An Overview of Spinal Lesions

Spinal lesions can cause an array of symptoms depending on their type and cause. Lesion is a general term used in medicine to refer an area of tissue that has been injured, destroyed, altered (for the worse) or otherwise has a problem. Spinal lesions may be due to cancerous and non-cancerous tumors, trauma, infection, demyelinating disorders such as multiple sclerosis, and congenital defects. Diagnostic testing includes imaging, especially with magnetic resonance imaging (MRI). Treatment depends on the cause of the lesion.

Spinal lesions may have symptoms of non-specific back pain, or myofascial syndrome. You may not be able to pinpoint where it is coming from.

But if the lesion affects the spinal nerve roots or spinal cord you are likely to have nerve symptoms, which can include weakness, numbness, tingling, or electrical shock going down one leg or arm. You may have difficulty with fine motor skills (such as writing) or with walking, balance, or coordination. The type of nerve symptoms will depend on where the lesion is located as well as the extent of the lesion.

In cases of infectious causes, you may have other symptoms of infection, such as fever.

Serious symptoms that should be considered a red flag include:

• Bowel/bladder dysfunction (urinary retention is the most common dysfunction)
• Progressive neurologic weakness
• Saddle anesthesia (loss of sensation only in the buttocks, perineum, and inner thighs)
• Bilateral radiculopathy (pain, numbness, and weakness in the back and legs)
• Incapacitating pain
• Unrelenting night pain

Spinal lesions have a wide variety of causes.

• Congenital causes include malformations of the spine and spinal cord that are present from birth, often associated with spina bifida or scoliosis
• Trauma
• Autoimmune conditions. Multiple sclerosis produces spinal cord lesions in a majority of cases.
• Infections, including polio, HIV, West Nile virus, and syphilis. Some infections result in a spinal abscess.
• Spinal cord infarction
• Tumors (cancerous and non-cancerous, primary or metastatic)
• Chronic progressive myelopathy from arthritis or degenerative disc disease

A medical history and physical examination will be the start of diagnostic procedures. The medical history assesses trauma and risks for spinal infection, cancer, and congenital malformations. The physical will check for sensory and strength changes. Blood and urine tests may be done to check for underlying problems and general health.

If the symptoms point to underlying problems, you may be referred to imaging or to a specialist. Imaging can include X-rays and magnetic resonance imaging (MRI). A positron emission tomography scan might be used if a tumor is suspected.

In the case of tumors, a biopsy will be performed to obtain a sample for examination under the microscope.

The treatment will depend on the underlying cause of the spinal lesion. Surgical correction may be possible for some structural lesions or may be required if the lesion affects surrounding structures.

Drainage or removal of lesions such as abscesses, cysts, and tumors will depend on the age and condition of the person, as well as the size of the lesion and what structures it is affecting. Radiation, chemotherapy, or targeted therapies may be used for malignant or metastatic tumors.

Treatment of the underlying condition, such as with antibiotics or antivirals for infections, or disease-modifying therapies for multiple sclerosis, may also be done.

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

It can be disturbing to be told that you have a spinal lesion. But when your doctor tells you that you have a lesion, it simply means "something's going on" that may form the basis for further exploration and/or treatment.