A Paper on THE DIAGNOSIS AND TREATMENT OF SPINAL CORD TUMOURS
Authors: D. J. Armour
Journal: BMJ (1928)

IN this discussioion on tie diagnosis and treatmuenit of spinal cord tumours I will limit mvself to the strict meaning of the term-namely, those tumiiiouirs arising from the cord, from the n-erve iroots, or fi-oum the spinal meniinges-and exclude those ar ising-, priinam'ily or seconidarily, from the vertebral column anid the soft tissues surrotundinig it.Exceptioin will bemade in the case of chondromata growing from an interver tebr al disc.Clinically, spinal cord tumllour's may be said to cause a paraplegia by compression, the nature of wlich cannot be irevealed by x rays.It slhould-be remiemnbered, however, that tumours arising fromii nerves or ner ve roots outside the spinal canial may extenid into it thriough an inter- vertebral forameni, and, vice versa, olne originating in the spinal canal inay extenid in the saiiie way into the soft tissIues surrouiidlnlg tIme veitebt'al columiin.Moreover, a tumloutr miiay be botlh intr-adur'al anid extr'adural, without any clear evidence as to its point of origini.More than three-fourths of spinal cord tumouirs amre extramedullary, and less than onie-fourtlh intraniedullary.Of time extra- i-iedullary tumours, the intradural are more frequeent tha the extr adur al by three to onie.Of inltr adur al tumours, about two-thirds occupy a dor sal or dorso-lateral position and one-third a venitr-al or venitro-lateral position-a imiatter for rejoicinig oni the part of the surgeon. SYMIPTOMS.in the majority of cases of slpinal cord tumiiouL the onset of symptoms is slowly progressive, thle course of the disease being slow and chronic.From the clinical standpoint it may be divided into three stages: (1) of oot synmptomns, usually unilateral; (2) of Brown-S6quard paralysis; (3) of complete compression paraplegia, or bilater al paralysis.According to Starr, " a Ceortain order is comuwoilly observed in the symptonms "-nanlely: (1) Paimi referred to the periplhery. (2)Incriease of eflex activity below the point of compression. (3)Paralysis-spastic paraplegia in ex- tenisionl. (4)Loss of sensibility. (5)Loss of reflex activity with flaccid paralysis.The first symptoim comiiplainied of by the patient is usually sensorly, eitlher paini or' some formi of paraestlhesia.There are exceeptions to this, but though1 at the onset somiie cases have llo sensory symp)toms, they usually appeal later in the course of the disease.A few cases m'uii a completely l)ainless couirse.These were formlelrly supposed to be cases of nmeduillar) tumouri, biit it is nlow knlown that some ale extrammuedul larv.Root pain, due to irritation-" tlle neuralgic stage is the most frequent ear-ly symptom." There is no other disease which causes such definitely localized recurring and persistent pain " (Stari).-It nay be paroxysmal and remittent, slowilng marke(d variationis in its severity, anid is frequienitl) aggravated by cough-iing anid siieez.ingor by movements of the si)ine.Tlhe lpain may appeal suddenily, mamy persist for montl-hs or1 years, disappearing as symptoms of cord comnpressioni ap)pear, o0 it m'zlay conltiniue thlroughout the whloleduriationi of the diseaste.The paini is referreed to the couirse of the nieirve inivolved, and mlay be thoughlt to be duie to innumerable conlditions in various parts of tlhe bod\ or limllbs.Pain in tlle back maya be an early symptom in spinal cor d tumiiour, and may be the only onie comlplained of for a very long period..This is especially true of lunmbo-sacral £and cauda equina tumiours.Various postures may be assumied by the patient to get melief from'i the paini.Bennett' has called attenition to the fact that or tlhopaedic surgeons are frequently consulted by patienits coml- * Read in opening a discussion in the Section of Surgery of the Annlutal Meeting of the British Medical Association, Cardiff, 1928.plaining of local and referred pains in the region of thte spine whIio-have no bone lesionhut a lesionof-the card.He records four cases of spiinal cord tumour, all having shown-symptoms that suggested osseous, muscular, andl ligamllentous changes rather thian any neurological condi- tion.They showed (1) variable pain in the spine andl nler ve roots;(2) extreme spasmu of the erector spinae muscles, followed by lateral deformity of the spine;(3) extreme bilateral spasm of the hamstring group-all appear-ing lonig before anymltotor or' sensory changeslha( occurred.