There are three common types of spinal tumors that can cause back pain: vertebral column tumors, intradural-extramedullary tumors, and intramedullary tumors.
1. Vertebral Column Tumors
Primary tumors: These tumors occur in the vertebral column, and grow either from the bone or disc elements of the spine. They typically occur in younger adults. Osteogenic sarcoma (osteosarcoma) is the most common malignant bone tumor. Most primary spinal tumors are quite rare and usually grow slowly.
Metastatic tumors: Most often, spinal tumors metastasize (spread) from cancer in another area of the body. These tumors usually produce pain that does not get better with rest, may be worse at night, and is often accompanied by other signs of serious illness (such as weight loss, fever/chills/shakes, nausea or vomiting).
- In women, spinal tumors most frequently spread from cancer that originates in the breast or lung.
- In men, spinal tumors most frequently spread from cancer that originates in the prostate or lung.
2. Intradural-Extramedullary Tumors
Intradural-Extramedullary (inside the dura) tumors grow within the spinal canal (under the membrane that covers the spinal cord) but outside of the nerves. Usually these tumors are benign and slow growing. However, they can cause symptoms of pain and weakness.
Most of these spinal tumors are:
- Meningiomas that occur in the membranes surrounding the spinal cord and are usually benign but may be malignant. These tumors are more common in middle age and elderly women.
- Nerve sheath tumors (schwannomas and neurofibromas) that arise from the nerve roots that come off the spinal cord. Again, this type of tumor is usually benign and slow growing, and it may be years before any neurological problems occur.
3. Intramedullary Tumors
Intramedullary tumors grow from inside the spinal cord or inside the individual nerves and often arise from the cells that provide physical support and insulation for the nervous system (glial cells). These tumors occur most often in the cervical spine (neck). They tend to be benign, but surgery to remove the tumor may be difficult.
The two most common types of intramedullary tumors are astrocytomas and ependymomas.
surgical treatment options
If any tumor is found in the spine (and there is no other known cancer), a complete examination of all common organs where cancer develops is usually warranted. Evaluation may include:
- Complete medical history
- Complete physical examination
- Complete neurological examination
- Radiographic studies of the spine, chest and GI system to screen for tumors
- MRI and CAT scans to examine the spine.
Treatments for each common type of spinal tumor is explained in more detail below.
Treatment of Vertebral Column Tumors
Because most of these tumors arise from advanced cancer from another organ, the goal of spinal treatment is usually to:
- Control the severe pain that often occurs with these tumors (e.g. by removing pressure on the nerve roots)
- Preserve neurological function (e.g. by removing the pressure on the spinal cord)
- Fix structural instability in the spine (e.g. by reconstructing the unstable spine with a spinal fusion)
Treating Intradural-Extramedullary and Intramedullary Tumors
These types of tumors are usually surgically removed. The goal of treatment is usually to:
Totally remove the tumor
- Preserve neurological function
The spinal cord and nerves are highly sensitive and avoiding damage to these structures is a critical part of surgery. Monitoring techniques may be used throughout the surgery to determine the function of the spinal cord as the tumors are being removed (e.g. SSEP).
If the tumor cannot be completely removed (e.g. if it adheres to many spinal nerves), postoperative radiation therapy may improve outcome in some cases. If the tumor is metastatic, chemotherapy may also be helpful.
Following the surgery, it may take some time for the nerves to fully heal. Usually rehabilitation and time significantly helps improve a patient’s neurological function.
If you'd like to discuss this condition with one of our doctors, we would be more than happy to contact you. You don't need a primary care physician referral for us to see you.
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