What Is Spinal Tumors ?
A Spinal tumor – a cancerous or noncancerous growth that develops with the cervical (neck), thoracic (midback) or lumbosacral (lowback) regions or near the spinal cord or bones of the spine. They may be primary originating from the spinal cord or metastatic originating elsewhere (eg: lung, breast etc)
Anatomy of Spinal Tumors
The spine is composed of individual bones (vertebrae) stacked one on top of the other in a column. Each vertebra possesses a cylindrical body, which participates in weight bearing and an arch of bone (laminae and spinous processes) which protects the spinal cord and its coverings. The bony arch is connected to the body by two small columns of bone (pedicles). The circular canal between the body, arch, and pedicles houses the spinal cord and is called the spinal canal.
The spinal cord is contained within the spinal canal and is covered by a layer of connective tissue, the dura mater. Tumors which are located outside the dura are called extradural. These are usually metastatic tumors and most often arise in the vertebrae themselves. Tumors arising inside the dura, but outside the actual substance of the spinal cord are termed intradural-extramedullary. These are usually nerve sheath tumors or meningiomas. Tumors arising within the substance of the spinal cord itself are called intramedullary tumors. These are usually astrocytomas or ependymomas. Different types of tumors often behave differently and require different treatments.
Any type of tumor may occur in the spine, including:
A small number of spinal tumors occur in the nerves of the spinal cord itself. Most often these are ependymomas and other gliomas.
Tumors that start in spinal tissue are called primary spinal tumors. Tumors that spread to the spine from some other place (metatastasis) are called secondary spinal tumors.
The cause of primary spinal tumors is unknown. Some primary spinal tumors occur with genetic defects. A spinal tumor is much less common than a primary brain tumor.
Spinal Tumors Can Occur
- Inside the cord (intramedullary)
- In the membranes (meninges) covering the spinal cord (extramedullary - intradural)
- Between the meninges and bones of the spine (extradural)
As it grows, the tumor can affect the:
- Blood vessels
- Bones of the spine
- Nerve roots
- Spinal cord cells
It may press on (compress) the spinal cord or nerve roots (similar to spinal cord trauma), invade normal cells, or block blood vessels and lead to a lack of oxygen (ischemia).
The symptoms depend on the location, type of tumor, and your general health. Tumors that have spread to the spine from another site (metastatic tumors) often progress quickly. Primary tumors often progress slowly over weeks to years.
Tumors in the spinal cord (intramedullary) usually cause symptoms, sometimes over large portions of the body. Tumors outside the spinal cord (extramedullary) may grow for a long time before causing nerve damage.
Symptoms May Include:
- Abnormal sensations, loss of sensation:
- Especially in the legs (may be in the knee or ankle, with or without shooting pain down the leg)
- May worsen
- Gets worse over time
- In any area -- middle or low back are most common
- Is usually severe and not relieved by pain medication
- Is worse when lying down
- Is worse with strain, cough, sneeze
- May extend to the hip, leg, or feet (or arms), or all extremities
- May stay in the spine
- Causes falls
- Especially in the legs
- Makes walking difficult
- May get worse (progressive)
Exams And Tests
A nervous system (neurologic) examination may find the location of the tumor.
The health care provider may also find the following during an exam:
- Abnormal reflexes
- Increased muscle tone
- Loss of pain and temperature sensation
- Tenderness in the spine
These tests may confirm spinal tumor:
- Antidiuretic hormone (ADH) test
- Cerebrospinal fluid (CSF) examination
- Cytology (cell studies) of CSF
- Spinal CT
- Spine MRI or lumbosacral spine MRI
- Spine x-ray
The goal of treatment is to reduce or prevent nerve damage from pressure on (compression of) the spinal cord.
Treatment should given quickly. The faster symptoms develop, the sooner treatment is needed to prevent permanent injury. Any new or unexplained back pain in a patient with cancer should be taken seriously.
- Corticosteroids (dexamethasone) may be given to reduce inflammation and swelling.
- Surgery may be needed to relieve compression on the spinal cord. Some tumors can be completely removed. In other cases, part of the tumor may be removed to relieve pressure on the spinal cord.
- Radiation therapy may be used with, or instead of, surgery.
- Chemotherapy has not been proven effective against most spinal tumors, but it may be recommended in some cases.
- Physical therapy may be needed to improve muscle strength and the ability to function independently.
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