Spinal tumor

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Spinal tumor epidemiology.

Spinal tumor classification.

Spinal tumor clinical features

Diagnosing a spinal tumor involves a combination of medical history evaluation, physical examinations, and various diagnostic tests. Here are the steps typically involved in diagnosing a spinal tumor:

Medical History: Your doctor will begin by asking about your medical history, including any symptoms you've been experiencing, the duration of these symptoms, and any relevant medical conditions or family history of tumors.

Physical Examination: A thorough physical examination may be performed to assess neurological function, including reflexes, muscle strength, and sensory perception. Your doctor will also examine your spine for signs of deformity or tenderness.

Imaging Studies: Various imaging studies are crucial for identifying and evaluating spinal tumors:

a. X-rays: X-rays provide an initial view of the spine and can show any abnormalities in the bone structure, such as fractures or bone lesions. However, they may not provide detailed information about soft tissue or the tumor itself.

b. Magnetic Resonance Imaging (MRI): MRI is a highly valuable imaging tool for evaluating spinal tumors. It provides detailed images of the spinal cord, nerve roots, and surrounding soft tissues. An MRI can help determine the location, size, and characteristics of the tumor.

c. Computed Tomography (CT) Scan: CT scans are often used in conjunction with MRI to provide additional information about bone involvement and to create a more comprehensive picture of the tumor and surrounding structures.

d. Myelogram: This procedure involves injecting a contrast dye into the cerebrospinal fluid surrounding the spinal cord and nerve roots, followed by a series of X-rays or a CT scan. It can help identify spinal cord compression and locate tumors.

Biopsy: If the imaging studies suggest the presence of a tumor, a biopsy may be necessary to determine the type of tumor. This is typically done by a neurosurgeon or an interventional radiologist, who will take a small sample of tissue for laboratory analysis. The biopsy results can help guide treatment decisions.

Blood Tests: Blood tests may be conducted to check for specific markers associated with certain types of tumors or to assess general health before surgery or other treatments.

Neurological Testing: Further neurological tests, such as electromyography (EMG) and nerve conduction studies, may be performed to evaluate nerve function and the extent of neurological deficits.

Once the diagnosis is confirmed, the medical team will work with you to develop an appropriate treatment plan. The treatment approach depends on the type, location, and size of the spinal tumor, as well as the overall health and preferences of the patient. Treatment options may include surgery, radiation therapy, chemotherapy, or a combination of these modalities. Early diagnosis and prompt treatment are essential for the best possible outcomes in spinal tumor cases.

The recommendations were developed by members of the Development Recommendations Group representing seven stakeholder scientific societies and organizations of specialists involved in various forms of care for patients with spinal tumours in Poland. The recommendations are based on data yielded from systematic reviews of the literature identified through electronic database searches. The strength of the recommendations was graded according to the North American Spine Society's grades of recommendation for summaries or reviews of studies.

Results: The recommendation group developed 89 level A-C recommendations and a supplementary list of institutions able to manage primary malignant spinal tumours, namely, spinal sarcomas, at the expert level. This list, further called an appendix, helps clinicians who encounter spinal tumours refer patients with suspected spinal sarcoma or chordoma for pathological diagnosis, surgery and radiosurgery. The list constitutes a basis of the network of expertise for the management of primary malignant spinal tumours and should be understood as a communication network of specialists involved in the care of primary spinal malignancies.

Conclusion: The developed recommendations together with the national network of expertise should optimize the management of patients with spinal tumours, especially rare malignancies, and optimize their referral and allocation within the Polish national health service system ¹⁾.

see Spinal tumor treatment.

The patient is a 58-year-old male, who is a former smoker and has a history of extrinsic asthma. He presented with chronic low back pain and was diagnosed with an intradural lesion at the L3-L4 level. The patient did not exhibit any neurological focal deficits.

Diagnosis:

The diagnostic impression is an intradural lesion at the L3-L4 level. The leading differential diagnoses include a possible ependymoma, while metastasis is considered less likely. The surgical intervention has been recommended to obtain a pathological diagnosis, guide further treatment, and provide symptomatic relief.

Procedure:

The patient will be positioned in the prone decubitus on the surgical table. Radiological marking of the L3 and L4 levels will be performed to avoid confusion due to sacralization of L5. The surgical procedure will involve midline exposure and skeletonization of the spinous processes at the L3 and L4 levels. A laminectomy will be carried out using a piezoelectric tool, along with flavectomy, and exposure of the spinal canal. The dura will be opened along the midline, and cerebrospinal fluid (CSF) will be collected using a syringe for cytological analysis. Microsurgical resection of the intradural lesion, which appears to be related to the filum, will be performed. Primary dural closure will be accomplished, and the laminas will be repositioned using miniplates and screws. The closure will follow the standard technique.

Equipment Required:

For this surgical procedure, the following equipment will be necessary:

X-ray machine

Microscope

Piezoelectric motor

Requests for intraoperative pathology examination, definitive pathology, and CSF cytology will be prepared.

Expected Complications to Avoid:

The primary complications to be vigilant against include:

Incorrect level entry

Laminotomy extension

CSF leakage

Lumbosacral root injury

Hematoma in the surgical bed

Infection

Postoperative Follow-up:

As part of the postoperative care plan, a lumbar MRI will be requested to assess the surgical outcome and ensure the patient's recovery is progressing as expected.