Spinal tumors are a significant cause of morbidity and disability. These can be extradural involving the spine, intradural extramedullary and intramedullary. Surgery is required in majority of these patients to relieve the neurological compression and for histopathological diagnosis.
Spinal tumors can be divided into broadly three groups:
1. Extradural affecting the spinal column: This is the most common group. This includes beningn lesions to malignant lesions as metastasis, plasmacytoma , aneurysmal bone cyst, chondrosarcoma and local infiltration of the adjacent retroperitoneal malignancies. Metastatic spine disease constitutes a major subgroup in view of increase in the survival of solid body tumors. Pain is the most common symptom followed by neurological deficits depending upon the extent of spinal canal compromise.
Treatment options include local radiotherapy in those with no instability and no deficits, vertebroplasty in those with persistent pain to surgery for decompression of the neural elements and fixation to allow for spinal stabilisation and early mobilisation and better pain relief. Vertebroplasty and surgery and fixation can be achieved through either conventional or minimally invasive methods.
2. Intradural extramedullary tumors: meningiomas and schwanommas are slow growing beningn tumors presenting with neurological deficits due to compression of the spinal cord and nerve roots. Surgical excision results in good results and outcomes. This can be done effectively through minimally invasive methods. Timely surgery before severe neurological deficits is the key to good results.
3. Intramedullary tumors: Astrocytomas and Ependymomas affect the spinal cord and present with progressive neruological deficits. These require microscopic surgery and intra-operative monitoring. Intra-operative monitoring is essential to detect any involvement of the intact nerual elements while decompressing the tumor and avoid poor neurological outcomes.
In all these tumors, timely intervention is the key to good results. Quite often, the patients delay treatment due to undue fears and apprehensions and thereby delay the surgery. This eventually affects the outcomes and recovery. It is improtant to discuss with the neurosurgeon the pros and cons and then take the appropriate decision.