A spinal tumor is an abnormal growth of tissue within or surrounding the spinal cord and/or bones of the spine resulting from uncontrolled, progressive multiplication of cells, seemingly unchecked by the mechanisms that control normal cells. Spinal tumors can be either benign (noncancerous) or malignant (cancerous). Spinal tumors can start in the spine or spinal cord (a primary spinal tumor) or can spread into the spine from cancer somewhere else in the spine (a secondary brain tumor).
Spinal tumors can be classified according to the area of the spine in which they occur (cervical, thoracic, lumbar and sacral tumors). They also may be referred according to their location in the spine – anterior (front) or posterior (back). From a doctor's point of view, spinal tumors can be divided into three groups:
These spinal tumors develop inside the spinal cord or a separate nerve, and usually can be found in the cervical (neck) region. They commonly develop from ependymal or glial cells that can be found in the interstitial tissue of the cord. Ependymomas and astrocytomas occur here most frequently. Usually they are benign, however, removing them can be challenging. A rare congenital spinal tumor - Intramedullary lipoma can also be located here, usually in the thoracic section.
These spinal tumors grow at the spinal cord’s end (filum terminale ependymomas), in the nerve roots (schwannomas and neurofibromas) or in the spinal cord’s arachnoid mater (meningiomas). Even though meningiomas are usually benign, they can be difficult to remove and may recur. Nerve root tumors are often benign too, but neurofibromas may gradually become malignant. Ependymomas at the spinal cord base can be massive, and treatment of these spinal tumors may be difficult due to anatomical structures in this area.
In most cases, these spinal tumors develop from metastatic cancer or schwannomas, which derives from the surface cells of the nerve roots. Sometimes an extradural spinal tumor protrudes through the intervertebral foramina, growing inside and outside the spinal canal.
Metastatic spinal tumors
A spinal column is a common place for a bone to metastasis. Approximately 30% to 70% of patients diagnosed with cancer will have their cancer spread to their spine. Lung, breast, and prostate cancer are particularly likely to spread into the spine.
In men, the most common cause of bone metastasis is lung cancer, and in women, it is breast cancer. Lymphoma, sarcoma, melanoma, thyroid, and tumors in kidney and gastrointestinal tract can also spread and form spinal tumors.
The success of any treatment for spinal tumors largely depends on prompt diagnosis and identification of the primary tumor site. Many factors may determine the outcome: the type of primary cancer, the number of lesions, the presence of metastases, and the severity of spinal cord compression.
The majority (from 85% to 90%) of all primary central nervous system (CNS) tumors are brain tumors. Primary spinal tumors are rare compared to CNS tumors that arise in the brain. Overall prevalence is approximately 1:4. In the USA about 10,000 people develop primary or metastatic spinal cord tumors each year.
Benign spinal tumors such as neurofibromas and meningiomas account for 55% to 65% of all primary spinal tumors.
Intramedullary tumors are rarer, accounting for 5% to 10% of all spinal tumors.
Most meningiomas occur in women between the ages of 40 and 70.
Metastatic spinal tumors are much more common than primary spinal tumors, accounting for an estimated 70% of all spinal tumors.
Causes of Spinal Tumors
No one knows what causes spinal tumors; there are only a few known risk factors that have been established by research. In some cases, spinal tumors develop after exposure to cancer-causing agents. In people with compromised immune systems, spinal cord lymphomas develop more frequently, because these spinal tumors originate from a type of immune cells- lymphocytes. In some families, high incidence of spinal tumors can be explained by genes. There are two rare genetic diseases which may result in the primary spinal tumor:
- Von Hippel-Lindau Disease: a multi-system disorder characterized by the formation of benign blood vessel tumors (hemangioblastomas) spinal cord, retina, and the brain, and other types of tumors in kidneys, pancreas, adrenal glands.
- Neurofibromatosis Type II: also an inherited disorder, characterized by the development of brain tumors affecting nerves related to hearing, which may lead to loss of hearing in one or both ears. Benign spinal tumors may also develop in the arachnoid layer of the spinal cord or in the supporting glial cells
Outcome mainly depends on several factors: whether the spinal tumor is benign or malignant, primary or metastatic, and on the age and overall health of the patient. After removing the primary spinal tumor completely the malignancy can potentially be cured. With metastatic spinal tumors, the goal is almost always palliative; treatment may improve patient’s quality of life and prolong life expectancy.
Spinal Tumor Symptoms
The most common spinal tumor symptom is back pain, especially in the middle or lower back. This pain is not the result of injury and it does not greatly depend on stress or physical activity, it often gets worse at night. Pain may spread to the arms, hips, legs or feet and may worsen with time. Conservative treatment, which often helps with basic back pain is usually ineffective.
Other spinal tumor symptoms may develop over time, depending on the localization of the tumor. When a malignant spinal tumor grows, it can compress nearby structures, such as bones of the spine, nerve roots, and blood vessels. Pressure on the spinal cord can be life-threatening.
The spinal tumor symptoms rely upon the area, sort of tumor, and your general well-being. Tumors that have spread to the spine from another area (metastatic tumors) regularly advance rapidly.
Spinal tumor symptoms are very highly to occur, in some cases, over substantial portions of the body. Tumors outside the spinal column may develop for quite a while before causing nerve harm.
Spinal tumor symptoms may include:
- Unusual sensations or loss of sensation, particularly in the legs (might be in the knee or lower leg, with or without shooting pain down the leg)
- A chilly impression of the legs, cool fingers or hands, or coolness in different areas of the body
- Back pain is a spinal tumor symptom
- Deteriorates after some time in any region - center or low back are generally normal spinal tumor symptom
- Pain typically extreme and not alleviated by pain medicine
- A sense of pain even when sitting
- Pain may stretch out to the hip, leg, or feet (or arms), or all furthest points
- Fecal incontinence
- Urinary incontinence
- Muscle compressions, twitching or fits (fasciculations)
- A decrease in motor skills
- Muscle spasms
Contingent upon the area and kind of spinal tumor, diverse spinal tumor symptoms can grow, particularly as a tumor develops and influences your spinal rope, encompassing nerves or veins.
A spinal tumor symptom might be determined to need blood work and analytic imaging examines. An x-ray demonstrates the hard structures of the spine. A CT (Computerized Tomography) check gives cross-sectional pictures of the spine for more point by point assessment of the spinal bones. Spinal MRI gives a precise photo of the delicate tissues. This incorporates the spine, spinal string, and nerves which help find the tumor and see the degree of association.
Much of the time the type of tumor will be diagnosed by a biopsy. A biopsy gets a small portion of tissue to be assessed under a magnifying lens. This can decide the type of tumor and help determine the seriousness. A definitive objective is to dispose of all tumors and keep up spinal auxiliary respectability. Basic generous tumors may simply require occasional observations. Threatening spinal tumors may require surgery, chemotherapy, radiation, or potentially stereotactic radiosurgery.
The first step if a spinal tumor symptom is suspected is a thorough medical examination with emphasis on back pain and neurological deficits. Radiological tests are necessary for an accurate and positive diagnosis of a spinal tumor.
- X-ray: Application of radiation to produce a film or picture of a part of the body can show the structure of the spinal column. They can help in the search for other potential causes of pain, i.e. infections, fractures, arthritis, etc. X-rays are not very reliable in diagnosing spinal tumors.
- Computed Tomography Scan (CT or CAT scan): A diagnostic image created after a computer reads x-rays from different angles. It shows the shape and size of the spinal canal and the structures around it. This is very good at visualizing bony structures
- Magnetic Resonance Imaging (MRI): A diagnostic test that produces three-dimensional images of body structures using powerful magnets and computer technology. This can show soft tissue structures such as the spinal cord, nerve roots, and surrounding areas, as well as enlargement, degeneration, and spinal tumors.
After the presence of the spinal tumor was radiologically confirmed, the only way to determine whether the spinal tumor is benign or malignant is to perform a biopsy- examination of a small tissue sample under a microscope. If the spinal tumor is malignant, biopsy also helps determine the cancer type, which provides vital information for the choice of treatment.
Staging classifies spinal tumors according to the size, assessing bony, soft tissue, and spinal canal involvement. Sometimes an entire body scan with use of nuclear technology may be needed, as well as a CT scan of the lungs and abdomen for determining the stage. The findings and results from laboratory tests are also used to confirm the spinal tumor symptom.
Spinal Tumor Surgery and Treatment
Spinal tumors can be treated nonsurgically with chemotherapy and radiation therapy. Patients with asymptomatic or mildly symptomatic tumors and without signs of changing/progressing tumors may be observed and monitored with regular MRIs. There are a few spinal tumors which respond well to chemotherapy or radiation therapy, but some types of metastatic spinal tumors are characterized as radio-resistant (for example, gastrointestinal or kidney tumors), and in those cases, spinal tumor surgery may be the only viable treatment option.
Spinal Tumor Surgery
Primary spinal tumor surgery may be removed completely through resection. Treatment of patients with metastatic spinal tumors is mainly palliative, directed at alleviating pain, stabilizing the spine and restoring or preserving neurological function. For patients with metastases resistant to radiation or chemotherapy, who are expected to live 12 weeks or longer operation may be considered as a treatment option. Spinal tumor surgery is also indicated for patients with spinal cord compression, the need for stabilization pathological fractures and intractable pain.
The posterior approach allows for the identification of the dura and exposure of the nerve roots. Several levels can be decompressed epidurally, and a posterior multilevel segmental fixation can be performed. The anterior approach is the best for decompression of ventral tumors and reconstruction of the anterior column. Short-segment fixation devices also can be placed on this approach. Thoracic and lumbar spinal tumor which affect both the anterior and posterior vertebral columns are a challenge to surgically remove completely. Usually, a posterior (back) approach in combination with a separately staged anterior (front) approach is used to treat these complex spinal tumors.
Surgical spine tumor removal is suggested for patients who may benefit by the tumor extraction, either regarding extracting the growth or potentially decreasing any serious indications related to the tumor.
There are many types of surgery that might be considered as an option for treatment of a spinal tumor. As a rule, there are two classes of surgery:
- Minimal surgery - surgical methodologies that incorporate moderately small incision(s)
- Open surgery - more broad surgical strategies that require a larger incision(s)
Negligibly intrusive surgeries are all the more generally performed, albeit open (more broad) surgical systems might be an alternative in specific cases.
Stereotactic radiosurgery (SRS). This technique for conveying radiation is equipped for conveying high measurements of unequivocally focused on radiation. In SRS, specialists utilize PCs to concentrate radiation pillars on tumors with pinpoint exactness and from numerous edges.
SRS has certain cutoff points on the size and particular type of the tumors that can be dealt with, yet where fitting, it has demonstrated to be very effective, and developing examination underpins its utilization for the treatment of spinal and vertebral tumors.
Chemotherapy. A standard treatment for certain types of tumors. Chemotherapy utilizes medicines to attack tumor cells or prevent them from developing. Your specialist can decide if chemotherapy may be valuable for you, either alone or in a mix of radiation treatment.
Reactions may incorporate weariness, queasiness, heaving, expanded danger of contamination and male pattern baldness.
Different medications. Since spinal tumor surgery and radiation treatment and tumors themselves can cause irritation inside the spinal cord, specialists now and then recommend corticosteroids to diminish the swelling, either after spinal tumor surgery or amid radiation medications. Despite the fact that corticosteroids diminish aggravation, they are normally utilized just for brief periods to maintain a strategic distance from genuine symptoms as muscle shortcoming, osteoporosis, hypertension, diabetes and an expanded helplessness to contamination.
Usually, the hospital stay after removing a spinal tumor is about 5-10 days, depending on the case. A period of physical rehabilitation follows the spinal tumor surgery, which may require a stay in a physical rehabilitation hospital, at an outpatient facility or at the patient’s home. Depending on the complexity of the spinal tumor surgery and the patient’s condition, the total recovery time after spinal tumor surgery lasts 3 to 12 months.
Elective prescription Despite the fact that there aren't any optional medications that have been proven to cure growth, some options or integral medicines may help assuage some of your manifestations.
One such treatment is needle therapy. Amid needle therapy treatment, an expert inserts small needles into your skin at exact focuses. Research demonstrates that needle therapy might be useful in calming sickness and nausea. Needle therapy may likewise help relieve certain types of pain in individuals with growth.
Discuss the pros and cons of all treatment options with your physician to make the appropriate decision that is best for you.