Tumors of the spine
An abnormal mass of tissue inside or around the spinal cord and/or spinal column is called a spinal tumor. These cells appear to be unaffected by the systems that regulate healthy cells, since they proliferate and develop out of control. Both benign (non-cancerous) and malignant (cancerous) spinal tumors are possible. Metastatic or secondary tumors arise when cancer spreads from another location to the spine, while primary tumors start in the spine or spinal cord.
There are two terms used to describe spinal tumors.
1.)By the area of the spine where they are found. The cervical, thoracic, lumbar, and sacrum are these fundamental regions.
2.) Based on where they are located in the spine: intradural-extramedullary
The most frequent location for bone metastases is the bony spinal column. According to estimates, at least 30% and possibly as many as 70% of cancer patients will develop spinal metastases. Vertebral hemangiomas are the most prevalent primary spine tumors, having their origins in the bony spine. These are benign lesions that hardly ever produce pain or other symptoms. Prostate, breast, and lung cancers are common primary tumors that extend to the spine. In women, breast cancer is the most common cancer to spread to the bone, whereas in men, lung cancer is the most prevalent. Multiple myeloma, lymphoma, melanoma, sarcoma, and malignancies of the thyroid, kidney, and gastrointestinal system are among the other cancers that can travel to the spine. The overall course of treatment depends on a timely diagnosis and identification of the original tumor. The type of initial malignancy, the quantity of lesions, the existence of distant non-skeletal metastases, and the existence and/or degree of spinal cord compression are some of the variables that can impact the result.
Reasons
Most initial spinal tumors have an unknown etiology. Exposure to substances that cause cancer may be the cause of some of them. People with weakened immune systems are more likely to develop spinal cord lymphomas, which are tumors that impact lymphocytes, a subset of immune cells. There is probably a genetic component because certain families seem to have a higher prevalence of spine tumors.
These two genetic disorders may cause primary tumors in a small percentage of cases:
Second neurofibromatosis:2
Benign tumors may form in the spinal cord’s arachnoid layer or in the glial cells that support it in this inherited (genetic) condition. Nonetheless, the more prevalent tumors linked to this condition impact the hearing-related nerves, which might unavoidably result in hearing loss in one or both ears.
Disease of von Hippel-Lindau:
This uncommon, multi-system condition is linked to various malignancies in the kidneys or adrenal glands as well as benign blood vessel tumors (hemangioblastomas) in the brain, retina, and spinal cord.
Which symptoms are present?
For both benign and malignant spinal tumors, the most common symptom is non-mechanical back pain, particularly in the middle or lower back.
Physical activity, stress, or injury are not the specific causes of this back discomfort. However, the pain may worsen when lying down at night and may worsen with more exercise.
Even when conservative, nonsurgical procedures are used to treat back pain that is linked to mechanical causes, the pain may increase with time and migrate to the hips, legs, feet, or arms.
Other signs and symptoms may include:
- weakness or loss of feeling in the arms, legs, or chest
- stiffness in the back
- Neurologic symptoms (like tingling) and/or pain
- Walking with difficulty
- Reduction in pain, heat, and cold sensitivity
- Absence of bladder or bowel function
- Immobility
- A big, deadly tumor that causes scoliosis or another spinal deformity
Examination and Diagnosis
The first step in detecting a spinal tumor is a comprehensive medical evaluation that focuses on neurological impairments and back discomfort. For a diagnosis to be both accurate and positive, radiological testing is necessary.
X-ray: The vertebral structure and joint shape can be seen by using radiation to create a film or image of a portion of the body. To look for further possible reasons of pain, such as tumors, infections, fractures, etc., X-rays of the spine are taken. However, X-rays are not very good at identifying cancers.
CT Scan
A CT/CAT scan, a diagnostic image produced by a computer reading X-rays, can reveal the size and form of the spinal canal, its contents, and the surrounding structures. It also does a great job at illustrating bone structures.
MRI
A diagnostic test that uses computer technology and strong magnets to create three-dimensional photographs of body structures. An MRI can display malignancies, enlargement, degeneration, and the spinal cord, nerve roots, and surrounding regions.
Bone Scan: A Technectium-99 diagnostic procedure. useful as a supplement for the diagnosis of infections, disorders involving aberrant bone metabolism, and bone malignancies (including primary bone tumors of the spine).
The imaging results from the radiology studies mentioned above point to the most likely form of tumor. However, in certain situations, a biopsy can be required if the diagnosis is not obvious or if there is a worry about the type of tumor being benign or malignant. A biopsy also aids in identifying the type of cancer, which in turn dictates treatment options, if the tumor is malignant.
Medical Intervention
The knowledge of medical oncologists, radiation oncologists, spine surgeons, and other medical professionals is frequently incorporated into multidisciplinary treatment decision-making. Therefore, the several facets of the patient’s general health and care objectives are taken into consideration while choosing therapies, including both surgical and non-surgical options.
Non-Surgical Interventions
Radiation therapy, chemotherapy, and observation are nonsurgical therapeutic options. Regular MRIs can be used to observe and track tumors that are asymptomatic or slightly symptomatic and do not seem to be changing or progressing. Radiation therapy works well for some malignancies, while chemotherapy works well for others. Surgery may be the only effective treatment option for certain types of metastatic cancers, such as those of the kidney and gastrointestinal tract, which are naturally radioresistant.
Spine Surgery
The type of tumor determines the surgical indications. Complete en bloc resection is a potential treatment option for primary (non-metastatic) spine cancers. The main objective of palliative care for patients with metastatic tumors is to stabilize the spine, reduce discomfort, and restore or preserve neurological function. Surgery is often reserved for patients with metastases who are likely to live for three to four months or more and whose tumor is resistant to chemotherapy or radiation. Intractable pain, spinal cord compression, and the requirement to stabilize pathological fractures are among the indications for surgery.
Preoperative embolization may be utilized to provide a simpler resection in situations where surgical resection is feasible. A catheter or tube is inserted via a groin artery during this surgery. The catheter delivers a liquid embolic substance that resembles glue to the tumor site after it has been guided up via the blood vessels. This stops the tumor’s blood vessels from feeding it. By cutting off the blood veins supplying the tumor, bleeding can frequently be better managed during surgery, lowering the danger of the procedure.
The position of the tumor within the spinal canal dictates the approach to the tumor if surgery is contemplated. The dura can be identified and the nerve roots can be exposed using the posterior (rear) technique. This method is frequently employed to reveal malignancies inside the dura or for tumors in the posterior portion of the spinal column. It is possible to decompress many levels and, if required, to execute multilevel segmental fixation. For malignancies in the front of the spine, the anterior (front) approach works quite well. Defects brought up by the removal of the vertebral bodies can also be repaired using this method.
Additionally, this method permits the insertion of short-segment fixation devices. Complete resection of thoracic and lumbar spinal tumors that impact both the anterior and posterior vertebral columns can be difficult. Surgery to address these complex lesions has frequently involved a posterior (back) approach followed by a separately staged anterior (front) approach.