Chapter 8 - Imaging of spinal lesions

Abstract

Spinal cord tumors can be classified based on the location of the tumor as intradural intramedullary, intradural extramedullary, or extradural. The differential diagnosis for each lesion can be narrowed by recognizing the location of the tumor. The most common intradural intramedullary lesions are astrocytoma, ependymoma, and hemangioblastoma, whereas the most common intradural extramedullary lesions are meningioma and schwannoma or neurofibroma. The most common extradural lesions are metastatic lesions. Primary spinal tumors are less common than intracranial tumors and represent 2–4% of primary central nervous system tumors. Clinical presentation of primary spinal cord tumors depends on the location of the lesion. In a recent series of intradural intramedullary spinal cord tumors (IMSCTs), pain was the most common presenting symptom (72%) and can manifest as back pain (27%), radicular pain (25%), or central pain (20%). Motor disturbance was next most common (55%), followed by sensory problems (39%). Intradural extramedullary spinal tumors are usually benign lesions with a few exceptions and can be cured with preserved neurologic function with surgery alone in the majority of cases. Intradural extramedullary tumors comprise more than 70% of intradural spinal cord tumors in adults and are only slightly less common in pediatric patients. The most common intradural extramedullary tumors are derived from nerve sheath cells (schwannomas and neurofibromas) or meningeal cells (meningiomas). Myxopapillary ependymoma is an extramedullary lesion arising from the conus medullaris and filum terminalis. Epidural spinal cord tumors are most likely to be metastatic lesions. Many types of cancers metastasize to the spine, with lung cancer, breast cancer, and prostate cancers being the most frequent malignancy to metastasize to the spine. Most of the metastatic lesions can be treated with radiation, unless the patient presents with neurological deficits requiring urgent surgical intervention.