The spine can develop neoplasm or cancerous growths. The most common malignancy of the spine are metastatic tumors. Because of the rich vascular supply of the spine it is one of the organs of the body that easily develops metastasis in the similar manner as the lungs and the liver. Malignancy arising from the spine is itself is categorized as primary spine tumors. Tumors of the spine can cause compression of the neural elements or destroy the integrity of its architecture.
The common denominator in spine malignancy is inflammation in and around the spine brought about by a growing mass. This leads to the following signs and symptoms.
Pain - is usually very severe and localized
to the involved level. Pain is usually
exaggerated. Patient would wake up
in the middle of their sleep because
of pain. Pain becomes progressively
intense in the evolution of the pathology.
Weakness - subtle signs of weakness due to
compression of the spinal cord and
nerve roots herald a progressively
increasing space occupying lesion.
This usually signifies a breach in the
integrity of the architecture of the
spine. Weakness in spine malignancy
heralds paralysis. Immediate treatment
should be instituted once weakness
Cauda Equina Syndrome - is a "surgical emergency."
Patients would usually experience severe leg
pains with sudden weakness of both lowers.
There would be an associated urinary or bowel
incontinence. This signifies severe cord
compression that necessitates immediate
Paralysis - is caused by an extension of tumor
mass into the spinal canal causing
cord compression. This condition is
usually irreversible in nature if not
immediately subjected to decompression
procedures. Paralysis invariably happens
early or late in the disease process. Once
patients develop weakness treatment
should be instituted immediately.
Deformity - seldom happens in malignancy.
Patient usually does not live long to
experience deformity once they are
paralyzed. For those who live long
enough after being treated adequately
their spine tumor, deformity is a
consequence of damage to the anatomy
of the spine or weakness brought about
by radiation to the spine.
When considering neoplasms of the spine basic serological exams are needed. Spine infection can usually mimic neoplastic disorders of the spine. Imaging exams may also help in the diagnoses and the demarcation of the geographic extent of the neoplasm. Your spine specialists would normally order one or combination of all these labs to fully evaluate your spine and offer the best management.
Blood exam - Complete Blood Count
Erythrocyte Sedimentation Rate
C- Reactive Proteins
Imaging - X-Rays
- CT Scans
- MRI with contrast medium
This demonstrates how a metastatic tumor can invade the cervical spine. The resulting tumor growth can compromise the spinal canal causing compression of the cord. This can lead to initial symptoms of weakness that quickly progresses to paralysis
This MRI show a tumor completely compressing the spinal canal of the thoracic spine. One would notice the complete obliteration of the image of the spinal cord. This has already resulted in complete paralysis of the patient. Immediate attention should be sought when malignancy of the spine is a consideration.
Copyright UPMC Spine Specialists (2012) Manila, Philippines
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