Spinal Cord Tumors

Since 60 to 85 per cent (1, 2) of spinal cord tumors are benign and potentially curable, it is of the utmost importance to establish the diagnosis before irreversible pressure changes have occurred in the cord. Our review of 68 verified cases indicates, however, that early diagnosis is infrequent. We believe that the reason for the common delay in making an early diagnosis of spinal cord tumor is failure on the part of many physicians to consider this possibility. Tumors of the spinal cord are not common. At the University of Chicago Clinics, only 58 cord tumors were diagnosed in 234,000 admissions over a ten-year period (3). In a similar period at the Cleveland Clinic, one verified cord tumor has been recorded for approximately every 2,518 patients examined. It is believed that early diagnosis of spinal cord tumors is possible in at least 95 per cent of the cases if careful clinical and roentgenologic investigations are conducted. In our series, 48 per cent of the patients with this diagnosis had spastic or flaccid paralysis and sphincter disturbances when first seen at the Clinic; this suggests that the diagnosis could have been made much sooner. Material This study is concerned only with primary tumors arising within the spinal canal and beneath the dura. Extradural tumors have been eliminated from consideration unless exploration established the fact that they originated beneath the dura and subsequently split it to occupy an extradural position. The histologic classification of the 71 tumors removed from 68 patients is presented in Table 1. As is usual the neurofibromas outnumbered all other cell types. Meningiomas and ependymomas followed in order of frequency. Foerster and Bailey (4) reported two instances of multiple spinal cord tumors in a series of 100 cases, and Camp (5) has indicated that 4 per cent of spinal cord tumors are multiple. In our group there was a patient who had one subdural meningioma removed from the region of D-8 in July 1933, a second meningioma removed at D-10 in November 1933, a third removed from D-6 in July 1946, and a fourth from D-9 in September 1946. The series is somewhat unusual in that it contained 2 developmental tumors—an epidermoid and a mixed tumor. To date approximately 80 developmental tumors have been reported in the literature. Of the 71 tumors, 48 were subdural; 11 were subdural and extradural; 12 were intramedullary. Our incidence of intramedullary tumors—16 per cent—is slightly higher than the 11.5 per cent reported by Rasmussen, Kernohan, and Adson (6), but it is within the limits of 10 to 20 per cent quoted by others (7). The distribution of tumors within the spinal canal was not unusual. Sixteen were in the cervical spine, 29 in the dorsal, 25 in the lumbar, and 1 in the sacral spine. As in most reported series of cord tumors, meningiomas predominated in the dorsal spine. Seventeen of our 22 meningiomas were dorsal. Clinical Aspects Age: Our patients ranged in age from 9 to 82 years.