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 spinal tumors may grow, leading to impingement on the spinal cord or nerves, potentially causing pain, neurologic problems, and in some cases paralysis.
Symptoms 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 faster 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, is worse at night, or not relieved with over-the-counter medications should be evaluated. Patients with progressive numbness, weakness, or changes in bowel or bladder function should get immediate medical attention. The spine provides the structural support for the body and protects the spinal cord. A tumor in the spine may destroy supporting structures causing deformity, instability or neurologic deficits. A comprehensive medical evaluation is essential for all patients with suspected spinal tumors.
A spinal tumor may be diagnosed with blood work and diagnostic imaging studies. An x-ray shows the bony structures within the spine. A CT (Computerized Tomography) scan gives cross sectional images of the spine for more detailed evaluation of the spinal bones. Spinal MRI provides an accurate picture of the soft tissues. This includes the spine, spinal cord, and nerves which help locate the tumor and see the extent of involvement. In many cases the type of tumor will be determined by a biopsy. A biopsy obtains a small piece of tissue to be evaluated under a microscope. This can help to determine the type of tumor and help predict the severity. The ultimate goal is to eliminate all tumors and maintain spinal structural integrity. Common benign tumors may just need occasional monitoring. Malignant spinal tumors may require surgery, chemotherapy, radiation, and/or stereotactic radiosurgery.
Metastatic spinal disease, or the spread of cancer from its original location to the spine, is extremely common. Metastatic disease means that the cancer cells from the primary site spread from the bloodstream or the lymphatic system to a remote site, such as the spine. The spine is the third most common site for metastatic cancer cells. The lung and the liver are the top two most likely sites. Nearly 60-70% of patients with cancer will have spinal metastases. Of patients with metastatic cancer, only one in ten are symptomatic. Most patients with spinal metastatic cancer will present to the physician’s office with either involvement of the spinal cord and nerve endings, or the vertebral column bones. The most common causes of metastatic spinal disease are generally primary tumors from the lung (31%) and breast (24%).
This patient had a spinal tumor indicated on the left by the arrows. The patient underwent surgery to remove the tumor and affected bone and spinal instrumentation was placed to stabilize the spine.
A fifty-two year old female patient presented with a history of breast cancer. Three years before coming to Virginia Spine Institute, she had a left breast lumpectomy and her tumor was approximately the size of a quarter. She had additional chemotherapy and radiation since some of her armpit lymph nodes had cancer cells present (lymphatic spread). At our office visit she complained of an insidious onset of neck pain, which had recently become quite severe. There was no obvious injury to cause progressive neck pain. Any posture other than lying flat in bed caused her significant discomfort. She also noticed gradual, but progressive, loss of function in her arms and legs. She felt that her balance and dexterity were both deteriorating. Her primary care physician thought she had arthritis, but she saw a chiropractor who noted brisk reflexes on her neurologic examination. The chiropractor ordered an MRI scan which showed a large tumor of the cervical spine, involving the C4, C5, and C6 vertebral bodies. There was significant compression of the spinal cord and the structure of her spine had been destroyed by the tumor.
Given the severity of her neck pain, as well as the progressive loss of function, she required surgery. Specimens sent from the involved vertebral bodies demonstrated obvious breast cancer tumor cells. The bones of C4, C5, and C6 were removed from the front of the neck, leaving only a shell of bone protecting the nerve endings and important blood vessels. Her operation was completed from both the front and the back of the neck, with a spinal reconstruction using titanium cages, plates, and screws. Her spinal cord was completely decompressed and her spine was stabilized in its normal posture. Her neck pain was successfully controlled and she regained her motor function. The surgery did not eradicate her cancer; she required additional chemotherapy and radiation by the patient’s oncologist.
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