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Understanding Spinal Tumors

Dr. Anand Blog Article

November 1st, 2017

As a spine surgeon, the majority of patients I see have complaints of low back pain resulting from injury to the spinal muscles, ligaments, joints, or discs. In fact, somewhere around 80 percent of Americans will suffer from acute back pain at least once in their lives, few requiring reparative surgery and most resolving over time. Though conditions like herniated discs, spinal instability, and stenosis account for a large amount of back pain, there is another much less common condition responsible for similar symptoms of acute and/or chronic back pain. Only 1 out of every 100,000 people (or about 10,000 people a year in the US) will develop spinal tumors.

A spinal tumor is an abnormal growth of tissue that creates a mass either inside or surrounding the spinal cord. These cells grow uncontrollably and can be either malignant (cancerous cells) or benign (non-cancerous cells). Even though some tumors do not contain cancer cells, they still pose a danger as serious problems may arise as the mass grows and presses on the spinal cord.

Under the broad category of “spinal tumors,” there are different sub-types, dependent upon where on the spine the mass is growing.

  1. Intramedullary spinal tumors occur inside the spinal cord
  2. Intradural extramedullary spinal tumors are located inside the spinal cord covering (but don’t enter the spinal cord)
  3. Extradural spinal tumors occur in the vertebral column involving cartilage and bone

The tumor’s location of origin also plays a role. Primary tumors originate in the spinal cord, and secondary tumors (or metastatic tumors) result from cancer that has spread from another location in the body to the spinal cord.

Here’s the tricky part. There is no one specific symptom that distinguishes a spinal tumor. The most common early symptom of all types of spinal tumors, benign and malignant, is simply back pain. This type of back pain, however, is not specifically attributed to injury, stress or physical activity. As the tumor grows it begins to put pressure on the spinal cord, surrounding nerve roots, blood vessels, and spinal bones that cause many similar symptoms to a herniated disc or other spine injuries. Some of these symptoms include: back pain that is worse at night and when lying down, pain that increases with activity, muscle weakness/numbness/tingling in the arms or legs, pain and difficulty when standing, difficulty with walking sometimes leading to falls, decreased sensitivity to pain/heat/cold, loss of bladder or bowel control, and erectile dysfunction. Having any of these symptoms does not mean you have a spinal tumor, but because early diagnosis and treatment are very important, I recommend my patients to schedule an office visit for any pain that is 1) progressive 2) not activity related 3) worsens at night and 4) for any patient developing back pain that has a history of cancer. Changes in bowel or bladder function and progressive muscle weakness require immediate medical attention.

In the event a spinal tumor is suspected to be the cause of symptoms (or even just to rule it out) a MRI or CT test may be used to show all of the parts of the spinal cord and spine, and pinpoint the location and size of the tumor. Sometimes these scans can be used with a contrast agent injected into the patient’s vein to highlight certain tissues and make any abnormalities easier to see. After confirmation of a tumor with these scans, the only definitive way to identify a benign or malignant tumor is through a biopsy to examine a small tissue sample. If the tumor happens to be malignant, the biopsy will also help determine the type of cancer present, determining treatment options.

Ideally, the goal of treatment would be to remove the tumor completely, however doing so runs the risk of permanent damage to the spinal cord and spinal nerves, in turn affecting some degree of bodily function. With spinal tumors there is no “one size fits all” solution, and every patient requires an individualized plan based on their own specifications. In developing a treatment plan, age, overall health, and location/origin of the tumor are all taken into consideration. Generally, if small benign tumors are detected that are not yet causing bothersome symptoms, carefully monitoring them may be best option with the least amount of risk involved. Surgery is recommended only when the benefits of removing the tumor outweigh the possible risk of spinal cord damage. If there are parts of the tumor remaining after surgery, radiation and/or chemotherapy can be used to eliminate them, and can also be used to attempt to shrink the tumor when surgery is deemed too risky.

Though rare, spinal tumors can cause serious and permanent disability if not detected and treated promptly. My best advice for all back pain sufferers: Err on the side of caution and visit your spine specialist at the first sign of suspicious symptoms for the best chance at a successful treatment.

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