Spinal ependymomas account for 1.8% of all central nervous system (CNS) neoplasms in adults. In this chapter we will review the epidemiology, clinical presentation, management, pathophysiology, and imaging findings of the most common spinal tumors. Management and treatment of these tumors is highly dependent on the clinical presentation, tumor location, and histology. The contrast resolution of MRI is useful in identifying the anatomic location and soft tissue extent of all spinal tumors. However, magnetic resonance imaging (MRI) is the most appropriate imaging modality for any spinal cord and extramedullary-intradural pathology and for most of the extradural lesions.

Additionally CT helps identify matrix calcifications and extent of osseous destruction in cases of extradural tumors. These images should be evaluated for the presence of intramedullary or epidural hyperdensity, which is always abnormal, usually reflecting trauma, neoplasm, or vascular malformation. Patients with symptomatic spinal cord tumors often undergo a computed tomography (CT) examination of the spine as the first imaging modality. Torticollis and scoliosis can be seen in younger children. The clinical presentation for spinal cord tumors often includes back pain, weakness, and/or insidious and progressive myelopathy.

(Illustrated by David Bier, University of Texas MD Anderson Cancer Center, Houston, TX.) Even though rare, IMSCTs are usually associated with significant neurologic dysfunction, morbidity, and mortality. IMSCTs primarily consist of gliomas (90%), of which ependymomas represent 60% and astrocytomas 30% ( Fig. IMSCTs are the least common spinal tumor type in adults (4%-10%) but the most common spinal tumors in children (35%). Intramedullary spinal cord tumors (IMSCTs) occur within the spinal cord. They are the second most common spinal tumors in adults (20%-30%) and most are either meningioma (50%) or peripheral nerve sheath tumors (50%). Extramedullary-intradural tumors include masses originating from the dura/arachnoid and nerves. The majority of spinal tumors (60%) in adults are extradural tumors and are most commonly (90%) metastases of systemic cancer. Extradural tumors include masses in the bones, disks, and paraspinal soft tissues. Spinal neoplasms are divided into three groups based on their anatomic locations: extradural, extramedullary-intradural, and intramedullary tumors ( Fig.

X ray cervical spine tumor