A spinal lesion is an abnormal tissue area or change on the spinal column or within the spinal cord. They can arise from injury, disease, or abnormal growths. While concerning, spinal lesions are not always indicative of severe conditions. A medical evaluation determines their exact nature and implications.
Understanding Spinal Lesions
Spinal lesions are abnormal tissue areas affecting the spinal cord or surrounding spinal column. They can range from solid masses to fluid-filled sacs, or areas of inflammation and cellular damage. They can be located within vertebral bone, directly on the spinal cord, or in surrounding tissues.
Lesions are classified by nature and behavior. Some are benign (non-cancerous and do not spread). Others are malignant (cancerous growths that can invade nearby tissues and spread). Lesion location also helps categorize them: intramedullary (within the spinal cord), intradural-extramedullary (inside the spinal cord’s covering but outside the cord), or extradural (outside the spinal cord’s covering).
Common Causes of Spinal Lesions
Spinal lesions can stem from a variety of underlying conditions, each with distinct characteristics and implications.
Tumors
Spinal tumors are a common cause of lesions, and they can be benign or malignant. Benign spinal tumors develop from various cell types within the spinal cord, spinal canal, or vertebrae. Examples include meningiomas (from protective membranes) and schwannomas (from nerve-covering cells). Hemangiomas, from blood vessel tissues, are also common benign primary spinal tumors. These benign tumors can still cause symptoms by compressing the spinal cord or nerves.
Malignant spinal tumors are characterized by uncontrolled cell multiplication and spread. These can be primary tumors, originating in the spine from bone, nerve, or supporting tissues, or metastatic tumors that have spread from other parts of the body. Metastatic spinal tumors are more common, often originating from cancers of the lung, breast, prostate, or kidney. Primary malignant spinal tumors include osteosarcoma (bone cancer) and multiple myeloma (affecting plasma cells in bone marrow). Other malignant types include chondrosarcoma (affecting cartilage) and Ewing sarcoma (impacting bone and soft tissue).
Infections
Infections can lead to spinal lesions when bacteria or fungi spread to the spine from another part of the body, often through the bloodstream. Staphylococcus aureus is a common bacterium, causing conditions like osteomyelitis (vertebral bone infection) and discitis (intervertebral disc infection). These infections can lead to inflammation and damage within the spinal structures. Risk factors include compromised immune systems, diabetes, intravenous drug use, and recent spinal surgery.
Inflammatory and Autoimmune Conditions
Inflammatory and autoimmune conditions occur when the body’s immune system mistakenly attacks its own healthy tissues, leading to inflammation and damage. Multiple sclerosis (MS) is a chronic disease that can cause lesions on the spinal cord by damaging the nerve’s protective covering, the myelin sheath. Transverse myelitis is another inflammatory condition that results in a focal lesion of the spinal cord. Certain types of arthritis, such as ankylosing spondylitis, can cause vertebrae to fuse over time, leading to stiffness and potentially affecting the spinal cord. Systemic lupus erythematosus (SLE) and Sjögren’s syndrome are other autoimmune disorders that can be associated with myelitis and spinal lesions.
Cysts and Vascular Malformations
Cysts are fluid-filled sacs that can develop in the spine. Synovial cysts, for example, are benign sacs that form in the facet joints of the spine due to age-related degenerative changes. If these cysts grow large enough, they can compress the spinal cord or nerves, leading to symptoms.
Vascular malformations are abnormal formations of blood vessels that can occur in or near the spinal cord. The two most common types are arteriovenous malformations (AVMs), which are tangles of vessels, and spinal dural arteriovenous fistulas (DAVFs), which involve abnormal connections between arteries and veins in the spinal cord’s covering. These malformations can cause damage by compressing the spinal cord, depriving it of oxygen-rich blood, or by rupturing and causing bleeding.
How Spinal Lesions are Diagnosed
Diagnosing spinal lesions begins with a thorough medical investigation prompted by a patient’s symptoms. Common symptoms include localized pain in the neck, back, or lower spine, which may worsen at night or with coughing. Neurological symptoms such as numbness, tingling, weakness in the limbs, or difficulty with fine motor skills are also common. Some individuals may experience problems with balance or coordination, changes in sexual function, or loss of bowel or bladder control.
A medical professional conducts a physical and neurological assessment to check reflexes, sensations, strength, and coordination. Imaging techniques visualize the spine and identify abnormalities. Magnetic Resonance Imaging (MRI) is a primary method due to its ability to provide detailed images of the spinal cord, soft tissues, and surrounding structures, helping to detect tumors, disc issues, and areas of inflammation.
Computed Tomography (CT) scans offer more detailed images of bone structures and can help determine a lesion’s size and location. X-rays can reveal bone damage, fractures, or changes in spinal alignment. In some cases, a myelogram (injecting dye into spinal fluid before an X-ray or CT scan) may be used to outline the spinal cord and nerve roots.
When a lesion’s nature is unclear from imaging alone, a biopsy may be performed to obtain a tissue sample for microscopic examination. This procedure helps determine if cells are benign or malignant and identifies the specific type of tumor or infection. Blood and urine tests can also look for signs of infection, inflammation, or certain diseases that might cause spinal lesions.
Implications and Management
The implications of a spinal lesion and the subsequent management depend on the specific cause identified through diagnosis. Early diagnosis is beneficial, allowing for timely intervention and potentially preventing the progression of symptoms or further damage. Treatment plans are personalized, considering the lesion’s type, size, location, and the patient’s overall health.
General management strategies for spinal lesions encompass a range of approaches. For some benign lesions not causing symptoms or growing, observation with regular monitoring may be sufficient. Medications are used to manage symptoms such as pain and inflammation; these can include anti-inflammatory drugs, muscle relaxants, or specific medications for infections or autoimmune conditions. For infections, antibiotics are prescribed, and for inflammatory conditions, immunosuppressants may be used.
Surgical intervention may be considered to remove tumors, relieve pressure on the spinal cord or nerves, or stabilize the spine in cases of vertebral damage. Radiation therapy, including targeted techniques like stereotactic radiosurgery, is a non-invasive option used for spinal tumors to shrink or destroy cancerous cells, especially in metastatic cases. Physical therapy is integrated into management plans to help improve mobility, reduce pain, and enhance overall function following diagnosis or treatment. Consulting with healthcare professionals is important for an accurate diagnosis and appropriate guidance regarding spinal lesions.