Spinal Tumors (Primary, Metastatic)

Spinal tumors include a wide range of abnormal growths that occur in and around the spinal column. These tumors are rarer than brain tumors and are classified by location and the type of tissue involved. The spinal column is made up of the spinal cord, which is composed of neurons and the cells that support and protect them, and the bones of the spine (vertebrae), which bear weight and encase the spinal cord.

Tumors that arise within the spinal cord itself are called intramedullary tumors. These tumors include:

Astrocytomas, which arise from the glial cells that support the neurons in the central nervous system;

Ependymomas, which arise from the cells that line cavities within the brain and spinal cord; and

Hemangioblastomas, tumors of the vascular system. Intramedullary tumors usually are benign, but may be malignant and can be significant because of their location.

If a tumor occurs between outside the spinal cord but within its protective covering, it is called an intradural-extramedullary tumor. These tumors most commonly are:

Meningiomas, which arise from the meninges, the leathery protective layer that covers the brain and spinal cord, or

Schwannomas and neurofibromas, tumors that arise from the sheaths that cover nerves and improve the conduction of nerve impulses. These types of tumors usually are benign and slowgrowing.

Extradural tumors are by far the most common spinal tumors. Also called vertebral column tumors, these tumors usually involve the bones and cartilage of the vertebrae and may be either benign or malignant. While some tumors, such as osteosarcomas, osteoblastomas, and osteoid osteomas, arise from the vertebrae themselves, most extradural tumors are metastaticthey spread to the spinal column from tumors that arise in other areas, most commonly the lungs, breasts, prostate, and kidneys.

Another way of classifying spinal tumors is by the cell type: Benign Spinal Tumors

Aneurysmal Bone Cysts (ABCs), which can be large and quite vascular, typically cause pain and swelling in children and adolescents.

Giant Cell Tumor can be found at the cervical, thoracic, or lumbar segments of the spine, but are more common in the sacrum. These tumors usually affect children, adolescents and young adults.

Hemangioma is known to be a progressive vascular mass that can cause vertebral collapse and paraparesis (slight paralysis). It occurs most often in the thoracic spine of adults.

Eosinophilic Granuloma rarely leads to vertebral collapse and paraparesis, and occasionally may heal spontaneously. These tumors are usually seen in children and adolescents.

Osteochondroma, which is rare and most frequently affects adolescents, is a slow-growing tumor of the cartilage usually found in the posterior (rear) spine.

Osteoid Osteoma is a small bone tumor usually affecting adolescents. It can cause night pain and may result in spinal deformity.

Osteoblastoma affects children and adolescents. These tumors can be large, aggressive, and painful sometimes causing spinal deformity and paralysis.

Malignant Spinal Tumors

Chondrosarcoma is a tumor affecting spinal cartilage in middle-aged adults. It grows slowly but can be dangerous. Usually aggressive medical intervention is required.

Chordoma is usually seen in adults frequently involving the sacrum, although it can affect other parts of the spine. These tumors often require aggressive medical therapy.

Ewing's Sarcoma is an aggressive tumor affecting adolescents and young adults. In some cases, it may metastasize.

Lymphoma may present in one or more vertebral bodies in middle aged or older adults. Sometimes the lymphatic system is involved.

Osteosarcoma is bone cancer found in adolescents and middle-aged adults. These tumors may metastasize requiring aggressive medical therapy.

Plasmacytoma occurs most often in middle aged and older adults. These tumors are common in the pedicle and vertebral body and may cause paraparesis. Spine pain does not always indicate tumor presence. However, early medical intervention is always warranted if spine pain does not resolve or if neurologic deficit is experienced.

Symptoms

Spinal tumors may cause a wide range of symptoms depending on their location and type; back or neck pain at the site of the tumor is the most common initial symptom. If a tumor begins to compress the spinal cord, it also may cause neurological symptoms, such as loss of sensation, muscle weakness, shooting pain in an arm or leg, or bladder and bowel dysfunction. Some slow-growing spinal tumors,

especially intradural-extramedullary tumors, can cause pain for years before they cause neurological symptoms. Extradural tumors also may undermine the structural stability of the vertebrae, leading to painful vertebral fractures.

Diagnosis

As with tumors that occur in the brain, spinal tumors usually are assessed with imaging studies. Magnetic resonance imaging (MRI) scans are the most accurate imaging tests for these tumors, and computed tomography (CT) scans also are used, especially to assess the degree of bony involvement. For either study, an agent that provides contrast in the image is administered intravenously so neurological surgeons can visualize the tumor against the normal structures in the background. In addition, a tissue sample may be taken prior to surgery for examination under a microscope.

Treatment

Patients with neck and back pain caused by a spinal tumor may initially be given anti-inflammatory medications (corticosteroids) to ease pain temporarily. For intramedullary and intraduralextramedullary tumors, surgery usually is the preferred treatment. Because these tumors are slowgrowing, complete surgical resection may provide a cure. Most of these tumors, particularly intraduralextramedullary ones, are clearly differentiated from the spinal cord, and therefore relatively easy to remove completely. Some intramedullary tumors may be difficult to distinguish from normal spinal tissue and therefore more difficult to remove. Even in these cases, however, surgery that removes most of the tumor can alleviate pain and provide significant benefit. In the rare case of more aggressive and rapidly growing tumors, surgery usually is followed by radiation therapy. Physical therapy often is necessary after surgery to return normal levels of neurological function.

Extradural tumors, however, present more of a problem. Metastatic tumors will grow quickly, so surgery will not stop their development. In these cases, treatment consists of reducing the tumor's bulk to alleviate pain, removing compression on the spinal cord, and maintaining the stability of the spine. Radiation therapy can be used to decrease tumor size to reduce pain. Surgery also may be considered to reduce the bulk of the tumor to alleviate pressure on the spinal cord and maintain the stability of the spine. Other procedures, such as the replacement of vertebrae with implants and the fusion of vertebrae, may be used to prevent fractures or treat the pain that they cause.