SPINAL TUMORS

Questions and Answers

Intramedullary Tumors

In the neck, intramedullary tumors are common. The following consist of the most common types:

Ependymoma

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.

Astrocytoma

Astrocytomas are tumors that develop from astrocytes, star-shaped cells in the brain and spinal cord that aid nerve cell activity. In children, it is the most prevalent kind of spinal cord tumor.

Hemangioblastoma

Hemangioblastoma is a cancer of the blood vessels that can develop in any part of the spinal cord.

Lipoma

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 Tumors

Intradural–extramedullary cancers arise in the dural sheath, the spinal cord’s outermost layer. The most common classifications are as follows:

Meningioma

A spinal meningioma originates in the thin membranes surrounding the spinal cord. It is most frequent in women and occurs in the upper back region.

Neurofibroma

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.

Schwannoma

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

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 Tumor Causes and Risk Factors

People rarely develop a primary spinal tumor.  Except for random genetic mutations that are not inherited, doctors know very little about the cause.  The only recognized cause relates to 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

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.

Surgery

TThe 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 is only 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.

Furthermore, surgery is often recommended if there’s spinal compression, the tumor won’t respond to conventional radiation therapy, or there’s spinal instability that minimally invasive surgery can’t fix. In such cases, your surgeon will remove as much tumor as possible while taking every precaution to protect your spinal cord and other major nerves.

Surgical Procedures for Metastatic Spine Tumors

Spinal Cord Decompression

This technique relieves pressure on your spinal cord and nerve roots. Decompression also creates enough space so that you can receive high-dose radiation without risking injury to your spinal cord.

Spinal Instrumentation

Your surgeon attaches pedicle screws and rods to your spine to redistribute stress on and align your bones. This technique is usually used if you have significant spinal cord compression, a collapsed vertebra, or a burst fracture that kyphoplasty can’t repair. When possible, your surgeons will use specially designed screws, a less-invasive technique.

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.

What is Spinal Cord Decompression Surgery and Its Benefits?

Spinal cord decompression surgery is a procedure designed to alleviate pressure on the spinal cord and nerve roots. This pressure often results from conditions such as herniated discs, spinal stenosis, or tumors, which can cause significant pain and neurological deficits.

Benefits of Spinal Cord Decompression Surgery

• Pain Relief: One of the primary benefits is the significant reduction in pain. By removing the source of compression, nerve irritation is minimized, providing substantial relief.
• Improved Mobility: Patients often experience better physical function and mobility post-surgery, enabling them to return to their daily activities with greater ease.
• Enhanced Quality of Life: Reducing pain and improving mobility directly contribute to an improved quality of life. Patients can engage in activities they might have previously avoided.
• Higher Radiation Tolerance: For those undergoing treatments like high-dose radiation, spinal cord decompression provides additional space around the spinal cord, lowering the risk of damage from radiation therapy.

By creating more space around the spinal cord, this surgery not only alleviates existing symptoms but also prepares patients for other necessary treatments, making it a crucial step in comprehensive spinal health care.

The Approaches to Spinal Tumor Surgery

The surgeons at the Southwest Scoliosis and Spine Institute possess the necessary knowledge, skills, abilities, experience, and expertise required to effectively and safely remove spinal tumors. These surgeons have undergone extensive training and education in the field of spinal surgery, specializing in the diagnosis and treatment of spinal tumors. They have a deep understanding of the complex anatomy of the spine and the intricacies involved in tumor removal procedures. With their comprehensive knowledge of spinal pathology and tumor behavior, they can accurately assess the type, location, and extent of the tumor, enabling them to plan and execute precise surgical interventions.

The surgeons’ exceptional surgical skills allow them to perform intricate procedures with utmost precision and care. Additionally, they are adept at using advanced surgical techniques and state-of-the-art technologies to ensure optimal outcomes for their patients. Their experience and expertise in spinal tumor surgery give them the ability to navigate the delicate structures of the spine while minimizing the risk of damage to surrounding tissues and preserving neurological function.

During spine tumor surgery, they stimulate nerves involved in movement and other key functions, measuring and recording how these nerves respond. Also, this real-time data helps the surgeon make informed decisions, ensuring that the spinal cord and major nerves are protected.

Furthermore, the surgeon meticulously removes as much of the tumor as possible, taking every precaution to preserve the spinal cord and avoid damaging critical neural pathways. By combining advanced surgical techniques with continuous intraoperative monitoring, the team can achieve optimal surgical outcomes while prioritizing the patient’s neurological health. Therefore, this comprehensive approach, integrating the skills of highly trained surgeons underscores the commitment to patient safety and the precision required in spinal tumor surgery.

Anterior Approaches

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.