spinal cord tumor
Introduction
Introduction to spinal cord tumor A spinal cord tumor is a new mass that grows in the spinal cord and can be benign or malignant. Spinal cord tumors can be either primary or secondary, with a lower incidence than intracranial tumors, and are rare in children. Spinal cord tumors are one of the important causes of spinal cord and cauda equina compression, and must be differentiated from those caused by degenerative spinal diseases. The term spinal cord tumor is broadly defined and includes tumors that occur in the spinal canal and adjacent tissue structures of the spinal cord. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: spinal cord compression syringomyelia
Cause
Spinal tumor cause
Spread of infection (60%)
The anatomical upper subarachnoid space of the spinal cord communicates with the lymphatic vessels of the mediastinum, abdominal cavity, and retroperitoneal space through the spinal nerves, so the infection can enter the spinal cord via the lymphatic vessels, with or without meningitis. Half of the patients were from lumbosacral infections and tail sinus infections. About 50% of the total reported cases can enter the spinal cord via arteries or veins. Clinically, it is common in the lungs, heart, genitourinary system, and skin purulent infections. Abscess can occur in any spinal segment, but it is more common in the dorsal aspect of the thoracic spinal cord.
Hidden infection (30%)
The source of the infection is unknown. The pathogenesis of spinal cord abscess is that the pathological changes of intraspinal abscess vary with the size of the abscess and the length of the disease. Small abscesses often occur frequently and can be seen with the aid of a microscope. Most are single-shot, involving several spinal segments, occasionally affecting most of the spinal cord.
Post-traumatic infection (30%)
More common open spinal cord trauma, waist wear and so on.
Prevention
Spinal cord tumor prevention
Pay attention to rest, work and rest, prevent infection, once the disease occurs, timely treatment, early detection, early diagnosis, early treatment is the key to prevention.
Complication
Spinal cord tumor complications Complications spinal cord compression syringomyelia
Complications of spinal cord tumors include spinal cord compression, syringomyelia, and tuberculosis.
Symptom
Symptoms of spinal cord tumors Common symptoms Spinal and limb malformations Spinal cord lesions Segmental dissociative sensory dysfunction Muscle tremor Upper cervical medullary lesions Spinal cord hemisection syndrome Spinal process Ankle pain Inability to locate neurological signs Separation
Symptoms and signs of spinal cord tumors
Patients with the following clinical manifestations should consider the possibility of intracranial tumors and perform further imaging studies:
1. The sensation of numbness and pain and the loss of consciousness or the disappearance of the sense of touch, and the sensory disorder gradually develops from the top to the bottom.
2. The pain symptoms appear later and range.
3. May be associated with lower motor neuron symptoms, spinal cord hemisection syndrome is rare or not obvious.
4. The occurrence of spinal canal obstruction is late or inconspicuous, the protein content of cerebrospinal fluid is not obvious, and the symptoms are not obvious after the cerebrospinal fluid is released.
5. Spinal processes are rare, and bone changes in the spine are rare.
Examine
Spinal cord tumor examination
First, X-ray examination: X-ray plain film examination of some spinal cord tumors can be seen as follows.
1. Vertebral bone destruction, the cone part or pedicle root shows a change in light transmission, and the vertebrae collapse.
2. The contour and distance of the pedicle are changed, the intervertebral foramen is enlarged, and the limitation of the spinal canal is expanded.
3. Paravertebral tissue deformation, the mass originates from paravertebral tissue, or extends through the intervertebral foramen.
4. The phenomenon of bone proliferation can be seen in sarcoma, bone hemangioma and meningioma.
Second, myelography: used to locate the spinal cord or cauda equina compression level, contrast agent obstruction is completely or nearly complete, extramedullary epidural tumor often has a cup mouth obstruction end, intramedullary tumor can show the contour of spinal cord enlargement, The contrast column is squeezed to one side.
Third, CT and CTM: It is required that the neurological examination can correctly provide the lesions of the CT examination. The intraspinal and extraspinal tumors can be accurately displayed, and the destruction of the vertebrae is easy to be clear.
MRI: Most T1-weighted image signals of spinal cord tumors including metastases are reduced or unchanged. The T2-weighted image showed a signal enhancement, but in the osteoblastoma, the partial anterior pancreatic cancer bone metastasis signal was reduced.
Spinal angiography, CT, CTM, especially MRI is an important means to clearly diagnose intramedullary tumors. It can accurately determine the location, size, nature of the tumor and its relationship with adjacent tissues, and provide a basis for treatment, although the vertebra Tube angiography can show that the spinal cord is swollen in the segment where the tumor is located. However, because the intramedullary tumor has a late appearance of the spinal canal obstruction compared with the extramedullary tumor, it is difficult to find early lesions. CTM can accurately display the location of the tumor and its nature, especially the delay. The scan clearly shows the cystic part of the upper and lower ends of the tumor.
MRI examination is very important. It is the most advanced examination method for the diagnosis of intraspinal tumors. MRI of ependymoma often consists of two parts: parenchymal and cystic. The former is the survival part of the tumor, and it is also an important part of surgical resection. T1 weighted image The signal is lower than the adjacent normal spinal cord signal, and the T2-weighted image signal is higher. Because the peripheral edema of the spinal cord is also high in the T2-weighted image, the abnormal signal area of T2 is larger than the actual size of the tumor. Membrane is a vascular-rich tumor, and its substantial part can undergo significant abnormal contrast enhancement. Therefore, preoperative Gd-DTDA enhanced scanning is very important. The cystic part is caused by necrosis and liquefaction, secondary syringomyelia formation and necrosis. The T1 and T2 weighted image signal intensity of the liquefaction part is between the parenchymal part of the tumor and the cerebrospinal fluid. The secondary syringomyelia signal is similar to the cerebrospinal fluid. The MRI of astrocytoma is similar to that of ependymoma. Sometimes it is difficult to identify and enhance the two. Scanning has a certain discriminating value, that is, the abnormal contrast enhancement in the central spinal cord is more in ependymoma, and no abnormal contrast is observed. many.
Diagnosis
Diagnosis and diagnosis of spinal cord tumor
diagnosis
There are tumors of other organs in the body and spinal pain, limb weakness, tingling, and ataxia should consider the possibility of spinal cord tumors and be located according to clinical manifestations, but must exclude lumbar muscle strain, spinal contusion, spinal cord insufficiency, spine Spinal cord dysfunction caused by fractures, disc herniation, syphilis, viral infection, multiple sclerosis, amyotrophic lateral sclerosis and other diseases. Some tests can be used to help diagnose spinal cord tumors. Spinal X-ray examination can show changes in bone mass, but not tumors that have not caused bone destruction. MRI is considered the best way to examine the spine and spinal cord. A biopsy can determine the type of tumor.
Differential diagnosis
Cervical spondylosis
The clinical manifestations of spinal cord tumors are very similar to those of cervical spondylosis. Because of the high incidence of spinal degenerative diseases, spinal cord tumors are often neglected. Therefore, clinicians should pay great attention to it. Spinal cord tumors often show root pain and gradually appear in the early stage. Symptoms of spinal cord compression, with fixed site, severe pain, persistence, increased coughing, etc., or at a later time, accompanied by stimulation or compression of the long spinal cord, so these patients should be routinely nerved System check and appropriate imaging examination.
Extramedullary tumor
The common clinical pathological types are neurofibromatosis, meningioma, and radiculopathy. It is more common and has the value of localization diagnosis. The sensory changes are obvious in the distal extremities, and the changes from the bottom to the top, no sensory separation, cone The sign of the sign appeared earlier and significantly, the symptoms of the lower motor neurons were not obvious, the spinal cord hemisection syndrome was more common, the spinal canal obstruction appeared earlier or more obvious, the cerebrospinal fluid protein was significantly increased, and the symptoms were aggravated by the extramedullary tumor after the cerebrospinal fluid was released. Spinal process is more common, especially epidural tumors, and spinal bone changes are more common.
Syringomyelia
Sudden onset, common in the lower neck and upper thoracic segments of adults aged 20 to 30 years old, most segments on one or both sides have sensory separation and lower motor neuron spasm, if the cavity extends downward, invading the lateral angle cells It is often accompanied by cervical sympathetic palsy syndrome (Horners syndrome) and upper limb skin dystrophy, early spinal canal obstruction, advanced vertebral canal obstruction, MRI can be clearly diagnosed and differentiated from intramedullary tumors.
