Spinal tumor syndrome is not a condition in itself. It is a clinical label for the patient’s condition with many differentials in the offering.
Most often, the term is used in cases of spine tuberculosis where there is no apparent osseous lesion.
To understand spinal tumor syndrome one must first know about the typical presentation of tuberculosis of the spine.
Most of the typical cases involve anterior bodies or posterior elements of a vertebra. Back pain is the most common presenting feature which lingers on for a long time. There would be spine deformity and slow appearance and worsening of neural deficits.
Most of the tubercular lesion present this way and lesions are visible on x-rays.
However, tuberculosis is known to involve just soft tissue of the spine without any involvement of bony lesions.
It was earlier thought to be extremely rare. But with new imaging, more and more cases are being labeled as extraosseous spinal tuberculosis.
These lesions may present with sudden onset neural deficit to the extent of paraplegia or quadriplegia [very unusual].
Now a patient presents with the neural deficit and gives no prior history of back pain. Moreover, there is no deformity in the spine, the back is absolutely normal.
This patient has a mass lesion in the spinal cord leading to a neural deficit. Spinal cord tumors behave this way – no back pain, back normal on examination and even normal x-rays [except when calcified].
Could it be a tumor?
Could it be tuberculosis?
We cannot know that clinically though patient’s other parameters and endemicity might point to the later. So we label the condition as spinal tumor syndrome.
The differential diagnoses include extraosseous tuberculosis like localized tuberculoma or a diffuse granuloma and spinal cord tumors.
In the endemic region, the patient would turn out to have tubercular lesions, mostly.
Evaluation of Patient with Spinal Tumor Syndrome
An atypical spinal tuberculosis is difficult to identify on plain radiographs. X-rays even fail to identify bony lesions <1cm.
Advanced imaging techniques like CT and MRI are required to delineate the lesion clearly.
MRI is the gold standard in imaging of these lesions.
CT-Myelography is another option.
As these lesions present with spinal compression and neural deficit, the treatment is surgical.
A cover of antitubercular medications is started and the patient is operated at the earliest.
Early surgical intervention gives good results and sometimes dramatic.
Importance of the Term
The term spinal tumor syndrome is a confusing term. It is a clinical or rather academic label which wants to convey the uncertainty of the findings. Any tubercular spinal lesion that does not have the typical clinical features is referred to as atypical spinal tuberculosis which is a better term than spinal tumor syndrome.
The patients of spinal tuberculosis who present with the features of compressive myelopathy and radiculopathy both, without any radiologically evident bony lesion are described as spinal tumor syndrome. The differential diagnoses are neurofibroma, meningioma, lipoma, astrocytoma and other neural tissue tumors too.
These lesions are difficult to diagnose clinically and radiographically. The reported incidence of atypical spinal tuberculosis is about 2.1%.
- Hasengawa K, Hideyuki M et al. Spinal tuberculosis. Clin Orthop. 2002; 403: 100-103.
- Martin RJ, Yuan HA. Neurosurgical care of spinal, epidural, subdural, and intramedullary abscess and arachnoiditis. Spinal infection. Orthop Clin North Am. 1996; 27(1): 125-136.
- Pande KC, Babhulkar SS. Atypical spinal tuberculosis. Clin Orthop. 2002; 398: 67-74.
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