Definition of Spinal Cord Tumors

There are both primary and secondary spinal cord tumors; The primary tumors arise in the spinal cord and the secondary is metastasis spreading from a malignant tumor somewhere else in the body. The secondary spinal cord tumor is the most common. The primary spinal cord tumors are usually the same type as brain tumors and may also be both benign and malignant. The primary tumors may originate from all kinds of cells in the spinal cord (nerve cells, supporting cells, cells in the blood vessel wall) or from the brain membrane surrounding the spinal cavity

Spinal cord tumors give other symptoms than a brain tumor as it only affects the part of the nervous system where the tumor is located. The symptoms are therefore usually very localized for example sensory impairment or paralysis in one arm or a leg.

Symptoms of Spinal Cord Tumors

The symptoms can develop insidiously over months to years. The symptoms depend on where the tumor is located, and how fast it grows. There can be seen:

• Pain in the back or neck. Typical radiation pain in the arms, neck, back or leg pain and may worsen with physical activity.
• Sensory disturbances in the arms or legs which can be one-sided or two-sided.
• Force reduction in the arms or legs. Can be one-sided or two-sided and may be limited to individual muscles.
• Changed reflexes below the place where the tumor is located and cause compression.
• Growing problems controlling urination and bowel function.
• Brown-Séquards syndrome, where only one side of the spinal cord is affected. Right beside the place where the tumor causes compression all sensory ability is lost. Below the tumor location the posterior and vibration sensory ability is lost on the side where the tumor compresses the spinal cord with loss of pain and temperature sense on the opposite side.

In some cases there may suddenly during hours or days develop a so-called cross syndrome. This is very serious condition calling for very fast treatment to avoid heavy disability. Symptoms of cross syndrome are:

• Pain in the back.
• Walk impairment due to reduced force in the legs or problems with the control legs.
• Problems with urination and bowel function either in the form of incontinence or problems with the disposal of urine or stool.

Precautions and diagnosis

With any of these symptoms medical assistance should be sought and with rapidly developing symptoms that could indicate cross syndrome fast medical attention is very important. The patient will undergo a neurological examination and if spinal cord tumor is suspected the examination includes MRI imaging of the back and neck.

Treatment of spinal cord tumors

• The tumor is removed as completely as possible without removing any of the healthy nerve tissue in the spinal cord. In some cases the symptoms disappear completely after surgery but in others there will still be residual of symptoms, but usually the improvement is very clear. In cases where the tumor also involves the spinal bones it may be necessary to stabilize the spine and prevent it from collapse with the subsequent risk of injury to the spinal cord.
• Radiation therapy: Some spinal cord tumors can be treated with radiation therapy, if they cannot be removed by surgery.

Outlook and complications

The outlook depends on how severe the symptoms are at the moment the tumor is diagnosed, and what type of tumor it is. Most of the benign and some of the malignant tumors have a good prognosis with normal recovery and few residual symptoms. Some malignant (astrocytoma and ependymoma) have a worse outlook with severe symptoms.

If there has been cross syndrome in more than 6-12 hours the chance for successful surgery or radiation therapy to recover walk, bladder and bowel function is very small unfortunately. If the bladder function cannot be restored it might be necessary to empty with a catheter and there will be an increased risk of bladder inflammation and subsequent risk of damage to the kidneys.

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