A spinal tumor is an abnormal growth of cells that develops within or surrounding the spinal cord. These cells grow and multiply uncontrollably, seemingly unchecked by the mechanisms that control normal cells. Spine tumors and spine cancer can develop in the bones, nerves, and other tissues that make up the spine. Fewer than 10 percent of spine tumors begin in the spine.
Spinal tumors can be benign or malignant. Additionally, they are classified by their location in the spine into three major groups: intradural-extramedullary, intramedullary and extradural. Some spine tumors, such as astrocytoma, happen more commonly in children and teenagers.
The overall prevalence is estimated at one spinal tumor for every four intracranial lesions. Intramedullary tumors are rare, accounting for only five to 10 percent of all spinal tumors.
tumors can be classified into different types depending on where they occur
relative to the protective membranes of the spinal cord. These are the main
types of spinal tumors:
- Vertebral Column Tumors
These tumors involve the bones of the vertebral column. There are also two types of vertebral column tumors.
Metastatic tumors: The majority of vertebral column tumors are metastatic. That is, the original or primary tumor developed in another organ and has spread to the vertebral column, usually through the bloodstream. These tumors usually produce pain that does not get better with rest, and may become worse at night. The most common metastatic spinal tumors in women are from the breast and lung. In men, metastatic spinal tumors are most often from the prostate and lung.
Primary tumors: These tumors occur in the vertebral column, and grow either from the bone or disc elements of the spine. They typically occur in younger adults. Most primary spinal tumors are quite rare and usually grow slowly.
- Intradural-Extramedullary Tumors
These tumors grow within the spinal canal but outside of the nerves or spinal cord. Usually these tumors are benign and slow growing. However, they can also cause symptoms of pain and weakness. Most of these spinal tumors are meningiomas that occurs in the membranes surrounding the spinal cord, and nerve sheath tumors that arise from the nerve roots that come off the spinal cord.
- Intramedullary Tumors
Intramedullary tumors are located inside the substance of the spinal cord, such as gliomas, astrocytomas or ependymomas. Of them, astrocytomas and ependymomas account for the majority and occur with about equal frequency, although astrocytomas are more common in children and ependymomas more common in adults.
What exactly causes spinal tumors is yet unknown. Some studies show that genetic conditions play a role. There appears to be a higher incidence of spinal tumors in particular families. Besides, spinal tumors might be caused by something in the environment, such as exposure to certain chemicals as cancer-causing agents. In a small number of cases, spinal tumors may result from the presence of two genetic diseases:
- Neurofibromatosis 2: In this hereditary disorder, benign tumors may develop in the arachnoid layer of the spinal cord or in the supporting glial cells. However, the tumors associated with this disorder will affect the nerves related to hearing and can unavoidably lead to loss of hearing in one or both ears.
- Von Hippel-Lindau disease: This rare, multi-system disorder is associated with benign blood vessel tumors in the brain, retina and spinal cord, and with other types of tumors in the kidneys or adrenal glands.
The most common symptom of spinal tumors is pain. If pain happens mainly when patients move, it means that the tumor is causing weakness or instability in the bones of the spine. Pain experienced at night or in the early morning is usually an early sign that the tumor has spread.
Spinal tumors that are close to major nerves can disrupt their ability to transmit messages between the body and the brain. This can cause neurologic symptoms, including:
- Weakness, tingling, or numbness in legs or arms
- Difficulty walking or balancing
- Loss of bowel and/or bladder control
- Feeling less sensitive to pain, heat and cold
A thorough evaluation which includes a complete medical history, a physical examination and a neurological examination is the first step to diagnose a spinal tumor. Next, the radiological tests are required for an accurate and positive diagnosis.
- X-ray: It produces a film or picture of a part of the body which can show the structure of the vertebrae and the outline of the joints. However, X-rays are not very reliable in diagnosing tumors.
- Computed tomography scan (CT scan): It is a diagnostic image created after a computer reads X-rays, which can show the shape and size of the spinal canal, its contents and the structures around it. Sometimes it is combined with an injected contrast dye to make abnormal changes in the spinal canal or spinal cord easier to see. It is very good at visualizing bony structures.
- Magnetic resonance imaging (MRI): It a powerful magnetic field and radio waves to produce accurate images of your spine, spinal cord and nerves, as well as enlargement, degeneration and tumors.
- Biopsy: The only way to determine the exact type of a spinal tumor is to examine a small tissue sample (biopsy) under a microscope. If the tumor is malignant, a biopsy also helps determine the cancer’s type, which subsequently determines treatment options.
The selection of treatments including both surgical and non-surgical is made depending on the type of spinal tumors and the patient’s overall health.
Generally, the goal of spinal tumor treatment is to eliminate the tumor completely, but it may be complicated accompanied by the risk of permanent damage to the spinal cord and surrounding nerves. Treatment options for most spinal tumors include:
Some spinal tumors may be discovered before they cause symptoms — often when you’re being evaluated for another condition. If small tumors aren’t growing or pressing on surrounding tissues, doctors may recommend periodic CT or MRI scans at an appropriate interval to monitor the tumor.
- Chemotherapy and radiation therapy
Some tumors respond well to chemotherapy and others to radiation therapy. However, there are specific types of metastatic tumors that are inherently radioresistant. In those cases, surgery may be the only viable treatment option.
Surgeries can remove the tumors with an acceptable risk of spinal cord or nerve injury damage. The high-powered microscopes used in microsurgery make it easier to distinguish tumor from healthy tissues. But even with the latest technological advances in surgery, not all tumors can be totally removed.
Recovery from spinal surgery may take weeks or longer, depending on the specific condition. Patients may experience a temporary loss of sensation or other complications, including bleeding and damage to nerve tissue.
Keywords: spinal tumor.