spinal cord tumour.pptx

By Mr.Pradeepsingh Byali

1. Definition A  spinal tumor  is an abnormal mass of tissue within or surrounding the  spinal cord  and/or  spinal column . These cells grow and multiply uncontrollably, seemingly unchecked by the mechanisms that control normal cells. Spinal tumors can be  benign  (non-cancerous) or  malignant  (cancerous). Primary tumors originate in the spine or spinal cord, and  metastatic  or secondary tumors result from cancer spreading from another site to the spine.

2. Causes and Risk Factors The cause of the majority of spinal tumors is currently not known. Primary spinal tumors are associated with a few  genetic syndromes . The cause of the majority of spinal tumors is currently not known. Primary spinal tumors are associated with a few  genetic syndromes . [1] [5]   Neurofibromas  are associated with neurofibromatosis 1 (NF1). [1]   Meningiomas and  schwannomas  are associated with neurofibromatosis 2 (NF2). [1]   Intramedullary   hemangioblastomas  can be seen in patients with von Hippel-Lindau disease. [5]  Spinal cord  lymphomas  are commonly seen in patients with suppressed immune systems. [5]  The majority of extradural tumors are due to metastasis, most commonly from breast, prostate, lung, and kidney cancer.

3. Signs and Symptoms The symptoms of spinal tumors are often non-specific, resulting in a delay in diagnosis. Spinal nerve compression and weakening of the vertebral structure cause the symptoms . Pain is the most common symptom at presentation .  muscle weakness,  sensory loss , numbness in hands and legs, and rapid onset  paralysis .  Bowel  or  bladder incontinence   Back pain  is a primary symptom of spinal cord compression in patients with known malignancy.

4. D efinition Spinal disc herniation  is an injury to the cushioning and connective tissue between  vertebrae , usually caused by excessive strain or trauma to the spine. 

5. CAUSES Herniation of the contents of the disc into the spinal canal often occurs when the anterior side (stomach side) of the disc is compressed while sitting or bending forward, and the contents ( nucleus pulposus ) get pressed against the tightly stretched and thinned membrane ( anulus fibrosus ) on the posterior side (back side) of the disc.

6. The majority of spinal disc herniations occur in the  lumbar  spine (95% at L4–L5 or L5–S1). [13]  The second most common site is the  cervical  region (C5–C6, C6–C7). The  thoracic  region accounts for only 1–2% of cases. Herniations usually occur postero -laterally, at the points where the  anulus fibrosus  is relatively thin and is not reinforced by the posterior or anterior longitudinal ligament.

7. Signs and symptoms They can range from little or no pain, if the disc is the only tissue injured, to severe and unrelenting  neck pain  or  low back pain  that radiates into regions served by nerve roots which have been irritated or impinged by the herniated material. Often, herniated discs are not diagnosed immediately, as patients present with undefined pains in the thighs, knees, or feet.

8. Symptoms may include sensory changes such as numbness, tingling,  paresthesia , and motor changes such as muscular weakness, paralysis, and affection of  reflexes .

9. Diagnosis Physical examination. Diagnosis of spinal disc herniation is made by a practitioner on the basis of a patient's history and symptoms, and by  physical examination . During an evaluation, tests may be performed to confirm or rule out other possible causes with similar symptoms – spondylolisthesis , degeneration,  tumors ,  metastases  and space-occupying  lesions , for instance – as well as to evaluate the efficacy of potential treatment options.

10. Projectional radiography  (X-ray imaging). Traditional plain X-rays are limited in their ability to image soft tissues such as discs, muscles, and nerves, but they are still used to confirm or exclude other possibilities such as tumors , infections, fractures, etc. In spite of their limitations, X-rays play a relatively inexpensive role in confirming the suspicion of the presence of a herniated disc. If a suspicion is thus strengthened, other methods may be used to provide final confirmation.

11. Computed tomography  scan (CT or CAT scan) is a diagnostic image created after a computer reads X-rays. It can show the shape and size of the spinal canal, its contents, and the structures around it, including soft tissues. Still, visual confirmation of a disc herniation can be difficult with a CT. Magnetic resonance imaging  (MRI) without contrast is a diagnostic test that produces three-dimensional images of body structures using powerful magnets and computer technology. It can show the spinal cord, nerve roots, and surrounding areas, as well as enlargement, degeneration, and tumors . It shows soft tissues better than CAT scans. An MRI performed with a high magnetic field strength usually provides the most conclusive evidence for diagnosis of a disc herniation .  T2 -weighted images allow for clear visualization of protruded disc material in the spinal canal.

12. Electromyography  and  nerve conduction studies  (EMG/NCS) measure the electrical impulses along nerve roots, peripheral nerves, and muscle tissue. Tests can indicate if there is ongoing nerve damage, if the nerves are in a state of healing from a past injury, or if there is another site of nerve compression. EMG/NCS studies are typically used to pinpoint the sources of nerve dysfunction  distal  to the spine.

13. Treatment Initial treatment usually consists of  nonsteroidal anti-inflammatory drugs  (NSAIDs), but long-term use of NSAIDs for people with persistent back pain is complicated by their possible cardiovascular and gastrointestinal toxicity . Lumbar disc herniation: Non -surgical methods of treatment are usually attempted first. Pain medications may be prescribed to alleviate acute pain and allow the patient to begin exercising and stretching. There are a number of non-surgical methods used in attempts to relieve the condition. They are considered  indicated ,  contraindicated , relatively contraindicated, or inconclusive, depending on the safety profile of their  risk–benefit ratio  and on whether they may or may not help:

14. Education on proper body mechanics Physical therapy  to address mechanical factors, and may include modalities to temporarily relieve pain (i.e.  traction ,  electrical stimulation ,  massage ) Nonsteroidal anti-inflammatory drugs  (NSAIDs) Weight control Spinal manipulation

15. Surgery Surgery may be useful when a herniated disc is causing significant pain radiating into the leg, significant leg weakness, bladder problems, or loss of bowel control . Discectomy  (the partial removal of a disc that is causing leg pain) can provide pain relief sooner than non-surgical treatments. Small endoscopic discectomy  (called  nano -endoscopic discectomy ) is non-invasive and does not cause  failed back syndrome . Invasive  microdiscectomy  with a one-inch skin opening has not been shown to result in a significantly different outcome from larger-opening discectomy with respect to pain .  It might however have less risk of infection . Failed back syndrome  is a significant, potentially disabling, result that can arise following invasive spine surgery to treat disc herniation . Smaller spine procedures such as  endoscopic transforaminal lumbar discectomy  cannot cause failed back syndrome, because no bone is removed.