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GENERAL CHARACTERISTICS OF PSYCHIATRIC DISORDERS IN OLDER
PEOPLE WITH SPINAL CORD TUMORS
(LITERATURE REVIEW)
Ibragimova Muazam Holdorovna
Assistant of the department of psychiatry, medical psychology and narcology, Samarkand State
Medical University, Samarkand, Republic of Uzbekistan
Shamshiyeva Zohida Saloxiddin qizi
Samarkand State Medical University Faculty of medicine №1,
516-Group student, Samarkand, Republic of Uzbekistan.
https://doi.org/10.5281/zenodo.10734961
Abstract.
primary spinal cord tumors are combined with many independent tumors that
develop from the spinal parenchyma, its roots, membranes, vertebrae and other structures, which
are involved in the formation of the spinal canal, differing in localization, histological structure,
clinical development and course prognosis. According to the International Classification of
diseases, 10 revisions (ICD 10) distinguish primary spinal cord tumors as benign, malignant
histological structure, and cranial nerve spinal tumors.
Key words:
Spinal tumors, neurosurgical and mental disorders, pathology of the nervous
system in adults.
ОБЩАЯ ХАРАКТЕРИСТИКА ПСИХИЧЕСКИХ НАРУШЕНИЙ У ЛЮДЕЙ
ПОЖИЛОГО ВОЗРАСТА С ОПУХОЛЯМИ СПИННОГО МОЗГА
(ЛИТЕРАТУРНЫЙ ОБЗОР)
Аннотация.
Первичные опухоли спинного мозга сочетаются со многими
самостоятельными опухолями, развивающимися из паренхимы спинного мозга, его
корешков, оболочек, позвонков и других структур, участвующих в формировании
позвоночного канала, различающихся по локализации, гистологическому строению,
клиническому развитию и прогноз курса. Согласно Международной классификации
болезней 10 ревизии (МКБ 10) различают первичные опухоли спинного мозга как
доброкачественные, злокачественные по гистологической структуре и опухоли черепно-
мозговых нервов.
Ключевые слова:
опухоли позвоночника, нейрохирургические и психические
расстройства, патология нервной системы у взрослых.
Introduction.
Spinal cord tumors make up 2% of all neoplasms and 3% of the pathology
of the nervous system in adults, compared to brain tumors, they occur in proportion 1:9 [1]. Most
often, spinal tumors are observed in a socially active group of people aged 30-50 years, which
determines the relevance of this problem.
Based on the data of statistical analysis of adults with spinal cord tumors in Crimea, the
following distribution of neoplasms by localization was noted. Cervical tumors accounted for 19
%, thoracic – 47 %, lumbosacral-23%, kauda equina and terminal filament – 11%, corresponding
to literature data [2].
More than 4/5 of all neoplasms are localized in the thoracic and lumbosacral parts of the
spinal cord, and in women 2.5 times more than in men. Two main groups of tumors were
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distinguished: 1) intramedules located inside the spinal substance; 2) extramedullary tumors that
grow outside the spinal cord and cause its compression. Extramedullary tumors are extradural and
subdural in relation to dura mater [3].
Diagnosis of spinal cord tumors included clinical and neurological examination in
conjunction with additional examination methods. Contrast magnetic resonance imaging (MRI)
was the main and mandatory modern stage of neuroimaging of spinal cord tumors. Other
techniques such as spinal radiography, myelography, cerebrospinal fluid testing have been
included in a comprehensive examination, but have been carried out according to guidelines [4].
It should be noted that the use of Mrtangiography allows the detection of spinal vascular
neoplasms such as angioma and hemangioma in 6-13% of cases [5].
Extramedullary tumors are four times more frequent than intramedullary tumors, with
neurin (1/3) and meningioma (1/4) predominating. Lipomas, angiomas, dermoid cysts,
epidermoids, and teratomas are less common [5].
Among intramedullary tumors, ependymomas are most common (11-12% of the total
number of neoplasms). Astrocytomas, oligodendrogliomas, glioblastomas and spongioblastomas
accounted for 31% of all vertebrates, the most common being astrocytomas (second only to
ependym) [6].
MRI was one of the most informative diagnostic methods [7]. The use of MRI made it
possible to see the spinal cord and spine along its entire length and determine the location of the
tumor. The accumulation of a contrast substance in the tumor stroma allows you to assess not only
the spread of the tumor process, but also the histological structure of the tumor (Figure 1). With
intramedullary tumors, MRI showed an increase in the volume of the spinal cord with rigid or
cystic components of the neoplasm, often with uneven contours. In the tumor infiltration zone,
altered sizes of spinal diameter sometimes increased by 1.5–2 times the normal shapes [8].
In extramedullary tumors, spinal compression was found in MRI, with the expansion of the
subarachnoid space in the process zone, often with the destruction of spinal canal structures.
Computed tomography in some cases helped to establish a differential diagnosis between
extramedullary and intramedullary tumors with osteolytic or osteoblastic changes in the spine [9-
11].
In patients with spinal neoplasms, a ligurological examination made it possible to identify
changes in the structure of the cerebrospinal fluid characteristic of the tumor process: protein-cell
dissociation, increased clotting of the cerebrospinal fluid with normal amounts of protein in the
cerebrospinal fluid (greater than 0,45 g/l) cells (fruan – Nonne phenomenon). The longer the
tumor, the higher the protein content in the cerebrospinal fluid [12-14].
Ligvorodynamic samples (Quekenstedt and Stukey) made it possible to determine the
degree of transition of the subarachnoid space.
The most common radiological signs in spinal tumors were: calcification of the tumor; the
presence of an Elsberg –Daik symptom (narrowing and flattening of the roots of the spine from
pressure by the tumor); osteoporosis or osteosclerosis with the elimination of various parts of the
spine [15].
In some cases, descending and ascending myelography was used to determine the upper
and lower limits of the tumor. Contrast of the subarachnoid space combined with MRI or computed
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tomography of water-soluble contrast agents allowed for a significant increase in the quality of
diagnosis of spinal cord tumors, particularly extramedullary tumors [16].
Despite the fact that the clinical picture of spinal tumors is very diverse in their onset and
direction, regardless of their histological structure and localization, the progressive course is
widespread, sometimes combined with remissions. Extramedullary tumors were characterized by
three stages of disease development: 1) radicular; 2) Brown-Secar syndrome; 3) paraparesis or
paraplegia.
The initial or radicular stage is characterized by an increase in severe pain in the area of
localization of the tumor. Most often, the source of pain is irritation of the spinal roots of the spinal
cord. With tumors localized in the cervical spine and tail region, the most severe pain occurs. At
the level of the upper chest, the neoplasm is often accompanied by moderate root pain [17-22].
The brown-Secar stage is characterized by the presence of a central paresis on the side of
the tumor and impaired muscle-articular feeling, tactile and vibrational sensitivity. The violation
of the types of superficial sensitivity is determined against: pain, temperature and less touch. The
brounsecar stage is replaced by the paraparesic stage [23].
The paraparesis (paraplegia) stage is the longest. Local neurological symptoms during this
period depend on the degree of location of the tumor. At this stage, the average duration of the
clinical course with extramedullary tumors is 2-3 years, with cauda equina neoplasms – up to 10
years or more [24].
Intramedullary tumors were characterized by diseases of the cervix or lumbar thickening,
radicular pain and dissociated sensitivity.
Pain syndrome is also observed in intramedullary tumors, but in contrast to extramedullary
tumor root pain for intramedullary tumors, pain syndrome is characterized by definitions such as
"pain", "break", or "bite" in the Torso or extremities [25].
Conductive is a reducing type of sensitivity, while with extramedules it is paresthesia and
loss of upward sensitivity. These disorders are based on the law of the eccentric arrangement of
long conductors in the spinal cord [26].
Dysfunction of the pelvic organs was due to the degree of spinal compression, which
manifested relatively late in cervical thickening with the localization of intramedullary tumors
[27].
The characteristic clinical picture of intramedullary tumors was muscle atrophy caused by
damage to the anterior spinal cord, but with less muscle spasticity than extramedullary tumors
[28].
Extramedullary tumors affecting the posterior surface of the spinal cord have led to the
early occurrence of conductive disorders of muscul-articular sensation, vibration and two-
dimensional sensitivity. Posterolateral localization of extramedullary tumors was manifested by
pain radicular syndrome, a zone of hypesthesia in this area, followed by a complete loss of
sensitivity. The initial period of radicular pain with previous localization tumors was often absent
with characteristic conductive paresis and subsequent impairment of surface sensitivity [29-32].
Cervical spinal tumors were manifested by sluggish paresis or paralysis in the upper
extremities, and Central paresis (paraplegia) in the lower part, impaired sensitivity below the level
of injury [33].
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The thoracic tumor was characterized by motor disorders of the Central type, with
sensitivity disorders below the level of injury. Lumbar thickening tumors (L1 – S2) were
manifested by sluggish paresis of the lower extremities, loss of sensitivity from the level of
localization of the tumor. Brain cone tumors (S3 – S5) were accompanied by loss of sensitivity in
the area of the buttocks, perineum and external genital organs. Peripheral-type pelvic dysfunction
(urinary incontinence, stool) has been reported [34-37].
In the practice of Neurosurgery, a topographic and anatomical classification of primary
spinal tumors is used: I. in relation to the spinal cord, tumors are divided into two main groups:
the spinal cord causes compression.outside-these are extramedules in the spinal substance itself
and intramedullary tumors that cause compression [38].
Extramedullary tumors of the spinal cord are classified relative to dura mater: intra and
extradural, located in the subdural and extradural location, but with extravertebral growth [39].
Also, extramedullary tumors are divided along the spinal cord: dorsal localization, lateral,
dorzo-lateral, ventral and ventrolateral localization.
II. According to the degree of spinal localization, spinal tumors are divided into: tumors at
the level of the upper cervical vertebrae (C1-C4) and the lower neck (C5 - Th1). tumors at the level
of the thoracic vertebrae (Th2-Th10) and lower thoracic and first lumbar (Th 11 - L1). Cauda
equina tumors (L2 - S5).
Epidemiological and statistical studies around the world usually focus on dangerous
situations in various structures of the central nervous system for this reason, there is no real data
on benign neoplasms of the spinal cord and the central nervous system in general [40-43].
Despite several projects in the world to study neoplasms of the central nervous system,
epidemiological data of primary spinal cord tumors are poorly studied, there are no single
indicators that indicate the actual frequency and growth of primary spinal tumors. There are several
reports in the scientific literature devoted to the study of the epidemiology of primary tumors of
the spine, and research data vary widely, as primary tumors of the spine have been studied as part
of all tumors in different countries, regions and places.Central nervous system or localization and
in separate nosological forms depending on age groups [44-47].
According to foreign and domestic literature, primary spinal cord tumors account for about
4-16 percent of all tumors originating from the central nervous system [48]. Based on the results
of long-term, randomized work carried out in countries with high economic growth, the incidence
rate of primary tumors of the spine is highest. According to some authors of primary spinal tumors,
there is a basic localization with age, therefore, in childhood and adolescence, more than half of
tumors are diagnosed in the upper cervix of the spinal cord and cauda equina roots, in the elderly
and elderly - almost 90% are located in the thoracolumbar spinal cord [49]. In patients aged 20-50
years, more than 50% of primary tumors of the spine are located in the thoracic region, up to 20%
are diagnosed in the cervical region, and 30% of tumors are located in the lumbar spinal cord [50].
Spinal tumors dissolve from the whitest substance intramedullary tumors make up 30-50%
of primary spinal tumors, but at the same time no more than 3% of all central nervous tumors.
They are most often manifested in childhood (up to 35%), and extramedules in adults [51]. The
rate of occurrence of the population is on average 0,5 in females and 0,3 per 100,000 inhabitants
per year in males. It is known that intramedules are represented by low levels of gliomas in which
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90% of primary spinal cord tumors can be successfully removed. The most common primary spinal
tumors among intramedullary spinal tumors are ependymoma (63-65%) cases, astrocytomas (24-
30%) cases, and at the same time 4/5 of all intramedullary spinal tumors. Other major spinal cord
tumors such as glioblastoma (7,5%) occur in cases, oligodendroglioma (3%) in cases, and the
remaining tumors (2%) in cases [51-54]. Some imo has been associated with genetic disorders
such as hemangioblastomas and GIPPEL-Lindau disease (Von HippelLindau disease – VHL),
which causes Type 2 neurofibromatosis (NF-2). Intramedullary tumors are observed in 19% of
patients with NF2 and 20% in VHL [55].
Modern methods of pain relief, microsurgical techniques, endoscopic equipment allow you
to remove a spinal tumor at any level and at almost all stages of the tumor process [56].
Surgical treatment included two steps: spinal access and tumor removal. Access is by
laminectomy as part of tumor localization or hemilaminectomy. With a tumor of the vertebral
div, individual parts of the vertebral div can be resected. Contraindications during surgery, a
patient with impaired respiratory and cardiovascular system function was in critical condition.
Extramedules the removal of the tumor begins at the poles and frees it from the surrounding
adhesions. If the tumor is subdural, then the dura mater (TMO) opens along the midline. The tumor
is often soldered with TMO and sometimes with the spinal cord.
Ependymoma of all glial intramedullary spinal neoplasms accounts for up to 65% of adults
and over 10% of all spinal cord tumors.
There are various histological subtypes of ependim, and most of them can be included in
the second type of malignancy classified by the who.
A number of authors claim that endomedular ependymomas can be classified as
extramedullary tumors, and up to 40% among spinal ependymomas. However, according to
literary data, spinal subependimomas can be diagnosed very rarely and often in combination with
neurofibromatosis type II [57].
Among Imo, astrocytoma is the second largest in the adult population, and up to 30% after
epindem. By the age of 10, astrocytomas reach up to 90% of all glial spinal cord tumors, and this
percentage is significantly reduced to 50% by the age of 15 [58]. Among the astrocytomas of the
spinal cord, about 75% - benign and 25% - malignant tumors occur.
Hemangioblastomas (gab) are rarely small benign, multi-vascularized single neoplasms
extending beyond one or two segments, often located on the posterior or posterolateral surface of
the spinal cord. Among all spinal imo, gab is 3-8% and in about 30% of cases is associated with
other diseases such as von Hippel-Lindau disease. These tumors are often identified (40-60%) in
cases with spinal cysts, which are large in size and are located in the diameter of the solid
component of the tumor tissue [59].
The most common (90%) of spinal cord tumors are extramedular localization, with 1,2
cases diagnosed per 100,000 inhabitants per year. Tumors such as neurinoma, Neurofibroma,
meningioma occur in 80% of all extramedullary spinal tumors of intradural localization [60].
In a comprehensive study of 1,322 patients with spinal intradural tumors at the Mayo
Clinic, most patients identified neuroma (29%) and meningiomas (26%), 22% intramedullary
gliomas, 12% extradural sarcoma, hemangioblastoma, chordoma, epidermoid cysts [61].
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Intradural extramedullary tumors, meningiomas ranged from 16,6 to 33% in children and
60% in elderly patients. Depending on age groups, neuromas accounted for 25-50% of all tumors,
25% in elderly patients,and no more than 10-11,1% in children [62].
Meningiomas are slow-growing tumors from arachnoid membranes, soft and hard shell
cells, often found in middle and elderly people between the ages of 50 and 70, in childhood these
tumors are almost not found (no more than 3%), among patients they are more common in women
(75-83%). A study of 7,148 patients in the United States from 2004 to 2010 found that the majority
of spinal meningiomas (96,1%) were who in class I, then who in Class II (2,5%) and who in Class
III (1,4%). Several meningiomas combined with Type 1 neurofibromatosis (NF i) range from 1-
2% [63].
Tumors in spinal nerve roots account for about 25% -30% of all extramedullary spinal
tumors in adults and 14% in children [13]. Neuroma is more common in middle-aged patients
(ages 30-50), while meningiomas are more common in middle-aged and elderly people.patients
[64-67].
In children, dysembriogenetic tumors (lipomas, dermoids, epidermoids, teratomas) are
more common (up to 5%) than in other age groups, and in adults they make up less than 2% of
spinal tumors and are often located in the lumbar part of the spinal canal. The embryonic origin of
these neoplasms leads to a frequent association of the tumor with other birth defects in the
development of the spine and spinal cord.
Extradural primary tumors of the spinal cord. Currently, most authors consider that the
group of primary tumors of the spine includes extradural spinal tumors. The characteristics of
primary extradural tumors compared to Intradural tumors are their histogenetic diversity, large
size, dominance of malignant forms, and pronounced structural changes of the vertebrae.
According to some data, extradural neoplasms make up 32% of all extramedullary tumors [68-74].
Hemangiomas occupy a special place among spinal cord tumors-they occur in 8.9 to 12.5%
of autopsies and in a very low percentage of clinically identified cases. Up to 66% of these tumors
occur in one vertebral lesion and 34% in most cases, often localized in the thoracic spine – in
(60%) cases, (30%) cases localized in the cervix and (10%) cases localized in the sacral spine [75-
79].
Among bone tumors, osteochondroma is most commonly diagnosed (36%) in cases and
does not exceed 10% of all osteochondromas. It is detected in 75% of cases in young people under
20 years of age, almost always localized in the projection of spinous processes [80-84].
Also, in the group of bone benign tumors, osteoid-osteoma is noted, which is diagnosed in
11-12% of all tumors in the spine. In the works of a number of authors, changes in the structure of
the spine with osteoid osteoma were recorded up to 20-30%, with osteoblastoma - up to 40-45%,
in men it is detected 2 times more often than in women and manifests itself mainly at a young age
[85-89].
Of all malignant spinal tumors, chordoma only occurs more often in the spine, not
exceeding 5% of all primary malignant bone tumors and 20% of malignant tumors in the spine
[90].
Conclusions.
thus, primary tumors of the spine are a relatively rare pathology, but they
cause great social and economic damage to society due to their impact on working-age children
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and adults. It should be noted that despite the increase in tumors of the central nervous system in
recent decades, according to literary data, there is no single information about the epidemiological
indicator of primary tumors of the spinal cord, and those with information are contradictory.
Epidemiological indicators of spinal primary tumors in the Kr area have not been studied, which
indicates the need to create Centers for the study of pathologies. Central nervous system. All of
the above allowed us to consider this study relevant for our country.
Intramedullary tumors were often able to be partially or subtotally removed within their
borders using an ultrasonic Cleaver. Cystic intracerebral tumors were removed with the opening
and aspiration of the cyst contents.
Excessive radicalism in intramedullary tumors, in addition to the removal of
ependymomas, can lead to a deep loss of all functions of the spinal cord in the postoperative period.
Tropho-paralytic complications that occur in this regard (pneumonia, pressure ulcers,
inflammatory changes in the urinary system) lead to negative consequences for the development
of the disease.
Extramedullary tumors are four times more common in adults than intramedullary tumors,
with predominance of anterior and anterior neurin and meningiomas with characteristic
neurological manifestations of pain syndrome, motor and sensory disorders, especially in the
cervical region. The radicality of surgical treatment of tumors depends not only on the location
and size of the tumor, but also on its histological structure, and is 95% for neurinomas and
meningiomas in the considered contingent of patients. The radicality of ependymome removal was
43% and is virtually absent in astracitomas and glioblastomas, which is N. N. According to the
Burdenko Institute of Neurosurgery, the treatment results are consistent: recovery is in 43%,
improvement is in 19%, postoperative mortality is in 16%, unchanged is in 7%, relapses are in 5%.
The use of videoendoscopic techniques in some cases increases the radicality of operations and
reduces the number of postoperative complications.
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