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  • Intraspinal tumor
  • Spinal cord neoplasm
  • Spinal cord space-occupying lesion

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  • 237.5 Neoplasm of uncertain behavior of brain and spinal cord
  • 238.0 Neoplasm of uncertain behavior of bone and articular cartilage

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  • C72.0 Malignant neoplasm of spinal cord
  • D33.4 for benign neoplasm of spinal cord
  • D43.4 Neoplasm of uncertain behavior of spinal cord
  • D48.0 Neoplasm of uncertain behavior of bone and articular cartilage

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Description

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  • Cell growth in or around the spinal cord
  • Spinal tumors account for approximately 15% of primary CNS tumors

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Essentials of Diagnosis

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  • Primary spinal tumors are ones that start in spinal tissue.
  • Secondary spinal tumors are spread from other sites (metastasis).

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General Considerations

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  • Spinal tumors are divided into 2 groups.
    • Intramedullary (those that arise within the spinal cord tissue)
    • Extramedullary (those that arise within the spinal column but outside of the spinal cord, in the meninges)
  • Most common primary extramedullary tumors are neurofibromas and meningiomas.
  • Physical presentation is the result of the location and extent of the tumor (see paraplegia and tetra/quadriplegia).
  • Onset of signs/symptoms is gradual.
  • Clinical correlation

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Demographics

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  • Equal male and female incidence; can impact any age

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Signs and Symptoms

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  • Back pain: usually worse with lying down or made worse by an extended time in a recumbent position
  • Stiffness of the back muscles
  • Vascular changes: cold sensation upper or lower extremity
  • Loss or alteration of sensation
  • Loss or alteration of motor function
  • Loss or alteration of bowel and bladder function
  • Urinary frequency
  • Urinary urgency
  • Sphincter disturbances
  • Syringomyelia-like symptoms
  • Brown-Séquard syndrome- like symptoms
  • Hydrocephalus
  • Increased intracranial pressure
  • Papilledema
  • Atrophy
  • Hyporeflexia
  • Spasticity
  • Hyperreflexia
  • Gait disturbances
  • Sexual dysfunction
  • Pain to palpation over the involved spinal segment in 50% of patients
  • Radicular pain
  • Paralysis
  • Tumors can affect
    • Spinal cord cells
    • Nerve root compression
    • Circulatory system
    • Bone strength

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Functional Implications

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  • Loss of independence with ADLs and self-care
  • Loss of independence with locomotion in home and community environments
  • Altered sensation predisposing patient to injury
  • Loss (or altered) ability to work and participate in leisure activity

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Possible Contributing Causes

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  • Unknown cause for primary spinal tumors
  • Spine and spinal cord are common metastatic sites for other forms of cancer including breast, bone, lung, lymphoma.

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Differential Diagnosis

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  • Leukemia
  • Lymphoma
  • Myeloma
  • Stenosis
  • Spondylitis
  • Muscle strain
  • Degenerative or protruding disc
  • Disease of the gall bladder
  • Disease of the kidney
  • Disease of the stomach or intestine
  • Disease of the pleura
  • Blood clot of the retroperitoneal space

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Laboratory Tests

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  • Complete blood count (CBC)
  • Urinalysis
  • Erythrocyte sedimentation rate (ESR)
    • Elevated ...

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