Spinal tumours result from an unrestricted multiplication of abnormal cells within the spine.
These tumours can arise from the spine, the spinal cord or the spinal nerve itself. But the more common variety is one which spreads to the spine from remote location.
Spinal tumours can affect any segment of the spinal column. However, metastatic tumours are mostly commonly seen in the thoracic spine.
Spinal tumours are divided into a few anatomical subtypes depending on the location of the tumour.
These tumours exist within the substance of the spinal cord. These tumours are rare and can be challenging to operate on due to their location. The common subtypes of these tumours are astrocytomas and ependymomas. Both of which originate from cells within the spinal cord.
At times, tumours from other locations can spread to this location in the spinal cord. When this happens they are called metastatic intramedullary tumours.
Depending on the location, size and other factors assessed on the contrast enhanced MRI scans, the strategy of treatment may range from a biopsy to complete tumour excision.
These tumours exist outside of the spinal cord itself but within the coverings of the spinal canal. Depending on the location in the spine, these tumours may affect only the spinal nerves or they can cause pressure on to the spinal cord.
The majority of these types of tumours are benign. Yet they can cause symptoms of pain and nerve damage due to the location and when they grow in size.
Some very small tumours may be picked up incidentally and can be managed by monitoring them on sequential scans. Larger tumours causing symptoms are treated with microsurgical techniques.
These lesions are located outside the spinal canal sac. They include:
Lesions in this location can cause symptoms due to compressing the nerves or the spinal cord encased in the spinal fluid sac. Compared to intradural tumours, most of these lesions can be treated quite effectively .
In case of primary spinal tumours, the treatment is surgical. It involves removing the tumour. In some cases, the treatment may be to monitor the tumour to look for any change in size or character over time. In very small schwannomas or neurofibromas it is sometimes reasonable to perform a series of scans over time. Intervention with surgical treatment occurs only if there is a progression.
Surgical treatment is customised to the patient taking in to account the location, size, symptoms and radiological features of the tumour. The final surgical strategy may range from conducting a biopsy and then offering chemo or radiotherapy based on the pathology report or complete surgical removal.
Surgery for these types of tumours need expert microsurgical techniques. This achieves maximal benefit whilst minimising the possibility of complications.
All these tumours need careful long term follow up to monitor for any progression or recurrence of tumour. This includes periodic clinical evaluation and ongoing scans for many years.
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