TUMORS of the spinal cord are among the rarer affections of the central nervous system. Frazier, in 1918, was able to collect only 330 cases in which operation had disclosed the tumor. Frazier's report does not include 135 cases recorded by Schlesinger, which were found in 35,000 necropsies over a period of eighteen years in Das Allgemeine Krankenhaus, Vienna. Since his report, Adson has added 119 cases of his own, in which operation was performed. Sargent has reported 27 cases, and Elsberg, 67. Some of these, no doubt, are represented in Frazier's collection. Browning, in a review of the literature, collected 80 cases of tuberculosis of the spinal cord. We have been able to find but few references in the literature to the direct X-ray evidence of spinal-cord tumors. Adson has commented on the erosion of the vertebral processes as a result of a spinal-cord tumor. Pancoast says, “Tumors of the spinal cord cannot be diagnosed by this method, and if by any chance they involve the vertebræ secondarily, the appearance is in no way suggestive of their primary origin.” According to Elsberg, the extradural tumors, more especially the sarcomas, may cause absorption of bone, which can be recognized in the roentgenogram. The X-ray shows that one or several laminæ have been absorbed. This is due to the pressure of the tumor on the arches of the vertebræ. Elsberg does not present roentgenograms showing the condition. Pathology According to Adson, the type of the spinal-cord tumor depends chiefly on its point of origin: those arising from the vertebræ are bony or cartilaginous; those arising from the meninges are endotheliomas, psammomas, and so forth. Such tumors are rarely malignant, are slow growing, and do not become very large. Tumors of the cord itself are usually gliomas: some degenerate and become cystic, others remain firm and solid. Ependymal gliomas arise from the conus and extend down through the canal of the lumbar region. Steinke classifies spinal-cord tumors into four general groups: (1) extramedullary (intradural and extradural); (2) intramedullary; (3) tumors of the cauda equina; and (4) vertebral (primary and secondary). The growths most often encountered by the surgeon are fibromas, sarcomas, gliomas, endotheliomas, psammomas, lipomas, tuberculous tumors, and gummas. Exostoses, chondromas, and so forth, occur but rarely. Potel and Veaudeau found that 52 per cent of all spinal-cord tumors occurred in the thoracic vertebræ, 20 per cent in the cervical region, and 28 per cent in the cauda equina and lumbosacral vertebræ. These figures were subsequently borne out by Frazier's cases; 152 of his cases were meningeal, 58 vertebral, 36 intramedullary, and 30 caudal. In 54 cases the point of origin was not stated. Symptoms The symptoms of spinal-cord tumor are not always typical; however, a thorough history and a careful neurologic examination will give the clinician the correct diagnosis in a fair percentage of cases.
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Carman et al. (1924) studied this question.