An Overview of Spinal Lesions

Lesion is a general term used to define tissue that has been injured, destroyed, altered (for the worse) or otherwise has a problem. Spinal lesions are such cases that affect the nervous tissue of the spine. They may be due to cancerous and non-cancerous tumors, trauma, infection, demyelinating disorders such as multiple sclerosis, and congenital defects, and symptoms depend on the spinal lesion type and cause.

Diagnostic testing includes imaging, especially with magnetic resonance imaging (MRI). Treatment depends on the cause of the spinal lesion.

Spinal lesions may have symptoms of non-specific back pain, or myofascial syndrome. You may not be able to pinpoint where your pain 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-like feelings 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.

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

Of note, 30% to 70% of people with cancer will have a bone metastasis to the spine, according to the American Association of Neurological Surgeons.

This process will start with a medical history to assess trauma and risks for spinal infection, cancer, and congenital malformations. A physical exam will check for sensory and strength changes. Blood and urine tests may also be done to screen 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 (PET) 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.

Drainage or removal of lesions such as abscesses, cysts, and tumors will depend on your age and condition, as well as the size of the lesion and what structures it is affecting.

Surgical correction may be possible for some structural lesions or may be required if the lesion affects surrounding structures. 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 necessary.

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

When your doctor tells you that you have a spinal lesion, it simply means that there is evidence that may form the basis for further exploration of its cause. Consider the finding a notable clue that gets you closer to a complete diagnosis.