Tumors of the spine are tumors that can develop from any of the tissues composing the spine, including bone, nerve, and soft tissues. The tumors can be located anywhere along the spine such as neck, thoracic, lumbar, or the sacrum. Tumors have two types of sources. The first type arises from cells that constitute the structure of the spine and spinal cord, and are named primary tumors.
The second type is caused by spread of tumor cells from other parts of the body (breast, prostate, etc.) to the spine, and they are named metastatic tumors.
What are Symptoms?
The most prominent symptom is pain located in the affected part of the spine, which may spread above and below (like neck or lower back pain). The pain is acute during the night, and may increase with physical activity. In tumors arising directly from the spinal cord, or when a vertebral tumor compresses the spinal cord, signs of spinal compression may be observed. Symptoms depend on the location of the compression and may include: numbness in the arms, legs or chest, weakness in the hands, arms and legs, and difficulty in walking.
How is it Diagnosed?
Diagnosis begins with a history and physical examination. Patients may have a history of prior or ongoing cancer. If your doctor suspects a tumor, he/she may order imaging studies such as direct X-rays, CT and MRI. In some cases, scintigraphy or PET scan may be requested to investigate if there uptake in other areas of the body.
If a tumor has been detected with imaging techniques, a biopsy will be the next step to learn the type and origin of the tumor. Most biopsies can be performed by spine surgeons or interventional radiology specialists under local anesthesia using a needle or a trochar. In some conditions, an open biopsy may be preferred. If the source and type of the tumor can be determined with biopsy, this will help in the determination of subsequent treatment.
What are Non-surgical Treatment Options?
Non-surgical treatment include observation, chemotherapy, and radiation treatment. Benign tumors that do not cause significant symptoms or without aggressive spread may be followed with imaging methods (often MRI). Also, malignant spine tumors or metastases may be sensitive to chemo or radiotherapy. In these tumors, chemo or radiotherapy may be the first choice.
When is Surgery Necessary?
Primary malignant tumors arising from the spine often require surgical treatment the moment they are detected. The aim is to remove tumor cells from the area as soon as possible. Surgery is also necessary in malignant primary tumors or metastatic tumors if they are causing progressive neurologic deficits or loss of urine/stool control in a short period of time. Surgical therapy is also needed when the tumor severely disrupts the strength of the spine or to stabilize the pathologic vertebra when abnormal movement is present in the spine. Another condition requiring surgery is when the tumor is not sensitive to chemo or radiotherapy and there is lack of response to these treatments.
What are Surgical Treatment Options?
Surgery of spine tumors involves partial or complete removal of the tumor. This decision must be made by your surgeon. When making a decision, your surgeon will consider criteria, such as: the type of the tumor, distribution, benign versus malignant character, sensitivity versus resistance to chemo-radiotherapy, neurologic risk rate, and expected survival. These criteria will be evaluated, and subsequently risk-benefit ratios and possible treatment alternatives will be presented to you.
The tumor itself or surgery may cause injury of the spine and result in abnormal movement, which may require repair with metal implants. These treatments can be made from the front or back of the vertebra, and occasionally from both.
Emptying the tumor tissue from the vertebral body by using curets and filling the defect by cement is a viable surgical option for non-agressive benign tumors.
Surgical treatment of malignant tumors include complete removal of the entire tumor with its surrounding tissues. The defect is then reconstructed by using cages and instrumentation.
Hospital stay after surgery ranges between 3 to 10 days, and a period of physical therapy and rehabilitation may be necessary. Length of stay depends on the need for and duration of physical therapy, and whether it can be performed at home.
In some tumors, chemotherapy or raditherapy may be necessary after surgical treatment. Application of these treatments may affect total healing time.
The total healing time ranges between 3 months and 1 year depending on the complexity of the surgical operation.
What is Involed with Long-term Follow Up?
Depending on the type of tumor, your doctor will follow you at various intervals and for some period of time. The follow up consists of using X-rays and MRI. The tumor has the chance to recur, and this may change according to its type.