Spinal Tumors
OVEVIEW:
A spinal tumor is a growth that develops in or near the spinal cord or within the bones and discs of the spine. Spinal tumors may be cancerous (malignant) or noncancerous (benign).
Spine tumors, both benign and malignant can cause significant disability when they occur in the spine. This is because spine tumors may grow, leading to impingement on the spinal cord or nerves, potentially causing pain, neurologic problems, and in some cases paralysis [Figure 1].
Figure 1
SYMPTOMS:
Symptoms may vary depending on the location and type of tumor. The most common symptom of a spinal tumor is pain in the area of the tumor. This pain often radiates to other areas of the body and may be worse at night. Patients with tumors causing neurologic compression may experience loss of sensation, muscle weakness, difficulty walking, numbness in the arms or legs, loss of bowel or bladder function, scoliosis, and paralysis.
Spinal tumors progress at different rates. In general, malignant (cancerous tumors) grow more quickly than benign (noncancerous tumors).
Most back pain is not the result of a spine tumor. However, patients with persistent back pain that is not activity related or is worse at night or not relieved with over-the-counter medications should seek treatment. Patients who develop progressive numbness, weakness, or changes in bowel or bladder function should seek immediate medical attention.
CAUSES:
There are a number of different causes of spinal tumors. In many cases the tumors develop due to an abnormality of the genetic structure in the cell.
The spine provides the structural support for the body and protects the spinal cord. A tumor in the spine may lead to destruction of the supportive structure leading to deformity, instability or neurologic compromise. Complete medical evaluation is important for all patients with suspected spinal tumors. Full medical history and physical examination including neurologic examination is important.
DIAGNOSIS:
For some patients additional testing including blood work or other diagnostic imaging is important. The initial evaluation for most patients with suspected tumor includes an x-ray of the affected area to allow visualization of the bone structures within the spine. CT (Computerized Tomography) allows for cross sectional images of the spine to be viewed and allows for careful evaluation of the bones in the spine. Spinal MRI (Magnetic Resonance Imaging) provides an accurate picture of the spine, spinal cord, and nerves to help evaluate the location and involvement of spinal tumors. In most cases the addition of intravenous contrast (gadolinium) is recommended [Figure 2].
Figure 2: CT (right) and MRI (left) scans of the lumbar spine showing a tumor in the vertebral body. The tumor can be seen to erode the bone away on the CT scan (left arrow) and to compress the nerves on the MRI (right arrow).
In many cases the only way to determine the type of tumor that is present is to perform a biopsy. The purpose of the biopsy is to obtain a small piece of tissue to be evaluated under a microscope. A biopsy can help to determine the type of tumor that is present and predict if further progression is likely.
The goal of treating spinal tumors is to eliminate the tumor and maintain spinal structural integrity. For some patients with common benign tumors, periodic monitoring is all that is required. For patients with malignant spinal tumors or neurologic compromise, further treatment including surgery, chemotherapy, radiation, and stereotactic radiosurgery may be appropriate.
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