The spinal cord in neck contains nerve cells and nerve fibers. The nerve cells are known as neurons and neurons mostly occupy central section of spinal cord known as grey matter. The outer white structure of spinal cord is formed by sensory and motor nerve fibers. The sensory fibers travel from peripheral tissue to brain and subcortical centers (centers below brain and above spinal cord) while motor nerve fibers travel from brain as well as subcortical section to peripheral tissue. Irritation and injury of sensory nerve fiber causes symptoms like pain, tingling and numbness. While, irritation or injury of motor nerve fibers causes weaknesses or paralysis of muscles of chest, abdomen, arms or legs. Severe damage to the structure of spinal cord can cause quadriplegia or paralysis of all 4 extremities.
The symptoms caused by spinal cord tumor in neck depend on extent of compression of spinal cord by tumor mass in neck. Mild to moderate compression and spread of tumor in neck within spinal cord may cause symptoms of pain and tingling of mild to severe in intensity. While, moderate to severe compression of spinal cord due to tumor in neck may result in pain, numbness and / or weakness in one or all four extremities. The partial or severe compression of spinal cord when caused by spinal cord tumor in neck results in unilateral or bilateral symptoms that are spread over arm, chest, abdomen and lower extremities. The severe compression of spinal cord on one side due to tumor may cause paralysis of both upper and lower extremity of same side. Severe compression of entire spinal cord by spinal cord tumor in neck may result in quadriplegia or paralysis of all four extremities.
Anatomy of Spinal Cord in Neck
The spinal cord in neck is divided in 7 segments. There are 8 cervical nerves that branches out from spinal cord in neck. The first cervical nerve lies above first cervical segment of spinal cord and remaining 7 are directly connected to 7 segments of spinal cord. These 8 cervical nerve supplies all anatomical structures of neck and upper extremities.
Hundreds of nerve cells and bundle of several hundred of sensory and motor nerves fibers form spinal cord. These nerve fibers are linearly extended up and down to and from brain to peripheral tissue. Spinal cord is covered by three membrane known as pia, arachnoid and dura mater. The space between pia and arachnoid mater is filled with fluid known as cerebrospinal fluid. The space outside dura mater is known as epidural space. Spinal cord tumor in neck is divided into three types depending on location where the tumor is situated within spinal cord in neck.
Types of Spinal Cord Tumor of Neck (Cervical)
The non-aggressive spinal cord tumor in neck is known as benign cervical tumor and aggressive tumor is known as malignant spinal cord tumor. Most of the spinal cord tumor in neck are non-aggressive benign tumor and often diagnosed in later stages when tumor is severely compressing the spinal cord.
Types of spinal cord tumor in neck:
Intra-medullary Spinal Cord Tumor of Neck
Intramedullary spinal cord tumor of neck is most often a benign tumor. Tumor mostly develops from nerve cells (neuron) within spinal cord and rarely from nerve fibers. The most common tumor arising from nerve cells in neck are Astrocytomas and Ependymomas.
Extra-medullary Spinal Cord Tumor of Neck
Extra-medullary spinal cord tumor begins to grow around the spinal cord and eventually causes compression of the spinal cord. Most of the extra-medullary spinal cord tumor originates from arachnoid membrane and known as meningioma. Few extradural spinal tumors originate from dorsal ganglion nerve cells, which is located at the base of spinal nerve. Non-malignant benign extra-medullary spinal cord tumor grows slowly in size and causes compression of the spinal cord. The aggressive malignant extra-medullary spinal cord tumor of neck may infiltrate into spinal cord and cause severe destruction of nerve cells and nerve fibers.
Extra-dural Spinal Cord Tumor of Neck
Extradural spinal tumors are most common spinal cord tumor of neck. Extradural tumor originates outside dura mater in epidural space. The list of tumor includes Lipoma, Neuroma, Osteoma and Osteosarcoma. Most of the extra-dural tumor are malignant bone tumor and attached to vertebral column. The extradural benign spinal cord tumor in neck also grows from nerve fibers, epidural fatty tissue and surrounding bone. The rapid growth of malignant tumor often results in rapid symptoms caused by compression of spinal cord as well as infiltration of cancer cells within spinal cord. Extra dural non-malignant spinal cord tumor in neck causes mild to moderate compression of spinal cord and later when symptoms are ignored may form substantial large mass resulting in severe compression of spinal cord in neck. The malignant extra-medullary tumor often grows very rapidly in size and causes rapid infiltration of spinal cord resulting in severe damage of nerve fibers and nerve cells resulting in quadriplegia.
Symptoms and Signs Caused by Spinal Cord Tumor in Neck
Spinal cord tumor in neck causes symptoms by irritation or destruction of sensory and motor nerve fibers as well as nerve cells. Initial symptoms are caused by irritation of sensory and motor nerve fibers within the spinal cord. Irritation of sensory nerve fibers causes pain and numbness as well as irritation of motor nerve fibers causes weakness in one or all of the four extremities.
Symptoms caused by spinal cord tumor are as follows-
Acute and Chronic Pain-
Initial acute pain lasts for 3 to 6 months. Pain lasting more than 6 months is known as chronic pain. Acute pain is caused by initial irritation of pain fibers located within spinal cord in neck. Pain may be observed in neck, upper extremity, chest wall, abdomen or lower extremity depending on the irritation of specific sensory nerve fibers located with spinal cord. Severe pain may spread in multiple anatomical structures of the body when the tumor consistently grows in size resulting in severe spinal cord compression. Severe pain is also observed in multiple anatomical areas when infiltration of tumor cell is wide spread within the spinal cord
Pain is often severe and continuous. Pain is mistaken for arthritis and muscle pain since cause of origination of pain is often unknown. The radiological studies are performed only when pain become severe and does not respond to pain medications. Similarly advanced radiological studies are necessary when pain symptom is associated with numbness and weakness. The MRI and CT scan are the specific radiological studies, which assist to attain diagnosis of spinal cord tumor. Pain intensity increases in lying position or during night. Pain is also increased with activities.
Symptoms of Tingling and Numbness Caused Due to Spinal Cord Tumor in Neck-
Tingling is the initial abnormal sensory symptom often associated with pain. In few cases of initial compression of spinal cord by tumor mass in neck, the only symptom observed is occasional infrequent tingling. Tingling may precede or succeed the symptoms of pain. In few cases tingling may be first isolated symptom. If treatment is delayed then further sensory nerve damage causes severe pain and numbness. Presence of numbness suggests the sensory nerve is probably permanently destructed and impairment is irreversible unless pressure over spinal cord is removed. Numbness is reversible if pressure is removed within few days of observing symptoms.
Symptoms of Weakness in Extremities Caused Due to Spinal Cord Tumor in Neck
Symptoms such as weaknesses are caused by several medical conditions. Weakness in absence of sensory symptoms like pain, tingling and numbness is often investigated for electrolyte or nutritional abnormalities. Few cases of weakness are also treated for depression and anxiety. The compression or infiltration by a spinal cord tumor in neck rarely involves only motor nerve. The isolated symptoms of weakness may involve one or two extremities on one side and rarely all four extremities. In most of the cases in people suffering with spinal cord tumor of neck, weakness follows symptoms of pain, tingling and numbness. Weakness is often associated with pain and tingling. If complaint such as weakness in presence of numbness is ignored then patient suffering with large spinal cord tumor mass in neck may become quadriplegic within few weeks. Spread of weakness depends on destruction of bundle of nerves, which provides motor nerve supply to chest, abdomen or extremities. Severe compression of spinal cord on one side often causes severe weakness simultaneously spread over chest, abdomen and extremities.
Symptoms of Frequent Fall Caused Due to Spinal Cord Tumor in Neck-
Patient during initial phase of spinal cord tumor growth in neck often gives a medical history of frequent fall and difficulties to get in and out of chair. History of frequent fall and presence of severe pain in extremities with or without numbness is often diagnosed as joint arthritis of leg. History of pain, tingling and fall is a warning sign of possible disease involving spinal cord and immediate MRI or CT Scan should be requested to rule out spinal cord tumor. In few cases patient may not give history of fall but may give history of difficulties to get in and out of bed as well as unable to stand from sitting position without support.
Symptoms of Paralysis (Paraplegia and Quadriplegia) Caused due to Spinal Cord Tumor in Neck
The destruction of motor fibers caused by compression of spinal cord by spinal tumor in neck results in severe malfunction of motor nerves. The impulses from brain and subcortical centers when stops passing through motor nerves to the peripheral muscles then muscles do not function and becomes unable to contract or relax. Such a failure of function of muscles resulting in failure to contract or relax causes severe weakness. Severe muscle weakness in entire arm and leg results in paraplegia or quadriplegia. Paraplegia is a condition when two extremities are paralyzed and quadriplegia when four extremities are paralyzed. Paraplegia and quadriplegia condition develops when entire bundle of motor nerve is damaged by compression or infiltration by spinal cord tumor mass in neck. Paraplegia and quadriplegia develops when initial symptoms of pain, tingling, numbness and weakness are either ignored or diagnosed as a caused by different disease than spinal cord tumor of neck.
Symptoms of Incontinence Caused due to Spinal Cord Tumor in Neck
The parasympathetic nerve fibers of urinary bladder, sigmoid colon and anus are bundled within spinal cord. These bundle of parasympathetic nerves travel up and down within spinal cord. The parasympathetic nerves branches out from spinal cord and passes to urinary bladder, sigmoid colon, urethra and anus as a third and forth sacral nerves. Severe compression or infiltration by spinal tumor mass in neck causes permanent or temporary damage of these parasympathetic nerves. The symptoms that follow are incontinence of urine and stool.
Investigations and Diagnosis of Spinal Cord Tumor in Neck
The reliable study for diagnosis of spinal cord tumor of neck is CT Scan and MRI study of the vertebral column and spinal cord.
Blood, urine and stool examination in most of the cases is normal. In later stages during sedentary life style because of severe weaknesses and being unable to move, the blood electrolytes often turns abnormal. In few cases of sedentary patient, blood examination may suggest low hemoglobin and red blood cell count causing anemia.
X-Ray Chest- Chest X-Ray is routinely performed in most of the cases who are complaining of chest pain and weakness. Chest pain may be caused by irritation of sensory nerve by spinal cord tumor of neck. Chest X-ray if showing positive signs of tumor mass in patients complaining of chest pain then detailed history of pain is essential to rule out metastasis (spread of tumor) to neck spinal cord. Urgent MRI and CT Scan are recommended if chest X-Ray of patient suffering with pain, tingling, numbness or weakness show cancer growth in lung. MRI and CT Scan of entire vertebral column and spinal cord are indicated to rule out metastasis of primary tumor into spinal cord.
X-Ray Neck Vertebral Column- X-Ray of spinal cord and vertebral column in neck may not differentiate the tumor mass if the tumor mass is benign. The X-Ray does show irregularities of bones when malignant tumor is attached to bones of vertebral column of neck.
CT Scan of Neck Vertebral Column and Spinal Cord – Neck CT Scan will differentiate the tumor mass in neck from normal anatomical structure. CT scan may not show details of tumor infiltration into tissue of spinal cord but will show the severity compression of spinal cord. CT scan also shows the details of extradural malignant tumor, which originates from bones of vertebral column.
CT Scan of Lung, Brain and Abdomen
CT scan of lung, brain and abdomen is recommended once neck spinal cord tumor mass is diagnosed by MRI or CT scan. The primary malignant tumor of lung, brain and colon may metastasize to spinal cord of neck.
MRI of Neck Vertebral Column and Spinal Cord-
MRI (Magnetic Resonance Image) study gives better information details of abnormalities associated with soft tissue like spinal cord, ligaments and tendons. While CT scan provides better information of bones and cartilages. The spinal cord compression and infiltration of spinal cord tumor of neck is evaluated with MRI for detailed information. The decision to perform surgery depends on adherence or infiltration of tumor in to spinal cord and MRI provides information of tumor behavior.
Once the spinal cord tumor is diagnosed with CT scan and MRI then the tumor biopsy is performed to evaluate the tumor behavior. Biopsy will differentiate benign and malignant character of the tumor. The staging classification of spinal cord tumor mass is assessed following detailed pathological study of biopsy samples. Staging is necessary to classify benign and malignant spinal cord tumor of neck.
Treatment of Spinal Cord Tumor of Neck
The choice of treatment for spinal cord tumor of the neck is conservative treatment, chemotherapy and surgical treatment. The non-aggressive benign tumor is treated with conservative treatment and chemotherapy. The aggressive benign and malignant tumor is treated with surgery followed by chemotherapy.
Most of the spinal cord tumor of neck is treated with surgery. Outcome and follow up results are better if tumor mass is surgically removed.
Excision of Spinal Cord Tumor in Neck- Small isolated spinal cord tumor of neck is surgically removed. Removal of small tumor during early stages is harmless and post-surgical complications are often none. Large spinal cord tumor is often closely adhered to spinal cord and causes severe pressure over spinal cord. Such large spinal cord tumor mass is difficult to remove without causing surgical trauma to spinal cord. In many cases tumor mass is partially removed and residual tumor is treated with chemotherapy. The malignant aggressive tumor is seldom treated with surgery. In few cases palliative surgery is performed for symptomatic pain relief and improve symptoms like numbness and weakness. Such surgery is known as palliative surgery. Sometime palliative surgery is performed to prevent quadriplegia or paraplegia. Large tumor mass in few cases is removed after embolization of blood vessels.
Embolization of Spinal Cord Tumor in Neck- Embolization of blood vessels is performed to eliminate blood supply to tumor mass, so tumor mass will not grow and possibly shrink. A small catheter is passed into several arteries supplying blood to tumor mass. Through the catheter, which is placed in arteries or arterioles (smaller artery) several tiny coil are inserted and placed within the lumen of these arteries. Coil initiate blood clot and eventually blood clot blocks the arterial blood flow to the tumor mass. Lack of blood supply helps to prevent growth and eventually causes shrinkage of the tumor mass. Later surgery is performed to excise the tumor, which is smaller in size. The surgery helps to remove the compression of spinal cord and helps to relieve symptoms. Excision could be partial or complete depending on tumor adherence or infiltration into spinal cord.
Chemotherapy for Spinal Cord Tumor of Neck
Large tumor mass of spinal cord located in neck are often treated with chemotherapy so as to shrink the tumor mass. The smaller tumor mass may be easier to dissect from normal tissue prior to excision. Few aggressive malignant tumor and large benign tumor are partially excised since most of the tumor is either adhered to spinal cord or infiltrated in spinal cord. The remaining tumor is treated with chemotherapy.
Life Expectancy, Outcome and Prognosis of Spinal Cord Tumor of Neck
The prognosis depends on symptomatic relief. Outcome is favorable depending on early diagnosis and when spinal cord tumor mass in neck is small resulting in longer life expectancy. Survival rate of patient with spinal cord tumor of neck is higher resulting in longer life expectancy when tumor mass is small and operable. Small benign tumor mass is often completely removed and recurrence is rare. The life expectancy and survival rate following surgical treatment resulting in complete removal of spinal cord tumor of neck is excellent. Patient may expect a prolonged normal life expectancy unless patient is suffering from any other serious illnesses. The prognosis is also excellent in such cases after removal of the tumor. The symptomatic pain relief and improvement in numbness as well as weakness is satisfactory when most of the large benign tumor is surgically removed.
The outcome and prognosis is worst in spite of surgical treatment and chemotherapy when large tumor mass has infiltrated into spinal cord or causes severe compression of spinal cord. Life expectancy in such cases is less than 5 years and survival rate is very low beyond 5 years. Prognosis is also not satisfactory with malignant spinal cord tumor of neck when tumor mass is compressing the spinal cord and possibly infiltrated in spinal cord. Life expectancy is often less than few months when large tumor mass is aggressive and malignant. Survival rate in such cases is very low often counted in weeks or months.