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Understanding Spine Tumors
Article written by F D Virionis, MD
Tumors can occur in the spine, as in any other part of the human body. They can involve the bone (vertebrae) or the spinal cord and nerves. They can be benign or malignant (cancerous). They can affect any age, even children. Typically patients present with back pain, weakness or numbness in the arms and legs or difficulties with control of their bladder and bowel. A spinal tumor can also present with similar symptoms to common back, arm or "sciatica" type pains which are produced by degenerative causes, such as disc herniation and spinal stenosis. Thus, these tumors can be hard to diagnose.
Numerous tests are useful in diagnosing spinal tumors. X-rays can be helpful if there is significant bone destruction or collapse. A Magnetic Resonance Imaging (MRI) study frequently gives the physician information as to the type of the tumor, the stability of the spine and the course for treatment. Occasionally biopsies are required for definitive diagnosis. Additional tests may be needed in some patients (bone scan, CT scan, etc.). From there on, there are a few possibilities:
- Tumors of the spinal cord. These can be benign (ependymoma, hemangioblastoma) and in those cases a total surgical removal is the treatment of choice. In other cases, such as astrocytomas, a biopsy or partial removal followed by radiation and chemotherapy is often the best option.
- Tumors of the meninges or nerves. These tumors are almost always benign (meningiomas, schwannomas, neurofibromas) and surgery is the best option for those tumors that cause symptoms.
- Tumors of the vertebrae. These tumors involve and destroy the bone that surrounds the spinal cord. They can be primary (i.e. the spine is the only site of the tumor) or metastatic (i.e. typically cancerous tumors originating in some other part of the body). For primary tumors, a complete resection (many times called en-bloc) is attempted. For metastatic tumors, radiation and surgery are the main treatment modalities, depending on multiple factors:
- sensitivity or resistance to radiation
- the presence or absence of spinal stability
- the presence or absence of spinal cord compression and related symptoms
- the extent of disease in other organs