Spinal Tumors

Spinal Tumors: Classification & Red Flags - Location & Alarms

• Classification (by Dural Relationship):
  • Extradural (ED): Most common (~55%). Outside dura. Often metastatic (lung, breast, prostate).
    • Vertebral bodies, epidural space.
  • Intradural-Extramedullary (IDEM): ~40%. Within dura, outside cord.
    • Meningiomas, nerve sheath tumors (schwannomas, neurofibromas).
  • Intramedullary (IM): Least common (~5%). Within spinal cord.
    • Ependymomas, astrocytomas.
• Red Flags (Alarm Symptoms):
  • Pain: Persistent, progressive, non-mechanical; worse at night/recumbency.
  • Neurological deficits: Weakness, sensory loss, gait issues, bowel/bladder dysfunction (⚠️ Cauda Equina Syndrome).
  • Systemic: Unexplained weight loss, fever.
  • History of malignancy.
  • Age: <20 or >50 years.
  • No improvement after 4-6 weeks conservative therapy.

⭐ Most spinal metastases occur in the thoracic spine. Common primary sources: Lung, Breast, Prostate (📌 Mnemonic: LBP - Lung, Breast, Prostate).

Spinal Tumors: Diagnosis & Key Players - Unmasking Culprits

• Diagnosis:
  • Clinical: Persistent, progressive back pain (esp. night, non-mechanical), radiculopathy, myelopathy (motor/sensory deficits, sphincter dysfunction).
  • Imaging:
    • MRI with Gadolinium: Gold standard for diagnosis & surgical planning. Defines tumor extent, cord compression, neural involvement.
    • CT Scan: Best for bony architecture, matrix calcification, useful for biopsy guidance.
    • X-ray: Initial screen; may show vertebral collapse, pedicle erosion, lytic/blastic lesions.
  • Biopsy: Histopathological confirmation (CT-guided or open) is essential for definitive diagnosis and guiding treatment.

Spinal Tumors: Management & Stability - Strategic Interventions

• Management Goals: Neural decompression, spinal stability, tumor control, pain relief.
• Treatment Pillars:
  • Surgery: Excision, decompression, fusion/instrumentation.
  • Radiotherapy (RT): EBRT, SRS; for radiosensitive tumors or as adjuvant.
  • Chemotherapy: Systemic (e.g., myeloma, lymphoma).
  • Steroids: Manage edema & acute neuro-deficits.
• Spinal Instability Neoplastic Score (SINS):
  • Guides surgical decision-making.
  • Score: Stable (0-6), Potentially Unstable (7-12), Unstable (13-18).
  • Assesses: Location, pain, lesion type, alignment, vertebral body collapse (>50%), posterior element involvement.

⭐ > Patients with a SINS score of ≥7 often benefit from surgical consultation regarding stabilization, regardless of oncologic prognosis.

High‑Yield Points - ⚡ Biggest Takeaways

• Metastatic tumors are the most common spinal tumors (e.g., from breast, lung, prostate).
• Persistent back pain, especially night pain or pain unrelieved by rest, is a key symptom.
• MRI with gadolinium is the imaging modality of choice for diagnosis and staging.
• Multiple myeloma is the most common primary malignant bone tumor affecting the spine.
• Osteoid osteoma: characteristic night pain relieved by NSAIDs; nidus visible on CT.
• Chordomas: locally aggressive malignant tumors, typically in the sacrum/clivus.
• Neurological deficits (e.g., weakness, sensory loss, bowel/bladder dysfunction) warrant urgent evaluation for cord compression.