Spinal Lesion Treatment: Comprehensive Options by Etiology

Spinal lesions encompass tumors, infections, demyelination, vascular malformations, and degenerative cysts. Treatment is etiology-specific.

Diagnostic First Step

MRI with contrast (entire spine if indicated) → characterizes lesion (intramedullary, intradural-extramedullary, extradural). Biopsy if indeterminate.

Treatment by Category

1. Primary Tumors

• Intramedullary: Ependymoma, astrocytoma → resection (maximal safe), ± RT.
• Intradural-extramedullary: Meningioma, schwannoma → gross total resection (Simpson Grade I).
• Extradural (metastasis): Radiation (SBRT), decompression ± stabilization, systemic therapy.

2. Infectious

• Epidural abscess: urgent decompression + 6wks IV antibiotics.
• Discitis/osteomyelitis: antibiotics ± instrumentation.
• TB (Pott's): 9–12mo multi-drug regimen.

3. Demyelinating

• MS plaque: high-dose IV methylprednisolone → DMT.
• NMOSD/MOGAD: acute steroids → PLEX if refractory → immunosuppression.

4. Vascular

• AVM/DAVF: embolization ± radiosurgery ± resection.
• Infarction: anticoagulation/antiplatelet, rehab.

5. Degenerative/Other

• Synovial cyst: facet injection, decompression.
• Lipoma: observation or resection if symptomatic.

Multidisciplinary Team

Neurosurgery, neuro-oncology, radiation oncology, neurology, infectious disease, physiatry, pain management.