the muscles to reduce them. Depending on where the tumor of the spinal cord is located, there are certain symptoms.

With the development of tumors of the spinal cord, in connection with its structure, the following feature of the development of conductive sensory disorders is observed. For the extramedullary tumor is characterized by the so-called upward type of sensitivity disorders, that is, as the tumor grows, the boundary of the sensory disorders spreads upward. Initially, the breaches seize the legs, and then pass to the pelvis, chest, arms, and so on. With intramedullary tumors, there is a descending type of sensitivity disorder: the border extends from the top down. The first disorders in this case correspond to the segment in which the tumor is located, and then the lower parts of the trunk and extremities are trapped.

When the tumor is squeezed by the motor pathways carrying information for the muscles, paresis occurs with a simultaneous increase muscle tone and reflexes, as well as pathological stops (hand wrists) appear (a symptom of Babinsky and others).

As the tumor grows, the conductors carrying information to the centers of urination and defecation can be squeezed. In this case, at first, there are imperative desires to urinate (defecate). The word "imperative" means that they require immediate satisfaction, otherwise the patient may not retain urine (feces). Gradually such violations reach the degree of complete incontinence of urine and feces.

In general, the tumor of the spinal cord manifests itself by a combination of the above symptoms. After all, at the level where the tumor has arisen, both the segmental and the exploratory apparatus are simultaneously subjected to compression. Therefore, signs always combine violations of different systems. Diagnosis requires the doctor to maximize and accurately record all available symptoms.

As the tumor grows, it begins to squeeze half the spinal cord (across), and then a picture of total transverse compression appears. The compression of the half of the spinal cord is called the Brown-Sekar syndrome. With this syndrome on the side of the location of the tumor, there is a decrease in muscle strength in the limb (limbs), is lost joint-muscular feeling and vibration sensitivity, and on the opposite - the pain and temperature sensitivity. This is such a peculiar cross-over of symptoms, despite the one-sided localization of the tumor. Complete transverse compression is characterized by bilateral paresis (paralysis) of the lower or all four limbs with a simultaneous loss of all kinds of sensitivity in them, a violation of the function of the pelvic bodies.

Diagnostics

Tumors of the spinal cord are difficult to diagnose at an early stage of their development of diseases. This is due to the nonspecific symptoms that the tumor manifests itself at the beginning of its formation. Therefore, a variety of methods are used to diagnose tumors of the spinal cord, allowing a correct diagnosis. In addition to a thorough neurological examination, the most informative methods include:

• magnetic resonance imaging (MRI) and computed tomography (CT). More precise is the study with intravenous contrast. These methods allow you to accurately determine the location of the tumor, which is important for surgical treatment;
• radionuclide diagnostics. The method consists in the introduction into the body of radiopharmaceuticals, which accumulate in different ways in the tissues of the tumor and normal tissues.

In a number of cases, spinal puncture with liquorodynamic tests and examination of the obtained cerebrospinal fluid are performed. Likvorodinamicheskie samples allow to reveal infringements of patency of a subarachnoid space in the field of a spinal cord. There are several types. One of them is the compression of the cervical veins for several seconds with the fixation of the subsequent increase in pressure of the cerebrospinal fluid. When investigating the cerebrospinal fluid in a spinal cord tumor, an increase in the protein content is detected, with the lower the tumor, the higher the protein level. Sometimes it is even possible to detect tumor cells when examining the cerebrospinal fluid under a microscope.

Even in the diagnosis of tumors of the spinal cord can use spondylography (X-rays), myelography (the introduction of contrast media into the cerebrospinal fluid). However, in recent years, these methods have been used less and less frequently due to the emergence of more informative and less invasive methods (MRI and CT).

Treatment

The only effective method of treating the tumor of the spinal cord is its surgical removal. The most likely complete recovery in cases of early diagnosis, benign, small tumor sizes, with clearly delineated boundaries. Tumors of a malignant nature have a worse prognosis.

If the tumor is large and extends over a considerable distance along the spinal cord, then completely removing it is almost impossible. In such cases, try to excise as much as possible tumor tissue, while minimally affect the brain itself and the spine.

Surgical treatment is not justified in cases of multiple metastatic tumors.

To ensure access to the spinal cord, it is often necessary to remove the spinous processes and arches of the vertebrae (if the operation requires rear access). This is called a laminectomy. If it is necessary to remove more than 2-3 arcs of vertebrae, then at the end of the operation, the spinal column is stabilized with the help of metal plates to preserve its supporting function. That is why MRI or CT is so valuable that it is possible to accurately determine the location of the tumor, and therefore to plan access to it with minimal consequences for the patient.

To approach the tumors located on the front surface of the spinal cord, use front access, from the side of the thoracic or abdominal cavity. In some cases of tumors, the hourglass type requires combining the anterior and posterior approaches for radical tumor removal.

In malignant tumors, in addition to surgical treatment, the patient undergoes radiation therapy (including stereotactic radiotherapy) and chemotherapy. In this case, the treatment is carried out jointly by neurosurgeons with oncologists.

In the postoperative period, patients need medical treatment, which helps restore blood supply in the spinal cord. Also curative exercise and massage of the extremities are shown. A special role is played by careful care and prevention of pressure sores.

The problem of tumors of the spinal cord, in view of the worldwide trend of growth of neoplasms in general, is very urgent. This perfidious disease can for a long time remain unrecognized and do not give bright clinical manifestations. And when symptoms appear that cause the patient to seek medical help, the tumor is already reaching a considerable size, which complicates the treatment process. Be attentive to your health and even with minor changes consult your doctor!