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932 Spinal Cord Neoplasia

Spinal Cord Neoplasia Client Education
Sheet
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○ Mean duration of signs ≈6 weeks,
BASIC INFORMATION
range is 1 day to 1 year. In one study, ○ Nephroblastoma (rare): dogs < 2 years
old, intradural/extramedullary, between
Definition duration of clinical signs before T10 and L2 vertebrae
• Spinal neoplasms encompass a wide range diagnosis was longest for intradural/ ○ Multiple cartilaginous exostosis/osteochon-
of cancers. Vertebral neoplasms are often extramedullary tumors, followed by droma can undergo malignant transforma-
included in discussions of spinal neoplasms extradural tumors. Shortest duration tion to osteosarcoma or chondrosarcoma.
because they secondarily impact the spinal was for intramedullary tumors. Acute • Feline lymphoma: FeLV infection
cord and thereby result in clinical signs of presentation also observed, notably with
neurologic dysfunction. lymphoma DIAGNOSIS
• Spinal neoplasms are divided into primary ○ Intramedullary neoplasms: dogs with
and secondary (metastatic or extension from secondary neoplasms (metastasis) tend to Diagnostic Overview
extravertebral tissues) tumors. be older and have a shorter duration of Presumptive diagnosis is based on cross-sectional
• Primary neoplasms can arise from vertebrae, clinical signs before presentation compared imaging. MRI is the gold standard. Lesion
meninges, or neuroparenchyma. with dogs with primary intramedullary location (extravertebral, vertebral, extradural,
○ Vertebral neoplasia: osteosarcoma, fibro- neoplasms. intradural/extramedullary, or intramedullary),
sarcoma, hemangiosarcoma, plasma cell • Feline lymphoma: acute onset (often ≤ 7 lesion intensity, lesion topography (borders,
tumor/multiple myeloma, lymphoma, days) shape), and degree of contrast enhancement
cartilaginous exostosis/osteochondroma may suggest a specific histologic type. In dogs
○ Meningeal: meningioma PHYSICAL EXAM FINDINGS with an intramedullary lesion, MRI is sensi-
○ Neuroparenchyma: nerve sheath tumors • Neurologic exam (p. 1136). Deficits depend tive imaging modality for discrimination of
(NSTs), glial tumors (oligodendroglioma, on location and are often asymmetrical. Pain intramedullary neoplasms from other causes.
astrocytoma, oligoastrocytoma, gliomatosis may be noted on palpation of the vertebral Despite this, definitive diagnosis requires
cerebri), ependymoma, metastatic choroid column. histologic evaluation.
plexus carcinoma, cordoma • Neurologic signs can often be localized to
○ Mesenchymal tumors: myxoma/ a region of the spinal cord: Differential Diagnosis
myxosarcoma, histiocytic sarcoma, ○ C1-C5 spinal cord segments: upper motor • Canine: intervertebral disc herniation,
nephroblastoma neuron (UMN) tetraparesis/plegia and discospondylitis, infectious meningomyelitis
○ Secondary neoplasia: metastatic cancers GP ataxia, postural reaction deficits, (canine distemper virus [CDV], rabies,
such as prostatic, mammary adenocar- normal to exaggerated myotatic reflexes, fungal, Neospora caninum/Toxoplasma gondii,
cinoma, osteosarcoma, transitional cell normal withdrawal reflexes, normal to bacterial), granulomatous meningoencephalo-
carcinoma, melanoma, thyroid carcinoma, increased muscular tone myelitis, trauma, cervical spondylomyelopa-
pheochromocytoma, and those that ○ C6-T2 spinal cord segments: tetraparesis/ thy, fibrocartilaginous embolic myelopathy,
secondarily invade the vertebral column plegia, postural reaction deficits all four orthopedic disease
± spinal cord (i.e., infiltrative lipoma/ limbs; thoracic limbs: short, choppy gait, • Feline: infectious meningomyelitis (feline
liposarcoma) decreased withdrawal reflexes, decreased infectious peritonitis virus, feline im-
muscular tone, muscle atrophy: pelvic munodeficiency virus [FIV], Toxoplasma
Epidemiology limbs: GP ataxia/UMN paresis, normal gondii, rabies, fungal, bacterial), trauma,
SPECIES, AGE, SEX to exaggerated myotatic reflexes, normal aortic thromboembolism, intervertebral disc
• Canine: middle-aged to older, large-breed withdrawal reflexes, normal to increased herniation
dogs muscular tone
○ Possible male predisposition for menin- ○ T3-L3 spinal cord segments: GP ataxia/ Initial Database
gioma (p. 557) UMN paraparesis/plegia; pelvic limbs: • CBC, serum biochemical profile, urinalysis,
○ Boxer and golden retriever predisposition normal to exaggerated myotatic reflexes, and radiographs of thorax, abdomen, and
for meningioma normal withdrawal reflexes, normal to vertebral column
• Feline: lymphoma; any age but in young increased muscular tone; normal thoracic • Depending on clinical suspicion: serologic
(median, 2-3 years) cats often have concur- limbs testing
rent feline leukemia (FeLV) infection ○ L4-S3 segments, roots or spinal nerves: ○ Feline: serologic testing for FeLV, FIV,
paraparesis/plegia; short-strided and Cryptococcus neoformans, T. gondii
Clinical Presentation crouched pelvic limb posture and gait, ○ Canine: serologic testing for C. neofor-
HISTORY, CHIEF COMPLAINT postural reaction deficits, decreased myo- mans, N. caninum, T. gondii, paired titers
• Clinical signs are related to the anatomic tatic and withdrawal reflexes, decreased (cerebrospinal fluid [CSF]/serum) for
location of the lesion. Lesions affecting the muscular tone, muscle atrophy in pelvic CDV
cervical spinal cord to the level of the cranial limbs; decreased perineal reflex, urinary
thoracic spinal cord (spinal cord segments T1 incontinence, and/or fecal incontinence; Advanced or Confirmatory Testing
and T2) present with tetraparesis, whereas decreased tail function • Cross-sectional imaging: MRI (p. 1132)
lesions affecting the thoracolumbar spinal is the gold standard; CT, combined CT/
cord caudal to the T2 spinal cord segment Etiology and Pathophysiology myelography, myelography may be helpful
present with paraparesis. Lesions affecting • Cause is unknown. for vertebral neoplasms
the sacral spinal cord may cause urinary and • Canine ○ MRI characterization
fecal incontinence. ○ Meningioma commonly affects first three ■ Meningioma is often a broad-based,
• Canine: chronic progressive paresis and/or cervical spinal cord segments. intradural/extramedullary lesion dem-
general proprioceptive (GP) ataxia (scuffing ○ Osteosarcoma may occur in prior radiation onstrating uniformly strong contrast
digits, knuckling, crossing limbs) therapy fields. enhancement and dural tail.

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