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Spine / Spinal Cord Tumors
SYMPTOMS
— DIAGNOSIS
— TREATMENT
Spinal cord tumors are tumors that arise from the tissues
of the spinal cord. The term spine tumor refers to tumors
that arise from the coverings of the spine including
the vertebral bones. Spinal cord tumors are relatively
rare, as are most spine tumors other than metastatic
tumors. Spinal metastases occur in upwards of 10 percent
of patients with cancer.
The most common spinal cord tumors (or intramedullary
tumors) are ependymomas, astrocytomas and hemangioblastomas.
The next group of spine tumors is known as intradural-extramedullary
tumors. These tumors are located within the covering
of the spinal cord (the dura) but outside the substance
of the spinal cord itself. The most common intradural-extramedullary
tumors are meningiomas and neurofibromas. A third group
of tumors are the primary bone tumors. These are uncommon
and rarely need surgical intervention. Some examples
of primary bone tumors are chordomas, osteoblastomas,
osteoid osteomas, aneurysmal bone cysts and vertebral
hemangiomas. Finally, metastatic tumors are quite commonly
seen.
Spine / Spinal
Cord Tumors Symptoms
The most common symptom of a spinal cord or spine tumor
is pain. The pain can be located near the level of the
tumor or it may radiate around the side, down the arm
or down the leg. The latter complaints are related to
pressure on the nerve roots that come off of the spinal
cord. Symptoms may be very similar to a disc herniation.
Eventually, loss of strength may be seen. Sensory loss
is also common. In the case of an intramedullary tumor,
so-called dissociated sensory loss is common. In these
cases, there is loss of sensitivity to pain and temperature
below the tumor but preserved sensitivity to light touch.
Gradual pressure on the spinal cord can cause spasticity.
Loss of bowel and or bladder control are important signs
of pressure on the spinal cord or the lower spinal nerves
(called the cauda equina).
Symptoms may come on gradually and then suddenly become
more severe. This is particularly true in metastatic
disease.
Spine / Spinal
Cord Tumors Diagnosis
As always, a careful history and physical examination
are the first steps in diagnosis. The diagnosis of a
spinal cord tumor may be slow because back pain is common
and spinal cord tumors are rare. It is not unusual for
some time to pass before a diagnosis is made. The invention
of the MRI scanner has made it much easier to diagnose
spinal cord and spine tumors. Frequently an MRI is the
only test necessary to make a diagnosis. In some cases,
however, a CT scan and or a nuclear medicine bone scan
may be helpful.
Spine / Spinal
Cord Tumors Treatment
The treatment of a spinal cord or spinal tumor depends
on the symptoms and the imaging studies (MRI scan, CT
scan, bone scan). In some cases of primary bone tumors,
all that be needed is observation. In most cases of
intramedullary, intradural-extramedullary and metastatic
tumors more aggressive intervention will be indicated.
In general, the intramedullary and intradural-extramedullary
tumors are treated with surgical resection. Metastatic
tumor treatment depends on the state of the cancer,
the neurological condition of the patient and the appearance
of the imaging studies. In some cases, treatment may
consist of steroid medication and radiation therapy.
In cases where severe compression of the spinal cord
or spinal nerves exists, decompression along with stabilization
(fusion) may be necessary. Each case must be evaluated
on an individual basis.
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