Spinal Tumors

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Spinal tumors of children may be found anywhere along the vertebral column. They cause symptoms by compression of the contents of the spinal canal. Localized back pain in a child or adolescent should raise suspicion of a spinal cord tumor, especially if the back pain is worse in the recumbent position and relieved when sitting up. The major signs and symptoms of spinal cord tumors are listed in Table 17-3. Most spinal cord tumors have associated muscle weakness, and the muscle group affected corresponds to the spinal level of the lesions.

Spinal tumors can be divided into three distinct groups:

1. Intramedullary: These tumors tend to be glial in origin and are usually gliomas or ependymomas.

2. Extramedullary, intradural: These tumors are likely to be neurofibromas often associated with neurofibromatosis. If they arise in adolescent females, menin-giomas are more likely.

3. Extramedullary, extradural: These tumors are most often of mesenchymal origin and may be due to direct extension of a neuroblastoma through the intervertebral foramina or due to a lymphoma. Tumors of the vertebra may also encroach on the spinal cord, leading to epidural compression of the cord and paraplegia (e.g., PNET or Langerhans cell histiocytosis occurring in a thoracic or cervical vertebral body).

Table 17-3. Major Signs and Symptoms of Spinal Tumors

Back pain (50% of cases); increased in supine position or with Valsalva maneuver Resistance to trunk flexion Paraspinal muscle spasm

Spinal deformity (especially progressive scoliosis) Gait disturbance Weakness, flaccid or spastic

Reflex changes (especially decreased in arms and increased in legs)

Sensory impairment below level of tumor (30% of cases)

Decreased perspiration below level of tumor

Extensor plantar responses (Babinski sign)

Sphincter impairment (urinary or anal)

Midline closure defects of skin or vertebral arches

Nystagmus (with lesions of upper cervical cord)

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