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105: TUMOR, SPINAL

Mollie Venglar, DSc, MSPT, NCS; Adrian Taylor, DPT

CONDITION/DISORDER SYNONYMS

  • Intraspinal tumor

  • Spinal cord neoplasm

  • Spinal cord space-occupying lesion

ICD-9-CM CODES

  • 237.5 Neoplasm of uncertain behavior of brain and spinal cord

  • 238.0 Neoplasm of uncertain behavior of bone and articular cartilage

ICD-10-CM CODES

  • 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

PREFERRED PRACTICE PATTERNS1

  • 5H: Impaired Motor Function, Peripheral Nerve Integrity, and Sensory Integrity Associated with Nonprogressive Disorders of the Spinal Cord

  • 6B: Impaired Aerobic Capacity/Endurance Associated with Deconditioning

PATIENT PRESENTATION

During an MRI to determine the extent of a disc lesion, the radiologist discovered a spinal tumor at the level of L3 in a 60-year-old patient. The patient had reported symptoms of “pins and needles” on the anterior and medial thigh, and progressive difficulty ascending and descending steps for the past 4 months to his primary care physician. The physician ordered an MRI assuming the radicular symptoms were related to a disc lesion in the lumbar spine. The patient was referred to a neurooncologist for further work up. The spinal tumor was determined to be extramedullary.

KEY FEATURES

Description

  • Cell growth in or around the spinal cord

  • Spinal tumors account for approximately 15% of primary CNS tumors

Essentials of Diagnosis

  • Primary spinal tumors are ones that start in spinal tissue

  • Secondary spinal tumors are spread from other sites (metastasis)

FIGURE 105-1

Radiograph of the spine of a 45-year-old woman whose cancer had metastasized from the breast. (From Skinner HB. Current Diagnosis & Treatment in Orthopedics. 4th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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General Considerations

  • Spinal tumors are divided into two 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.

Demographics

  • Equal male and female incidence; can impact any age

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • Atrophy

  • Back pain: Usually worse with lying down or made worse by an extended time in a recumbent position

  • Brown–Séquard syndrome-like symptoms

  • Gait disturbances

  • Hydrocephalus

  • Hyperreflexia

  • Hyporeflexia

  • Increased intracranial pressure

  • Loss or alternation of bowel and bladder function

  • Loss or alteration of motor function

  • Loss or alteration of ...

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