Roentgenographic Findings Associated W I T H Tumors O F the Spinal Column , Spinal Cord , and Associated Tisbtjes

I n the developmental stage of surgery of “spinal tumors,” which term is talreii to include tumors of the spinal column, spinal cord, and associated tissues, neurologists and neurosurgcons were inclined to wait until advanced signs of compression of the cord had developed before instituting operation. However, they soon learned that earlier diagnosis and surgical treatment were necessary if the most satisfactory results were to be obtained. This stimulated further investigation, introduction of special tests, employment of roentgenograms as a routine, and studies with radiopaque oil in selected cases. As a result, it is possible to detect the presence oE these lesions much earlier, so that the ratio of operable to inoperable tumors, as shown by recent studies, is now approximately 80 to 20, with a surgical mortality of 4 per cent. Spinal tumors may arise from any of the primary tissnes, and furthermore, these tissues may become the field of metastatic implants. Many tumors that arise within the spinal canal are considered amenable to operation, since those that arise from nerve roots, meninges, and blood vessels are encapsulated, usually nonmalignant, and removable. Intramedullary tumors are less amenable to surgical treatment, but ependymal-cell tnmom of the filum terminale frequently can be removed. Proliferative changes in the laminae, pedicles, spines, and bodies of the vertebrae, and in the intervertebral disks, may give rise to compression of the spinal cord, simulating that caused by tumors arising within the spinal canal. If recognized early, this condition can be relieved by surgical treatment. Foreign-body giant-cell tumors and osteochondrom;w are benign growths of the vertebrae which are amenable to opwation. Patients who have primary or metastatic malignant tumors are not considered fo r