Malignancy

          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

                    develops.

 

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
                 decompressive surgery.


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

                                             Tumor Markers



               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.

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Many illustrations in this Web Page were borrowed from open source Netter Anatomical Illustrations and the Sobotta Atlas of Human Anatomy.  However most of the original borrowed illustrations may not be recognized anymore.  Most of them were digitally modified and altered to serve the purposes of discussions and explanations contained within this web.



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