Tuesday, September 30, 2014
Spinal Cord Tumor
My aunt is 54 years of age and has experienced back pain for the last 6 months. She was initially diagnosed as having a "slipped disc" but later tests confirmed the presence of a spinal cord tumor(around both the front and back of the spine). The pathology report was inconclusive but suggested the presence of abnormal lymphoid cells. While she is awaiting her "new" diagnosis, she has been informed that the tumor may be due to lymphoma or potentially due to her taking methotrexate for arthritis. At her request, could you shed light on either of these conditions or spinal cord tumors in general? She is currently in the hospital and is frustrated, and she wants to understand the implications of each so that she may be able to make an informed decision in either circumstance so that she may choose the best treatment option.
Compression of the spinal cord from a tumor may have the same symptoms as compression from a slipped disc. An MRI of the spine can usually tell the difference.
Compression due to tumor is rarely from a tumor of the spinal cord itself but is usually caused by the invasion of the spinal canal (the channel where the cord passes) by tumor cells from outside the spine. A tumor of the bony vertebral column may press on the front part of the spinal cord. Tumors which occur outside of the spine but are next to the spine, such as lymphoma or neuroblastoma, may invade through the holes in the spine where the nerves normally pass in and out. Biopsy is necessary to determine the type of tumor involved. Treatment of the compression depends on the type of tumor involved with surgery, radiation, and chemotherapy all potential treatments. Spinal cord compression by a tumor is considered to be a medical emergency and requires prompt appropriate therapy to relieve the compression and prevent permanent damage to the spinal cord.
Methotrexate has been associated with increased inflammatory cells in the space around the brain and spinal cord -- but usually only when the methotrexate has been given directly into that space in high doses for the treatment of leukemia. The doses used for arthritis are much lower and the methotrexate is given orally.
Judith A Westman, MD
Associate Professor, Clinical Internal Medicine, Pediatrics and Medical Biochemistry
College of Medicine
The Ohio State University