Eunsang Kim, professor of neurosurgery at Guro Hospital of Korea University
It occurs in 2-4 people per 100,000 inhabitants… Risk of serious complications
It is easy to misunderstand as the symptoms are similar to spinal diseases such as herniated discs.
There is no prevention, the best solution is early diagnosis… High cure rate and low relapse rate
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The spinal cord is a central nerve located within the spinal canal of our body. It is connected to the brain and consists of nerve cells and nerve fibers responsible for sensory, motor and autonomic functions. In general, spinal cord tumor is a term that refers to a tumor that occurs within the parenchyma of the spinal cord. In general, tumors that occur in the spinal cord as well as in the spinal dura, spinal nerve roots, and cauda equina, a bundle of nerve roots at the end of the spinal cord, that are present in the spinal canal and pressurize or invade the nervous tissue are collectively called spinal tumors.
Spinal cord tumors account for approximately 10-15% of all central nervous system tumors, including the brain. Based on primary spinal cord tumors, the incidence is approximately 2 to 4 cases per 100,000 people per year. Depending on the site where it occurs, it is divided into intramedullary tumors, which occur inside the spinal cord, and extramedullary tumors, which occur outside the spinal cord. Based on age, the frequency of onset is high in people between 40 and 60 years old. The most common types of spinal cord tumors are schwannomas and meningiomas. Most of them are benign and can be operated on, so if they are removed early, they can be completely cured without nerve damage.
The exact cause of spinal cord tumors is not yet known. It is known that it can be caused by environmental factors such as exposure to chemicals and there are also cases where cancer spreads to the spinal cord from other parts of the body. Genes are also thought to have an effect on the development of spinal tumors. If you have an inherited disease such as neurofibromatosis type 2 or von Hippel-Lindau disease, the incidence rate may increase, so patients with this diagnosis and their families should exercise caution.
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Following spinal magnetic resonance imaging (MRI) on a 50-year-old patient with spinal tumor, a 1.6×1.8 cm extramedullary intradural tumor was observed within the spinal canal in the first lumbar region in the lateral location (left) and transverse. – sectional photographs (centre). If you look at the side photo (right) after surgery, you can see that the tumor has been completely removed from the spinal canal. Photo courtesy of Korea University Guro Hospital
Spinal cord tumors cause various symptoms depending on where they occur. Intradural extramedullary tumors, a type of extramedullary tumor, often cause back pain when the spinal cord and nerve roots are compressed or blood vessels are blocked. The characteristic is that the pain radiates not only to the lower back but also to other parts of the body. Pain, paresthesia or decreased sensation, muscle weakness, and muscle atrophy appear initially, and as the spinal cord is gradually compressed, spastic paralysis, decreased sensation under the lesion area, and hyperreflexia appear. If the pressure becomes severe and the spinal cord is damaged, paralysis of the lower extremities or even limbs may occur. Intramedullary tumors rarely cause pain, but instead cause loss of pain and temperature sensation, dissociative paresthesias in which touch remains normal, and severe defecation disorders. Compared with extramedullary tumors, stiffness is rare, but muscle atrophy is common. If the supracervical region is involved, spastic quadriparesis and sensory alterations may also occur.
Patients with spinal cord tumors often complain of neck and back pain, local pain radiating to the nerve roots that extends to the arms and legs, and paralysis, similar to common spinal diseases such as herniated discs and spinal stenosis. However, the difference is that pain in general spinal diseases worsens when moving the neck or back, while pain in spinal cord tumors appears regardless of body movement and can even worsen during night rest.
If back pain lasts more than 6 weeks or gets worse, if the pain appears regardless of activity or gets worse at night, or if a cancer patient has unprecedented back pain, it is necessary to check whether the cause of the symptoms is a spinal tumor. In particular, if sensation or strength in your arms and legs gradually weakens, or if bowel or bladder function is disrupted due to changes in bowel or bladder function, this is a sign that you need go to hospital as soon as possible.
Treatment for spinal cord tumors is similar to that of other tumors, including surgery, radiation therapy, and drug therapy. Surgical removal is considered a priority for primary spinal cord tumors, but if the tumor is removed unsafely or if it compresses the spinal cord after surgery, radiation therapy is performed. If the operation is performed early, not only do the symptoms of compression of the spinal cord or nerve roots disappear without consequences, but complete functional recovery is also possible. If steroids are used before and after surgery to reduce swelling in the area of spinal cord compression, you can expect improvement in neurological symptoms. If symptoms are mild before surgery or have only occurred recently, recovery is quick.
Meningiomas, schwannomas, etc. they are types with a good prognosis. On the other hand, if the symptoms occur a long time ago and the compression of the spinal cord is severe or necrosis of the spinal cord occurs due to blockage of blood supply, the prognosis after surgery is unfavorable. If adequate treatment is not given in time, it can result in loss of movement or sensation and can cause changes in bowel and bladder function, as well as permanent paralysis, functional disability and death, therefore early treatment is recommended.
Because the cause of most primary spinal tumors is unknown, prevention itself is difficult. When you have suspicious symptoms, it is best to visit a hospital to determine the exact cause. Spinal cord tumors have a high cure rate and a low recurrence rate if discovered and treated early. If your back pain persists for more than 6 weeks and you feel numbness, tingling or muscle weakness anywhere in your body, we recommend that you go to the hospital immediately.
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Eunsang Kim, professor of neurosurgery at Guro Hospital of Korea University. Photo courtesy of Korea University Guro Hospital
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