During examinations, doctors will find benign (noncancerous) and malignant (cancerous) spine tumors. As the tumors continue to grow, they can damage various tissues of the spine. Doctors refer to the first tumor that develops in the spine or spinal cord as a primary spinal tumor. Metastatic or secondary spinal tumors result from cancer that has spread to the spine from another part of the body.
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A spinal tumor is a mass of cells that grows abnormally within or around your spinal cord and/or spinal column. The long, flexible column of bones that protects your spinal cord refers to the spine (backbone). Additionally, it starts at the base of your head and finishes in your pelvis, where your tailbone is located. From your brainstem (bottom of your brain) to your low back, your spinal cord appears as a cylindrical structure that runs through the middle of your spine. Also, it consists of nerve bundles and cells that convey messages from your brain to the rest of your body and vice versa. Spinal tumors can be localized:
- Inside the spinal cord (intramedullary).
- Tissue covering the spinal cord (meninges) (sub-meninges-extra meninges).
- Between the meninges of the spine and the bones (extracorporeal).
- Vertebrae with bones in your spine.
Doctors find benign (noncancerous) or malignant (cancerous) spinal tumors. As the tumor continues to grow, it can damage various tissues of the spine. Doctors refer to the first tumor that develops in the spine or spinal cord as a primary spinal tumor. Furthermore, metastatic or secondary spinal tumors result from cancer migrating to the spine from another part of the body. Primary spinal cancers are far less prevalent than metastatic spinal tumors.
Types of Spinal Cord Tumors
The spine consists of vertebrae, which are stacked bones. Also, the tunnel in the center of this pillar, called the spinal canal, contains the spinal cord. Appropriately, it appears as a thin tube of nervous tissue that sends messages between the body and the brain through nerves and radiculopathy that branch off the spinal cord. Also, the central nervous system consists of the spinal cord and the brain. In addition, tumors that occur in or around the spinal cord are called primary spinal cord tumors. These tumors are rare. When they occur, they are often benign or non-cancerous. However, they can also be malignant or cancerous. That said, it has the potential to spread throughout the body. In addition, some benign tumors can grow rapidly.
In the neck, intramedullary tumors are common. The following consist of the most common types:
The most frequent kind of spinal tumor is ependymoma. It starts in the ependymal cells, which border the central canal of the spinal cord and aid in the direction of fluid flow.
Astrocytomas are tumors that develop from astrocytes, which are star-shaped cells present in the brain and spinal cord that aid nerve cell activity. In children, it is the most prevalent kind of spinal cord tumor.
Hemangioblastoma is a cancer of the blood vessels that can develop in any part of the spinal cord.
A Lipoma is an uncommon growth that starts in fat tissue in the center of the back and can press against the spinal cord. Please note that this is a congenital condition, which means it exists from birth.
Intradural–extramedullary cancers arise in the dural sheath, the spinal cord’s outermost layer. The most common classifications are as follows:
The thin membranes that surround the spinal cord are where a spinal meningioma originates. It is most frequent in women and occurs in the upper region of the back.
The protective coating of the spinal cord and nerves develops into a Neurofibroma. Neurofibromatosis, a disorder that generates nerve tumors across the central nervous system and skin, is a common cause.
Schwann cells, which generate the substance that insulates nerves, make up a schwannoma. It is commonly seen on the exterior of the spinal cord, within the dura.
Myxopapillary ependymoma develops in the tissues around the spinal cord.
Symptoms of Spinal Tumors
Some spinal tumors are asymptomatic, but most often cause back pain and can also cause numbness and weakness. For instance, symptoms of spinal tumors vary greatly depending on a tumor’s location and whether it is cancerous.
Spine Tumors Pain
Tumors of the spine can cause back pain by damaging healthy tissues such as vertebrae (bones) and nerve compression (pinching). Unfortunately, spinal tumor pain can feel like one or more of the following:
- The majority of spinal pain occurs in the lower back or neck, while pain from a spinal tumor usually occurs in the upper or middle back. The thoracic spine accounts for over 70% of all spinal tumors.
- Rather than being uncomfortable on the surface or on the skin, spinal tumor pain may feel like an ache or discomfort deep within the back.
- Pain from a spinal tumor can exist in one area of the back, or it may spread down a nerve root or the spinal cord. Shock-like pain in the chest, abdomen, leg(s), or arm is possible.
- Back pain caused by a spinal tumor gets worse in the morning for some people.
- Neck or lower back pain in the lumbar spine (lower back) accounts for around 20% of all spinal tumors, whereas the cervical spine (neck) accounts for 10%.
- When there are many tumors or a tumor has grown larger, spinal tumor-related pain can occur at multiple levels of the spine, including the thoracic and lumbar spine.
Spine Tumors Causes and Risk Factors
People rarely develop a primary spinal tumor. With the exception of random genetic mutations that are not inherited, doctors know very little about the cause. The only recognized cause relates to the exposure to radiation therapy in the treatment of early childhood cancer. That treatment can cause spinal tumors 20 or 30 years later. But, in essence, doctors at this time cannot predict who will develop a primary spinal tumor. However, spinal tumors that spread from cancer in other parts of the body to the spine are much more common. About 30-70% of cancers eventually spread to the spine. Cancers that will likely spread to the spine include lung, prostate, and breast cancer.
Treatment decisions are often made in an interdisciplinary manner, including the expertise of spine surgeons, medical oncologists, radiation oncologists, and other specialists. Therefore, treatment choices, including surgical and non-surgical treatment, take into account various aspects of the patient’s overall health and treatment goals.
Non-Surgical Treatments of Spinal Tumors
Non-surgical treatment options include observation, chemotherapy, and radiation therapy. Asymptomatic or mildly symptomatic tumors that appear altered or non-advanced can be observed and monitored with a routine MRI. Furthermore, some tumors respond well to chemotherapy, while others respond well to radiation therapy. However, there are certain types of metastatic tumors that are inherently radiation resistant (such as the gastrointestinal tract and kidneys). In these cases, doctors recommend surgery as the only viable treatment option.
The indications for surgery depend on the type of tumor and the health of the patient. Surgeons can surgically remove primary (non-metastatic) spinal tumors due to their potential cure with a complete mass resection. In patients with metastatic tumors, palliative treatment sets its goals at restoring or maintaining nerve function, stabilizing the spine, and relieving pain. Surgery only occurs as an option if patients with metastases are expected to survive for more than 3-4 months and the tumor appears resistant to radiation or chemotherapy. Indications for surgery include intractable pain, spinal cord compression, and the need to stabilize spinal fractures.
If surgical resection can move forward, preoperative embolization can be used to facilitate resection. In this procedure, a catheter or tube gets inserted through the groin artery. Then the catheter moves through the blood vessels to the site of the tumor, where it delivers a sticky liquid embolic agent that blocks the blood vessels that supply the tumor. Blocking the blood vessels that supply the tumor often helps reduce the risk of surgery by better controlling bleeding during surgery. When considering surgery, surgeons must configure the best way to access the tumor. MRI and CT scans will identify the best route. The posterior approach allows for dura mater identification and nerve root exposure. Surgeons use this approach to expose tumors behind the spine or in the dura.
The Approaches to Spinal Tumors Surgery
You can decompress multiple levels and perform multi-level segment pinning as needed. The anterior approach appears best for tumors in the anterior spine. This approach also allows the reconstruction of defects created by removing the vertebral bodies. Also, this approach allows the surgeon to place fixed devices in short segments. Tumors of the thoracic and lumbar spine that affect both the anterior and posterior spine can be a challenge for complete resection. Although not uncommon, surgeons use a posterior approach followed by a separate, stepwise anterior approach to surgically remove these complex tumors.
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If you or your loved one suffers from back pain from a spinal condition, we can help. Call Southwest Scoliosis and Spine Institute at 214-556-0555 to make an appointment today.