A spinal tumor is an abnormal growth developing either in or around the spinal column, spinal cord, or spinal nerves.
The human spine or spinal column is composed of 33-34 vertebral bones staying on top of each other. In the sacrum and coccyx, vertebrae are fused together, but in other parts, they are connected by joints. The spinal cord is located inside the spinal column and is surrounded by strong bones and ligaments. Therefore, the spine has two main functions: providing protection for the spinal cord and supporting the body weight. The spinal cord connects the brain with the rest of the body by many nerves coming out of it and traveling to all parts of the body.
The tumor is an abnormal growth caused by a genetic mutation. All the cells in the human body have a very peculiar genetic system for controlling growth and differentiation. Loss of this control causes cells to divide uncontrollably and cause tumors. Traditionally, tumors can be divided into two main groups: benign and malignant. Benign tumors grow from "inside". They are basically abnormally expanding structure that pushes nearby structures as it grows. They develop well-defined borders from normal tissue, and thus, surgical removal is relatively easy. Total tumor removal usually provides a cure for these patients.
Malignant tumors, on the other hand, are invasive. Tumor cells dislodge from the original location and invade nearby tissues. Therefore, the border between the tumor and normal tissue is poorly defined. Complete surgical elimination must include the removal of some normal tissue around the tumor, which may lead to loss of function. Malignant tumors may spread to surrounding tissue via direct invasion. Also, they may use lymphatic and blood vessels. This condition is called metastasis. Metastasis is very difficult to treat since surgery and radiation are of limited use.
Spinal tumors may arise either from the spinal cord and nerves or the spinal column. The spinal cord and nerves consist of nervous tissue, and therefore, tumors arising from them belong to neural lineage. The spinal column, on the other hand, is composed of bone and connective tissue. Thus, tumors arising from it belong to bone/connective tissue lineage and have completely different biological features.
Tumors arising from neural tissue are usually benign and may originate from the spinal cord itself, spinal nerves, or covers. Tumors located outside of the spinal cord are called extramedullary. They are generally easier to remove than tumors located inside of the spinal cord – intramedullary. For example, meningiomas are benign tumors originating from the spinal cord cover. They are extramedullary, benign, slowly growing tumors compressing the spinal cord from the outside. On the other hand, benign tumors like ependymomas and astrocytomas originate from the spinal cord itself (intramedullary) and, therefore, are more difficult to separate and remove.
The spinal cord and nerves are covered by a protective cover named dura mater. Tumors may be located inside this envelope or outside it. Therefore, tumors can be either extradural – outside the covers or intradural – inside the cover. Meningioma, for example, is located inside the cover and therefore is intradural. Schwannomas and neurofibromas are benign tumors originating from the spinal nerves. If the tumor arises from the section of the nerve outside the cover, it is called extradural. Schwannomas may be intradural or intra/extradural depending on the size and location. Sometimes, they have a dumbbell shape with two sections representing intra- and extradural sections. Malignant tumors can also affect the spinal cord and the nerves, but they are very rare.
Spinal column tumors arise from the vertebral bones. These tumors are classified into two main groups: primary and metastatic. Primary bone tumors develop from the bone or connective tissue comprising the spinal column. They can have benign, malignant, or mixed behavior.
Metastatic tumors, on the other hand, are extensions of other cancers into the bones. They comprise the vast majority of spine tumors. Technically, bone metastases occur in the bone marrow rather than in the bone tissue itself. Since the spine contains almost a third of the total body bone marrow, it is the most frequent bone metastasis site. Cancer cells dislodge from the main tumor site and are spread to the spine by blood flow. This process is called hematogenous metastasis. In some cases, the main tumor does not produce symptoms, and the tumor is first discovered in the spine.
Metastatic tumors can cause destruction of the tumor (osteolytic) or promote bone formation (osteoblastic). In some cases, tumors may have both osteolytic and osteoblastic features. Generally, osteolytic tumors are more dangerous since they weaken the bone and cause fractures.
The most common symptom of spine tumors is pain. The pain is usually located at the involved site but may radiate to different parts of the body if nerves and the spinal cord are involved. Pain may be very significant if the tumor is causing bone destruction and fracture. This type of fracture is called pathological and may cause excruciating pain.
A neurological deficit may be present if tumors of fractured bone parts compress the spinal cord and nerves. Usually, patients develop numbness, weakness (paralysis), ataxia (loss of balance), and inability to control bowel movements and urination.
Diagnostic evaluation starts with a thorough history and physical evaluation. It provides important information about the possibility of cancer, like weight loss or smoking habits. Assessing neurological status is very important since the patient may not be aware of the ongoing neurological deficit or may think that it is irrelevant.
Spine imaging is a key element in diagnostic work-up. Magnetic resonance imaging (MRI) of the spine with intravenous contrast is the most preferred modality. It is usually sufficient to demonstrate the presence and extent of the tumor as well as its relationship with the spinal cord and nerves. Computerized tomography (CT) and X-rays can show bone structures better than MRI.
For patients with suspected metastasis, positron emission tomography (PET) can demonstrate the main tumor as well as other metastasis if present. Lab tests with tumor markers may be necessary to assess the extent of the tumor. In some cases, a biopsy from an easily reachable area can be performed in order to establish the diagnosis.
Management of spinal tumors is highly specific. The most important aspect is the pathological diagnosis of the tumor. In some cases, the diagnosis is very straightforward, and the treatment is well-known. In other cases, extensive work-up may be required to reveal the nature of the tumor.
There are three options available for the treatment: surgery, chemotherapy, and radiation therapy. The choice of treatment depends on the sensitivity of the tumor to chemo- and radiotherapy and the feasibility of surgical removal.
Primary spinal cord and bone tumors are usually treated with surgery. It allows the removal of the mass effect, obtaining tissue for pathological diagnosis, and providing stability to the spine if needed. Completely removed benign tumors do not require further therapy. Malignant tumors may require adjuvant chemo and radiation treatment following the surgery. Surgical removal may be very challenging since the tumors may be hard to separate from the spinal cord and nerves. Therefore, it should be performed by an experienced surgeon.
Management of metastatic tumors depends on the type and stage of the tumor. Although these patients were once considered inoperable and terminal, modern therapeutic modalities now allow most of them to undergo surgery, with adjuvant chemo and radiation therapy. The goal of surgery is to relieve the pressure from the spinal cord and nerves and provide stability to the spine if compromised.
Tags: spinal tumor symptoms, spinal tumor diagnosis, spinal tumor types, spinal tumor classification, spinal tumor treatment, spinal tumor surgery
Common symptoms of a brain tumor can vary greatly and depend on the tumor's location, size, and growth rate. They may include headaches, seizures, changes in personality or behavior, memory problems, and difficulty with balance, speech, hearing, or vision. Learn more on this topic in our Brain Tumors section.Learn More
Treatment options for a pituitary adenoma include observation, medication, surgery, and radiation therapy. The best treatment option depends on the size and type of the tumor, the patient's overall health, and personal preferences. Learn more about Pituitary Adenoma treatment in the corresponding section.Learn More
Scoliosis treatment depends on the degree of the curve and the patient's age. Non-surgical treatments include physical therapy, brace use, and pain relievers. In severe cases, surgery may be required to correct the curve. Learn more about scoliosis is treated in our Scoliosis Treatment section.Learn More
The diagnosis of TOS is made in conjunction with the patient's history, symptoms, physical examination, imaging tests, and neurophysiological tests. Treatment can include physical therapy, pain management, and surgery in severe cases. Learn more about treatment options in our Thoracic Outlet Syndrome Treatment section.Learn More
Warning signs of a brain aneurysm can encompass sudden and severe headaches, blurred or double vision, neck pain, fainting or dizziness, and sensitivity to light. However, many aneurysms may not show symptoms until they leak or rupture. Learn more about this in our Brain Aneurysms section.Learn More
The need for surgery typically depends on the size, location, and growth rate of the aneurysm. Generally, aneurysms larger than 7mm, those located at certain parts of the brain, or those showing signs of growth on consecutive scans may require surgical intervention. To understand the specifics, it's best to consult with a neurosurgeon. More on this topic in our Brain Aneurysms section.Learn More
Currently, there's no standard blood test that can definitively diagnose brain cancer. While certain markers or changes may suggest a tumor's presence, imaging tests like MRI or CT scans remain primary diagnostic tools. Learn more about the diagnostic processes for brain cancer in our Brain Tumors section.Learn More
The growth rate of brain tumors can vary based on the type and grade of the tumor. Some tumors grow slowly and might not cause symptoms for years, while others can grow rapidly and present symptoms within weeks or months. The onset of symptoms also depends on the tumor's location and size. Learn more about the progression of brain tumors in our Brain Cancer section.Learn More
After brain surgery, patients might experience fatigue, mood fluctuations, or cognitive changes. Recovery time varies, and regular follow-ups are essential to monitor healing and detect any complications. Learn more about the recovery process for different disorders in our Brain Diseases Treatment section.Learn More
As we age, the spine undergoes natural degenerative changes. Discs may lose hydration and elasticity, vertebral bones might thin, and there can be a gradual narrowing of the spinal canal, which might lead to spinal stenosis or other conditions. Learn more about spine disorders in our Spine Diseases section.Learn More
Most patients start feeling better within 48 hours of kyphoplasty, with full recovery in a few weeks.Learn More
Recovery from vertebroplasty is typically quick, with most patients resuming normal activities within a few days.Learn More
Both procedures involve stabilizing fractured vertebrae, but kyphoplasty includes the inflation of a balloon to create space before cement is injected, whereas vertebroplasty injects cement directly without balloon inflation.Learn More
Patients with certain types of fractures, severe osteoporosis, or those with an active infection might not be suitable candidates for kyphoplasty. Always consult with a spinal specialist.Learn More
The three primary types of scoliosis are idiopathic (cause unknown, most common in adolescents), congenital (due to bone abnormalities present at birth), and neuromuscular (stemming from nerve or muscle disorders). Learn more about the differences between these types and the nature of this condition in the dedicated Scoliosis section.Learn More
Hunchback, or kyphosis, can be caused by poor posture, spinal trauma, congenital issues, osteoporosis, disc degeneration, or certain diseases like tuberculosis.Learn More
Tailbone pain, or coccydynia, without evident injury can arise from prolonged sitting, childbirth, tumors, infections, or can sometimes have an idiopathic (unknown) origin.Learn More