Tumores de columna y de médula espinal

One in ten primary tumors of the Central Nervous System are intraspinal. Most of these primary spinal tumors are benign, something that is not true among intracranial tumors.

Types of spinal and intrarachidian tumors

There are three groups of spinal and intrarachidian tumors, classified:

• Extradurals : these are more than half of the tumors. They originate in the vertebral bodies or in the epidural space, which means that they appear outside the cord and in the dura mater (the cover). Most of the tumors located in this area are metastatic, so their origin is found in a primitive and malignant tumor from another part of the body.. The most frequent are lymphoma, lung, breast and prostate. In these cases, the prognosis depends on the application of a resolutive treatment of the primitive process.
• Intradural - extramedullary: these are less than half, which are generated in the leptomeninge or nerve roots. In large part are meningiomas and neurinomas, both benign and can be cured if they are removed in their entirety.
• Intramedullary : these occur in less than one in ten cases and have their origin in the nerve tissue of the marrow itself. The most frequent are astrocytomas, which are usually located in the most eccentric part and the ependymomas, which occupy the most central place in the medullary tissue.

Symptoms of spinal and spinal cord tumors

Patients who show this pathology may have different symptoms. How most often pain occurs, which may be local in the affected area or irradiated elsewhere in the form of radiculopathy. Another symptom that can occur is the loss of strength or sensitivity in the trunk and extremities, as well as difficulties in urination or deposition due to damage to the bladder and rectal sphincter.

These symptoms can be so severe that they can end up condemning the patient to a wheelchair and with total incontinence of feces and urine.

How to diagnose spinal and spinal cord tumors

The most important test in the diagnosis of spinal and intrarachidian processes is the magnetic resonance of the spine.

If it is an extradural tumor, you will see a condition in the vertebrae and / or extradural space and possible understanding of the marrow.. If it is an intradural-extramedural tumor, a homogenous and regular mass will be seen that displaces the spinal cord inside the dura or meningeal covering.. If the tumor is intramedullary, what will be observed is an intrinsic lesion of the medulla, not as homogeneous or regular as those in the previous section.

Treatment for spinal and spinal cord tumors

The most used treatment in this field is surgery, which is considered urgent when there is a considerable loss of strength in the extremities, as well as alteration of the bladder or rectal sphincters.

In the intervention the surgical microscope is used to have a good illumination and enlargement of the field, which facilitates the maneuvers and allows to act with more precision. This prevents unnecessary damage to the bone or nerve structures. The ultrasonic aspirator is used to remove the tumor in many cases, since it allows fragmenting it by ultrasound and aspirating it without tugging on the nerve structures.

Radiotherapy and chemotherapy will be used in all those tumors that are sensitive to these treatment modalities, either as initial therapy, in the event that the surgery has been dismissed, or as complementary therapies.

Prognosis in spinal and spinal cord tumors

The prognosis in patients with spinal and intrarachidian tumors, given the wide variety of processes that can be found in this field, will depend on the histological nature of these and the degree of resection reached of the tumoral process.. Normally, well-localized benign tumors with total surgical excision have an excellent prognosis. Malignant tumors, which are diffuse and have partial surgical removal, will have a poor prognosis with short life expectancy and important and disabling sequelae.