Tumours of the Spine
description
Transcript of Tumours of the Spine
Tumours of the SpineTumours of the Spine
Brad HoffmannMBBCh FRCS(Eng) FRCS(SN)
FCS(SA) Neurosurg
Brad HoffmannMBBCh FRCS(Eng) FRCS(SN)
FCS(SA) Neurosurg
Spinal TumoursSpinal Tumours
15% of primary CNS tumours are in the spine
Most are benign Mostly present with compression rather than invasion
15% of primary CNS tumours are in the spine
Most are benign Mostly present with compression rather than invasion
Spinal tumours-typesSpinal tumours-types Extradural-55% (probably higher) Arise in bone or extradural tissues.
Intradural extramedullary-40%.
Intramedullary-5%. Affect white matter tracts and grey matter
Extradural-55% (probably higher) Arise in bone or extradural tissues.
Intradural extramedullary-40%.
Intramedullary-5%. Affect white matter tracts and grey matter
Differential diagnosisDifferential diagnosis
• ExtraduralMetastatic-lymphoma, lung, breast, prostate
Primary spinal tumours- chordomas, osteoid osteoma, osteoblastoma, aneurysmal bone cyst, vertebral haemangioma
Occasionally extradural- meningiomas, neurofibromas, chloromas, angiolipoma
• ExtraduralMetastatic-lymphoma, lung, breast, prostate
Primary spinal tumours- chordomas, osteoid osteoma, osteoblastoma, aneurysmal bone cyst, vertebral haemangioma
Occasionally extradural- meningiomas, neurofibromas, chloromas, angiolipoma
Differential diagnosisDifferential diagnosis Intradural extramedullary
MeningiomasNeurofibromasLipomas (also intramedullary)Metastatic (only 4%)
Intradural extramedullaryMeningiomasNeurofibromasLipomas (also intramedullary)Metastatic (only 4%)
Differential diagnosisDifferential diagnosis Intramedullary
Astrocytoma-30%Ependymoma-30%Miscellaneous
Malignant glioblastomaDermoidEpidermoidTeratomaLipomaHaemangioblastoma
IntramedullaryAstrocytoma-30%Ependymoma-30%Miscellaneous
Malignant glioblastomaDermoidEpidermoidTeratomaLipomaHaemangioblastoma
Intramedullary tumours-Presentation
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
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
Intramedullary tumours-TreatmentIntramedullary
tumours-Treatment
Surgery Radiotherapy (rare-glioma group)
Observation (“masterly inactivity”)
Surgery Radiotherapy (rare-glioma group)
Observation (“masterly inactivity”)
Intramedullary tumoursIntramedullary tumours
Intramedullary tumoursIntramedullary tumours
Intramedullary tumoursIntramedullary tumours
Spinal tumours-miscellaneous
Spinal tumours-miscellaneous
Spinal tumours-miscellaneous
Spinal tumours-miscellaneous
Spinal tumours-miscellaneous
Spinal tumours-miscellaneous
Spinal tumours-miscellaneous
Spinal tumours-miscellaneous
Spinal tumours-miscellaneous
Spinal tumours-miscellaneous
Spinal tumours-miscellaneous
Spinal tumours-miscellaneous
Thoracic meningiomaThoracic meningioma
Thoracic meningiomaThoracic meningioma
Spinal lipomaSpinal lipoma
Spinal lipomaSpinal lipoma
Intradural, extramedullary…Intradural,
extramedullary…
Spinal epidural metastases
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
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
Spinal metastasesSpinal 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
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
Spinal metastasesSpinal metastases
Most severe group- about 75% have abnormal Xrays:Pedicle erosionPedicle wideningCompression fractureScalloping of vertebral bodySclerosis, osteoblastic changes
Most severe group- about 75% have abnormal Xrays:Pedicle erosionPedicle wideningCompression fractureScalloping of vertebral bodySclerosis, osteoblastic changes
Spinal metastasesSpinal metastases
Further Ix:MRI +/- contrastRarely myelogramIsotope bone scan +ve in 66%Metastatic work-up
Further Ix:MRI +/- contrastRarely myelogramIsotope bone scan +ve in 66%Metastatic work-up
Spinal metastasesSpinal metastases
TreatmentIndividualisedUsually palliativeRadiotherapy most commonSurgeryDexamethasonePain control
TreatmentIndividualisedUsually palliativeRadiotherapy most commonSurgeryDexamethasonePain control
Other conditions to consider..
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
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
“Red flags”“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
Cancer or infection• Age >50 or <20• Hx of cancer• Unexplained weight loss• Immunosuppression• Drug abuse• UTI-fever, chills• Pain not relieved by rest
“Red flags”“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)
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)