Intradural Extramedullary Spinal Tumors are located inside the dura but outside the substance of the spinal cord, this compressing the spinal cord and the nerves.
The spinal cord gets damaged progressively with time due to continued compression
and continued growth of the tumor.
For a long time, radiological and silent damage may go on occurring without symptoms. Actually, the spinal cord goes on tolerating slow progressive damage without symptoms for a long time. Therefore, it is imperative that patients undergo MRI of the spine even with subtle symptoms to pick up intradural extramedullary spinal tumors at an early stage.
Symptoms depend on the location of the spinal tumor in the spine, that is whether it
is in the neck (cervical spine and craniospinal junction), upper back (dorsal spine),
lower back (lumbo-sacral spine).
Tumors located in the cervical spine and craniospinal junction may present with neck
pain radiating to the upper limbs. Further spinal cord compression may lead to
symptoms in both the arms and legs and finally even the bowel/bladder functions
may get involved.
Subtle symptoms may include
Paresthesias or abnormal sensations in the limbs
Numbness in the limbs
Minor weakness or loss of dexterity of the hands
Heaviness of the back and legs
Minor weakness in the legs
Advanced symptoms
Frank weakness in the limbs
Wasting or loss of muscle bulk in the hands and arms
Urinary retention/incontinence
Severe constipation/faecal incontinence
Tumors located in the dorsal spine may present with upper back pain radiating to the
front of the chest or abdomen. Further spinal cord compression may lead to
symptoms in both the legs (the arms are spared because the nerves of the arms leave
the spinal cord in the neck) and finally even the bowel/bladder functions may get
involved.
Subtle symptoms may include
Paresthesias or abnormal sensations in the lower limbs
Numbness in the lower limbs
Heaviness of the back and legs
Minor weakness in the legs
Advanced symptoms
Frank weakness in the lower limbs
Urinary retention/incontinence
Severe constipation/faecal incontinence
Tumors located in the lumbar spine may present with lower back pain radiating to the
legs. Further spinal cord compression may lead to symptoms in both the legs (the arms
are spared because the nerves of the arms leave the spinal cord in the neck) and finally
even the bowel/bladder functions may get involved.
Subtle symptoms may include
Pain or Paresthesias or abnormal sensations in the lower limbs
Numbness in the lower limbs
Minor weakness in the legs
Advanced symptoms
Frank weakness in the lower limbs
Urinary retention/incontinence
Severe constipation/faecal incontinence
Traditional surgical technique-
Surgery is required if the MRI shows significant sized tumors. Surgery is done from the the back of the spine through a midline incision. The bone at the back is partly removed and the dural covering of the spinal cord is opened. Most surgeons core out the inside part of the tumor using an Ultrasonic Aspirator and thereafter dissect the shell of the tumor away from the nerves/spinal cord, finally removing the shell of the tumor.
Dr Sujoy K Sanyal’s Curative Enbloc Excision Approach to Spinal tumors
I prefer to excise Intradural Extramedullary Spinal tumors en-bloc as one piece.
This decreases intra-operative blood loss/surgical time, decreases the chances of
recurrence almost to nil, and gives the best neurological outcome due to least
neural handling. Patients and their families are also pleased to see the tumor
removed as a single en-bloc piece at the end of surgery. Most patients with
Intradural Extramedullary Spinal tumors exhibit miraculous improvement over a
few weeks/months. And therefore, it is one of the most gratifying spinal
surgeries because a good surgery can make even paralyzed patients walk
normally.
Postoperative recovery-Miraculous improvement
The first purpose of surgery is to prevent further neurological deterioration. Patients with no significant symptoms pre-operatively are near normal immediately post-operatively.
Recovery in patients who already have neurological symptoms is quite miraculous in patients with Intradural Extramedullary Spinal tumors. Recovery depends on extent of symptoms, extent of spinal cord damage on pre-operative MRI and precision of surgery. Recovery happens over weeks/months and is maximized by an aggressive exercise/physiotherapy regimen.
But it must be mentioned again that most patients with Intradural Extramedullary Spinal tumors exhibit miraculous improvement over a few weeks/months. And therefore, it is one of the most gratifying spinal surgeries because a good surgery can make even paralyzed patients walk normally.
