intraspinal metastatic tumor
Introduction
Introduction to intraspinal metastatic tumor Intraspinal metastases are more common in the compression of the spinal cord, because the vast majority of patients often receive radiotherapy or surgery plus radiotherapy once they are diagnosed as intraspinal metastases, or give up treatment. Therefore, it is more difficult to determine the exact source of metastases. The primary lesion of intraspinal metastases is sometimes difficult to determine. The metastasis pathway of cancer cells is similar to brain metastasis. It is mainly spread by arteries, veins, lymphatic system and subarachnoid cerebrospinal fluid. Malignant tumors can be transferred to spinal canal. Within the lung cancer, liver cancer, breast cancer, thyroid cancer, digestive tract cancer and prostate cancer can be transferred to the spinal canal through the arteriovenous system, lymphatic system tumors such as lymphosarcoma, can directly invade the hard ridge through the paravertebral lymph nodes through the intervertebral foramen Extra-membranous, destruction of vertebrae and compression of the spinal cord, 2% to 5% of lymphoid tumors invade the spinal epidural, destroy the vertebrae and compress the spinal cord, acute leukemia, especially acute lymphocytic leukemia can infiltrate into the spinal canal The membrane or nerve root and its spinal cord wall cause compression or ischemia of the spinal cord, leading to spinal cord dysfunction. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: paraplegia high paraplegia
Cause
Intraspinal metastatic tumor
Primary lesion (30%):
The primary lesion of intraspinal metastases is sometimes difficult to determine. The metastasis pathway of cancer cells is similar to brain metastasis. It is mainly spread by arteries, veins, lymphatic system and subarachnoid cerebrospinal fluid. Malignant tumors can be transferred to spinal canal. Within the lung cancer, liver cancer, breast cancer, thyroid cancer, digestive tract cancer and prostate cancer can be transferred to the spinal canal through the arteriovenous system, lymphatic system tumors such as lymphosarcoma, can directly invade the hard ridge through the paravertebral lymph nodes through the intervertebral foramen Extra-membranous, destruction of vertebrae and compression of the spinal cord, 2% to 5% of lymphoid tumors invade the spinal epidural, destroy the vertebrae and compress the spinal cord, acute leukemia, especially acute lymphocytic leukemia can infiltrate into the spinal canal The membrane or nerve root and its spinal cord wall cause compression or ischemia of the spinal cord, leading to spinal cord dysfunction.
Intraspinal metastases can be distributed in the spinal canal or any segment of the spinal cord, but most commonly in the thoracic segment, most of the spinal canal metastases occur in the epidural, and some destroy the vertebral bone such as the vertebral body and adjacent structures. , causing compression fractures, intraspinal and intradural intraspinal metastases are rare, tumor cells can be extended into the spinal cord through the nerve root or subarachnoid space.
Transfer route (30%):
The pathways for tumor metastasis into the spinal canal are:
1 disseminated through the artery.
2 disseminated through the vertebral vein system.
3 disseminated through the subarachnoid space.
4 spread through the lymphatic system.
5 adjacent lesions directly invade the spinal canal.
Lung cancer and other diseases (25%):
Intraspinal metastases are mostly from lung cancer, kidney cancer, breast cancer, thyroid cancer, colon cancer and prostate cancer. Lymphatic tumors including lymphosarcoma, reticulum sarcoma and lymphoblastoma can invade the spinal cord and intraspinal metastasis. More than 2 to 3 times more than the intracranial, because the tumor of the spinal canal can invade the epidural through the intervertebral foramen, the tumor can destroy the vertebra, and acute leukemia, especially acute lymphocytic leukemia can be infiltrated into the hard The meninges, spinal cord or nerve roots can also infiltrate the walls of the spinal cord.
Prevention
Intraspinal metastatic tumor prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Intraspinal metastatic tumor complications Complications paraplegia high paraplegia
Due to the rapid development of the disease, incomplete and complete paraplegia may occur at the time of patient visit.
Symptom
Symptoms of metastatic tumors in the spinal canal Common symptoms Spinal cord compression Spinous process tenderness Spinal cord compression Back pain Intense radiculopathy
The clinical history of intraspinal metastases is often non-specific. Once the spinal cord compression symptoms appear, the patient will see the doctor and perform a spinal cord-specific examination. At this time, it is difficult to determine the primary lesion in some cases, so from the primary lesion to There was no accurate statistics on the time of intraspinal metastasis.
Because most of the spinal canal metastases grow in epidural infiltrates, it is easy to invade the spinal nerve roots, so pain is the most common first symptom. The nerve root pain starts from the back, often due to coughing, sneezing, deep breathing or Exercising by force and other actions, 96% of patients with spinal epidural metastatic tumors with pain as the first symptom, the pain is more obvious at night supine position, the nerve root pain site is consistent with the corresponding spinous process tender site, and there is a certain positioning. Value, incomplete and complete paraplegia accounted for about 86%, and about 14% of those who have not had paraplegia have severe pain as the main symptom.
Examine
Examination of metastatic tumors in the spinal canal
Cerebrospinal fluid dynamics determination, most patients have different degrees of obstruction, cerebrospinal fluid protein content is often increased, spinal X-ray film is more valuable for intraspinal metastases than any other tumor in the spinal canal, the main feature is around the spinal canal Osteoporosis destruction, the most common bone destruction of the lamina and pedicle, followed by vertebral destruction caused by compression fracture, the main value of CT scan for intraspinal metastasis is to determine the bone destruction around the spinal canal, Through the axial bone window image or three-dimensional reconstruction image, the bone destruction at the vertebral body, lamina and pedicle can be clearly displayed. The contour of the tumor itself is not as sensitive as magnetic resonance. The magnetic resonance is especially sensitive to the spinal cord and its spinal canal lesions. Sensitive, first of all can accurately locate and the spinal cord, vertebral body, lamina, intervertebral foramen and other structures can be clearly distinguished, due to tumor compression adjacent to spinal cord edema or compression deformation, often high T1 and high T2 signal, After the injection-enhanced examination, it is often found that the lesion can be significantly enhanced. In short, the location of the intraspinal metastases can be accurately detected by magnetic resonance imaging, the characteristics of the tumor itself, adjacent to the spinal cord and By pressure situation roots, provide the most accurate information for further treatment.
Diagnosis
Diagnosis and differentiation of intraspinal metastatic tumor
diagnosis
For patients with a history of malignant tumors, it is easy to diagnose intraspinal metastases if there is progressive spinal cord compression, but this typical case is rare. For spinal cord compression as the first symptom, it is necessary to combine the corresponding auxiliary examination. The diagnosis is not difficult. For patients with persistent low back pain in middle-aged and above, X-ray plain film shows that the vertebral body is damaged or has a history of tumor surgery or the original lesion has been found. It is not difficult to do with magnetic resonance and CT scan diagnosis. Diagnosis of intraspinal metastases.
Differential diagnosis
1. Chronic low back pain: Disc herniation or vertebral joint hyperplasia is the most common, metastatic tumor pain is fixed, continuous progress is not relieved by rest or position change, conventional analgesic effect is not good, for those with middle-aged or above pain The necessary inspections should be carried out.
2. Spinal tuberculosis: Spinal tuberculosis patients sometimes have no clear history of tuberculosis. When tuberculosis causes destruction of vertebral bodies and adjacent structures, radiographic imaging is often difficult to distinguish. Clinically, targeted examinations and general conservative treatment are still unclear. Surgery should be performed for targeted treatment.
3. Eosinophilic granuloma: often have low back pain, similar to spinal canal metastases, but this disease occurs mostly in children and young people, peripheral blood leukocytes and eosinophils are mostly, the condition is stable, can be used for long-term follow-up observation, no Special treatment.
