An Overview of Spinal Lesions

A spinal lesion describes any area of abnormal tissue on the spinal cord, whether it is benign (non-cancerous) or malignant (cancerous). Also known as a central lesion because of its impact on the central nervous system, spinal lesions have many different causes and, depending on their location, can cause different neurological (nerve-related) symptoms.

This article looks at the possible symptoms and causes of spinal lesions and provides an overview of how spinal lesions are commonly diagnosed and treated.

Symptoms

Spinal lesions can cause different symptoms depending on their location on the spinal cord as well as the lesion type and cause.

There may be problems with motor skills and abilities. Some people experience chronic pain, while others may have a loss of certain bodily functions due to the blockage or interruption of nerve signals.

Among the possible symptoms of a spinal cord lesion are:

• Pain
  
• Numbness
• Tingling, prickly, or burning sensation
• Electrical shock-like sensations
• Muscle weakness
• Muscle stiffness
• Difficulty with fine motor skills (such as writing)
• Problem with balance or coordination
• Loss of reflexes or overactive reflexes
• Muscle spasms
• Changes in sexual function
• Loss of bowel or bladder control
• Difficulty breathing
  
• Paralysis

Causes

A lesion is an abnormal change caused by a disease or injury that affects any tissue or organ. Spinal lesions have a wide variety of possible causes, including:

Trauma

All sorts of traumatic spinal cord injuries can result in spinal lesions. Most traumatic spinal cord lesions happen as a result of:

• Falls
• Road traffic accidents
• Gunshot wounds and assaults
• Sports or workplace injuries
• Medical or surgical injuries

With nearly 15 million people across the world living with spinal cord injuries, this is by far one of the most common causes of spinal cord lesions.

Depending on the severity of a spinal trauma, effects can range from vertebral (bone) pain to severe neurological lesions, such as tetraplegia (paralysis of all four limbs), or paraplegia (paralysis of the legs).

Infections

Several kinds of spinal infections can result in spinal lesions:

• Osteomyelitis is the most common type of spinal infection, and may affect the bone marrow, vertebrae, or soft tissues. It is frequently caused by the bacterium Staphylococcus aureus, which travels to the spinal column via the blood, causing gradual bone destruction.
• Discitis is an uncommon spinal infection that develops in the spaces between adjacent vertebrae (disc spaces). Again, staphylococcus is the most common culprit, and is sometimes introduced during surgery.
• Spinal epidural abscess is an infection that typically affects the lumbar region (lower back) of the spine. The abscess is a pocket of pus that builds up and causes swelling. It, too, is most often caused by staphylococcus infection.
• Spinal subdural abscess is a very rare infection that causes an abscess in the spinal canal. It can be a complication of tuberculosis infection, particularly in developing countries, but usually arises as a result of a staphylococcus infection elsewhere in the body.
• Meningitis refers to inflammation of the layers of protective membranes (meninges) that surround the brain and spine. The swelling is usually caused by a bacterial or viral infection, such as group B Streptococcus, or Escherichia coli (E-coli).
• Spinal cord abscess is another type of infection that causes infected, pus-filled pockets in and around the spine. Spinal cord infection often occurs as a complication of spinal subdural abscess. Like most types of spinal infections, it also tends to result from staphylococcus bacteria.

Benign Tumors

Tumors that begin in and around the spinal cord are called spinal cord tumors. While rare, benign spinal tumors can place pressure on the spinal cord, nerve roots, and nearby blood vessels, potentially resulting in an array of side effects.

Types of spinal tumors that are usually benign include:

• Neurofibroma: An overgrowth of nerve tissues, mast cells, collagen bundles, and other fibers that grow on the nerves exiting the spine
• Schwannoma: An overgrowth of Schwann cells that arise from nerve roots exiting the spine
• Meningioma: A tumor that grows in the meninges surrounding the spinal cord
• Ependymomas: A spinal tumor most often seen in children that develops from ependymal cells
• Astrocytoma: A common, star-shaped tumor consisting of a buildup of cells called astrocytes
• Hemangioblastoma: A tumor that grows in the blood vessels of the spinal cord
• Osteosarcoma: A tumor that may be benign or malignant, which consists of an overgrowth of osteoblast cells (cells that form new bones)

Many benign tumors are slow growing and may not cause any symptoms for years.

Cancer

Most malignant spinal tumors are metastatic, meaning that the cancer started in a different area of the body before spreading to the spine. But malignant spinal tumors can also develop in the spine first. These are called primary spinal tumors.

Types of malignant spinal tumors include:

• Osteosarcoma: A tumor that usually develops on the thigh or shin bone, but can start in the spine
• Chondrosarcoma: A tumor consisting of cartilage cells that may develop in the bones that form the spinal column
• Multiple myeloma: A cancer in which plasma cells in collect in bone marrow, and may break through the bone into the tissues around the spine
• Lymphoma: A group of cancers caused by lymphocytes that grow out of control and can form a tumor in the spine
• Chordoma: A type of tumor that usually develops in the spinal column, typically in the sacrum (a bone at the base of the spine)
• Ewing sarcoma: A rare cancer of the bone and surrounding soft tissues

Tumors that grow large enough can result in spinal misalignments and deformities.

Chronic Disease

Several autoimmune and inflammatory diseases can result in spinal lesions, including:

• Multiple sclerosis: A chronic disease that inflames and damages the myelin sheath (a protective sheath around nerves), resulting in lesions on the spinal cord that may interfere with normal nerve functioning
• Sarcoidosis: A chronic disease that causes inflammation and lesions in the spine, eventually leading to bone destruction, weakness, and a risk of bone fractures and collapses
• Ankylosing spondylitis: A type of chronic inflammatory arthritis that causes bone destruction, excessive bone formation, and bone spurs in and around the spine
• Rheumatoid arthritis: Another chronic inflammatory arthritis that can result in erosions and bone spurs on the spine

Vascular Disorders

The term vascular refers to blood vessels. Vascular disorders cause abnormalities in blood vessels that can form spinal cord lesions. Such vascular disorders include:

• Arteriovenous malformation: Characterized by an abnormal tangle of blood vessels in the spine and disruptions in blood flow to the spine
• Arteriovenous fistula: Characterized by an abnormal connection that forms between an artery and a vein in the spinal cord's protective covering, called the dura
• Cavernous angioma: Characterized by a cluster of abnormally dilated and thin blood vessels that take on a berry-like appearance
• Spinal aneurysm: Characterized by a bulging blood vessel in the spinal cord that may disrupt blood flow

Congenital Malformations

Many people are born with spinal malformations, such as an extra lumbar vertebrae. In many cases, these congenital conditions do not cause symptoms.

Congenital malformations that cause spinal lesions include:

• Scoliosis: In which the spine curves sideways instead of being straight
• Kyphosis: In which the spine excessively curves forwards, leading to a hunched posture
• Torticollis: In which the neck abnormally tilts to one side and rotate in the opposite direction
• Lordosis: In which the lower spine curves in a manner that makes the buttocks appear more prominent
• Vertebral defects: In which a vertebrae develops with an abnormal shape

Diagnosis

The diagnosis of a spinal lesion typically begins when a lesion is spotted on an X-ray or other imaging test. In addition to a physical exam and a review of your medical history, a neurological exam will be performed to check for any abnormalities in your reflexes, sensations, strength, and coordination.

Based on the findings, other tests may be performed to narrow the possible causes. These may include:

• Blood and urine tests to look for signs of infection, inflammation, or disease
• Imaging studies, including computed tomography (CT), or magnetic resonance imaging (MRI)
• Myelography to look for problems in the spinal canal
• Lumbar puncture (spinal tap) to obtain cerebrospinal fluid (CSF) for evaluation
• Spinal tumor biopsy to investigate for cancer

Treatment

The treatment of a spinal lesion varies by the underlying cause. Among the examples:

• Infections may be treated with antibiotics, antifungals, or antiviral drugs.
• Inflammatory conditions may be treated with anti-inflammatory drugs, steroids, or immunosuppressant drugs.
• Inflammatory may also be treated with immunosuppressants and disease-modifying therapies.
• Cancer may be treated with surgical resection (removal), radiation, chemotherapy, and targeted therapies. Benign tumors may require resection.
• Congenital conditions may benefit from spinal surgery or the use of corrective braces.
  

Physical therapy may be able to help restore function after treatment and initial recovery.

Summary

A spinal lesion is an abnormal change caused by a disease or injury that affects tissues of the spinal cord. Symptoms include pain, abnormal sensations, loss of motor skills or coordination, or the loss of certain bodily functions. Causes include trauma, infection, autoimmune diseases, inflammatory diseases, congenital malformations, and benign or cancerous tumors.

Spinal lesions are commonly spotted on imaging tests. Based on the suspected cause, the doctor may perform a neurological exam, various blood or urine tests, additional imaging tests, a spinal tap, or a tumor biopsy. The treatment varies by the diagnosed causes.