SPINAL TUMOR

Spinal tumor is a growth of tissue that develops within the spinal canal or within the bones of spine.

Tumors or neoplasm or space occupying lesions are classified broadly into intramedullary and extramedullary tumors.

1. SPINAL TUMOR DR. DARSHAN PARMAR (MPT-NEURO) Govt. physiotherapy college, jamnagar GUIDED BY: DR. AKTA MA’AM

2. DEFINITION Spinal tumor is a growth of tissue that develops within the spinal canal or within the bones of spine. Tumors or neoplasm or space occupying lesions are classified broadly into intramedullary and extramedullary tumors.

3. Majority of intraspinal tumors are benign & produce effects by compression of spinal cord rather than by invasion. Thus, a proportion of intraspinal tumors are amenable to surgical removal Intramedullary tumors are those present within the substance of the spinal cord.

4. Extramedullary tumors are those present outside the substance of the spinal cord. They can be further divided into intradural and extradural. The intradural ones are meningioma, ones that arise from the nerve roots and the extradural ones arises from epidural substances and vertebral bodies.

5. CLASSIFICATION OF TUMORS EXTRADURAL INTRADURAL INTRAMEDULLARY IN INFANTS Neuroblastoma Meningioma Ependymoma Ganglioneuroma Neurofibroma Sarcoma Angioma IN ADULTS Ganglioneuroma Meningioma Glioma Sarcoma Neurofibroma Ependymoma Chondroma

6. INTRAMEDULLARY EXTRAMEDULLARY

7. SYMPTOMS Tumors of the spinal cord can give rise to any one of the following symptoms: • Sensorimotor spinal tract syndrome • Radicular spinal cord syndrome • Intramedullary syringomyelia syndrome

8. SENSORIMOTOR SPINAL TRACT SYNDROME Starts with Pain and tenderness at affected spinus process Sensory Signs and Symptoms : Spinal tracts affects first leading to impairment in sensation and dysesthesia If the Spinothalamic tract is totally compressed then their will be loss of pain and temperature sensation. Motor Signs and Symptoms : UMN type as their will be compression in corticospinal tract. Level of severity depends on amount of compression.

9. RADICULAR SPINAL CORD SYNDROME Starts with pain and usually it is radiating type from the affected spine  Intensified by coughing, sneezing, prolonged recumbency. Tingling, Numbness and Paraesthesia Areflexia and LMN type of muscular palsy Along with the Radiating signs and symptoms, a person may have others symptoms like spastic paraparesis, loss of pain and temperature sensation, loss of sensation by posterior column and even bladder-bowel disturbances.

10. INTRAMEDULLARY SYNRIGOMYELIA SYNDROME Signs and symptoms are similar to syringomyelia Pain  Anterior horn cell gets involved  Involvement of Corticospinal fibers and other sensory tracts. Tenderness on spine detects pain of spinal tumor (aggravated by coughing, sneezing) Associated symptoms are tingling, numbness, paraesthesia or loss of sensation on particular dermatome. Altered DTR

11. INVESTIGATION CT scan MRI Myelogram CSF examination

12. PROGNOSIS Recovery generally depends on how quickly treatment begins and how much damage was done. Removal of meningiomas, neurofibromas, and some other primary spinal cord tumors may be curative.

13. MANAGEMENT If symptoms suggest that tumor is compressing spinal cord, corticosteroids are immediately given in high doses to reduce swelling Surgical intervention  Prognosis is mostly good Extradural tumor can be excised Intramedullary tumor requires Decompression like laminectomy followed by radiation.

14. PHYSIOTHERAPY Functional Mobility Pain management Bracing Improve Strength and Flexibility Bowel/Bladder management

15. FUNCTIONAL MOBILITY Patient and caregiver education Positioning  for skin and joint integrity Bed mobility Functional Transfer (Bed to wheelchair, wheelchair to bed, wheelchair to toilet-seat, wheelchair to chair/stool etc..) Gait Training

16. PAIN MANAGEMENT Postural bracing Hot packs, Cold packs TENS

17. BRACING Indication : Postural correction Proprioceptive awareness Stabilization of fractures Cervical collars (Soft cervical collar, Hard cervical collar) TLSO AFO Abdominal binder Compression stockings

18. IMPROVE BALANCE Strengthen Lower limb and core muscle  Improve Sitting Balance  Improve sit to stand  Improve standing balance  Improve dynamic balance.

19. IMPROVE STRENGTH AND FLEXIBILITY Passive ROM  Active assisted ROM  Active ROM  Resisted Exercise (weight, TheraBand, TheraTubes etc..) Stretching of tight muscle to improve flexibility.

20. BOWEL/BLADDER MANAGEMENT Pelvic floor exercise Kegels exercise Pillow squeezing Bridging

21. THANK YOU…..