Benign or malignant lesions originating from the primary spine itself, its surrounding muscle tissues, ligaments, nerve cells and membranes in the spinal cord are called spinal cord tumors.
General characteristics and incidence of the disease
Spinal tumors (OT) constitute approximately 10-25% of central nervous system tumors. Its incidence in the community is 100000/2-10. The incidence of both spine and spinal cord tumors varies according to the type and location of the tumor. For example, 95% of metastatic tumors that spread from another organ of the body to the spine are located outside the spinal cord (extadural), while 4% are located inside the spinal cord (intradural). These metastatic tumors may very rarely be located intramedullary in the spinal cord. Although not a general rule, tumors originating from the spinal cord and its membranes or the nerve itself are benign tumors.
Classification of spinal and spinal cord tumors
1 – INTRADURAL LOCATIONS
A: Intradural-extramedullary
B: Intradural-extramedullary
2 – EXTRADURAL RESIDENTS
A: Primary spinal tumors
B: Secondary (metastatic) spinal tumors
Complaints and findings of spinal and spinal cord tumors
Whether a spinal tumor is inside the spine or outside, they apply to the doctor with the complaint of pain in the form of low back, back and neck pain, according to the location of the tumor. Pain initially increases with coughing, straining and sneezing, which are maneuvers that increase intracranial pressure, and is relieved by rest. As the disease progresses, the pain is not relieved even with rest. Pain in metastatic spinal tumors usually occurs initially at rest, but becomes continuous as the disease progresses. While the pain initially resolves with medical painkillers, it then becomes persistent and resistant to medical drugs, preventing the person’s activity. The physician who first sees the patient in this period perceives this pain complaint as benign degenerative (lumbar, neck hernia) diseases and plans treatment. Secondly, according to the size and location of the tumor, sensory (paresthesia), motor (weakness), sphincter (urine, bladder) and autonomic complaints begin to appear. Here, complaints of semi-incision or complete incision of the spinal cord arise.
Intradural-extramedullary tumors
These tumors constitute 40% of all spinal tumors. 90% of these tumors are benign and 10% are malignant or metastatic tumors. 70% of intradural tumors are benign tumors such as meningioma or schwannoma.
Meningiomas
Spinal meningiomas are usually benign. They arise from spinal cord membranes, like meningiomas in the brain. They constitute 25-48% of all spinal intradural tumors. They are most common between the ages of 50 and 60. They are more common in women and are seen at a rate of 4-5/1. They are most commonly located in the thoracic 67-84%, 14-27% cervical (neck), 2-14% lumbar (waist) region. While they are usually located intradurally, they can be 3-9% extradural, 5-14% intradural and extradural. Pain is the most common complaint, followed by sensory, motor and sphincter complaints. Diagnosis of these tumors is very easy and Magnetic resonance (MR) is one of today’s advanced diagnostic methods. First of all, let the physician performing the examination think of a pre-diagnosis of a spinal cord or spinal tumor. The treatment of these tumors is quite easy, satisfactory and successful. The aim of surgical treatment is to completely remove the tumor from its origin. There are very rare types of malignant meningiomas. There is a risk of recurrence in these, and radiotherapy is added to them. Complications of spinal meningioma surgery are quite low compared to the surgeon’s experience.
Schwannoma/ Neurofibroma
They are nerve sheath tumors and they are rare tumors such as 100 000/ 0.3-0.5 in the general population. It is common between the ages of 30-50. The male to female ratio is the same. It chooses the cervical and lumbar regions, with the thoracic region being the most common. These tumors, like meningiomas, grow slowly, initially followed by pain, motor weakness and sensation, sphincter, complaints. The diagnosis of these tumors is made very easily and quickly by MRI, just like meningiomas. The treatment is surgical removal. The most important issue in the surgery is to correctly recognize the nerve root from which it originates and to remove the entire tumor with this root. Relapses are usually inevitable as a result of partial removals. Surgical success is closely related to the experience of the surgeon. The result is usually excellent.
Intradural- Intramedullary Tumors
In this group, 45% of spinal tumors are astrocytomas and 35% are ependymomas. Those in this location constitute 20-30% of all spinal tumors and 40-50% in children. These include other hemangioblastomas and residual tumors (dermoid, epidermoids, teratomas, lipomas), as well as neuronal tumors (oligodendroglioma, ganglogliomas) in this location. In these localized tumors, the initial complaint is pain, followed by motor, sensory, and sphincter complaints.
Ependymomas
It is the most common intramedullary tumor in adults and the second most common spinal tumor in children. It is common in 30-40 years of age. The male/female ratio is 2/1. Choosing the lumbosacral region most frequently, it is followed by the cervical and thoracic regions. The initial complaint is pain, followed by sensory, sphincter and motor findings. These patients usually come to the clinic in advanced stages. The reason for this is that the patient cannot define his/her complaints well, a good spinal cord examination cannot be performed, and most importantly, the appropriate examination is not performed. Despite all this, the diagnosis of these tumors is quite easy with today’s advanced MRI examination. Since spinal ependymomas have a pseudo-capsule, total removal is possible. Although there is no recurrence in those who have undergone total resection, there is a risk of recurrence in those who have partial resection. Ependymomas are sensitive to radiation therapy. Chemotherapy is used in some cases, although it is controversial.
Metastatic Spinal Tumors
The spine is the most common site of metastasis. Primary cancers such as lung, breast, prostate, kidney, thyroid, gastrointestinal region and lymphoma spread to the spine. 60% of metastatic tumors are seen in men and 40% in women. It is most common between the ages of 40 and 60. Metastases are most common in the lumbar region, followed by the thoracic and cervical regions. While 95% of spinal metastases are located extradurally, 4% are intradural-extramedullary and 1% are intramedullary. Patients’ complaints are usually short-lived, and the most common complaint is pain. The nature of this pain is that it is at rest, which distinguishes it from other spinal tumors. Tables such as half-cord cut or full cord cut follow the pain complaint very closely. First of all, the treatment is closely related to the life span of the primary tumor. The type and number of primary tumor involvement in the spine is decided according to the condition of other body organs. Bone scintigraphy and PET-CT lesion width should be considered in the treatment. Surgery, radiotherapy, and chemotherapy options are used alone or in combination in the treatment. Tumor decompression alone may not be sufficient in patients undergoing surgery and stabilization of the spine should be planned in the same session.