Spinal cord compression: Tumors and allied non-traumatic conditions

Abstract Tumors of the spinal cord, if diagnosed and removed early in their development, can be permanently cured. Any condition which produces compression of the spinal cord may simulate tumors of the spinal cord. In order to correlate more fully the relation of clinical, surgical, and pathologic aspects of compression of the spinal cord, material gathered from cases reported at The Mayo Clinic from 1912 to 1929 has been analyzed. In view of the difficulty in nomenclature of tumors of the spinal cord, the terminology was confined to an accepted classification, and the microscopic examination was made by means of frozen sections stained with hematoxylin and eosin. Of 312 cases analyzed, 223 tumors were found which did not involve the spinal cord except by compression; these were classified as extramedullary, and were divided again into 156 intradural and 67 extradural tumors. There were also 89 tumors which involved the spinal cord and were classified as intramedullary. Included in the group of 67 cases of extradural tumors compressing the spinal cord were lesions arising from bone, intervertebral disks, extradural fat, spinal nerves, and blood vessels, as well as unsuspected metastatic malignant lesions. A preoperative diagnosis of bony extradural lesion may often be made by roentgenologic examination; likewise, it is possible to make a presumptive diagnosis of metastatic malignant lesion when the primary lesion can be determined. The intradural extramedullary series of tumors comprised the largest group, and fortunately carried the most favorable prognosis. These lesions take their origin from the fibroblastic structures of the meninges and the vessels of the meninges, or they are projected into the subarachnoid space from without the dura or from within the spinal cord. The 2 types of tumor predominating are the endothelioma, or meningeal fibroblastoma, and the neurofibroma. In this series, about half of the intradural extramedullary tumors proved to be endotheliomas, and about a third were neurofibromas. In analyzing the intramedullary lesions, 89 cases were reviewed. Tissue was available in only 62 cases. Tumors arising from the cord and comprising the group of gliomas predominated, but also benign encapsulated tumors which were capable of complete removal were found. In a number of cases in which tissue was not removed, palliative relief was obtained by means of decompression, coincidental with laminectomy. In view of the fact that laminectomy can be performed with minimal risk, exploration can be carried out in many atypical cases of compression of the spinal cord for palliative as well as for diagnostic purposes. In a very high percentage of cases of compression of the spinal cord, a differential diagnosis between inflammatory and neoplastic lesions can be ascertained preoperatively by means of roentgenologic examination, complete neurologic study including examination of the cerebrospinal fluid, and the use of lipiodol when indicated. But the exact pathologic nature of the underlying cause of compression is rather difficult to determine, and this pathologic analysis furnishes evidence of the multiplicity of lesions that can be encountered at operation.