Jeffrey R. Carlson, MD
Tumors are an abnormal collection or mass of cells that multiply rapidly without the “on/off” switch normal cells possess. Spinal tumors that are directly related to spine cells are rare and we are not sure what causes most spinal tumors; however, a very small percentage can be caused by genetic disease.
The main types of spinal cord tumors are:
- Extradural – the tumors are located outside the dura, which is the thin covering surrounding the spinal cord
- Extramedullary – these tumors originate in either the membrane surrounding the spinal cord or in the nerve roots which exit from the spinal cord
- Intramedullary – these tumors start within the cells of the spinal cord.
When the tumor starts in the spine, it is called a primary tumor. Tumors can also originate in other parts of the body and travel (metastasize) to the spinal cord or bones. This type of tumor is called a secondary tumor. Spinal tumors are also classified by where they occur in the spine – cervical (neck), thoracic (middle spine – rib cage), lumbar (lower back), sacral (lower back to tailbone).
The symptoms of a spinal tumor can vary widely and may resemble those of a bulging or herniated disc, spinal stenosis, or spondylolisthesis. Pain, difficulty walking or a stiff back or neck are common, as are weakness or numbness down the arms or legs. However, the most common symptom for patients with spinal tumors is pain in the back. Back pain will usually improve with medications, physical therapy and injections over a few weeks. When the patient does not improve with these standard treatments or there is a change in their neurologic status, I become more suspicious that there is an underlying problem, including a tumor, that may be contributing to their pain. They may also have decreased sensitivity to hot or cold, paralysis, spinal deformities and scoliosis with larger, more aggressive tumors.
In my practice as a Spine Surgeon, spinal tumors may be seen on diagnostic x-rays or an MRI as part of my normal diagnostic work-up for patients with spine-related pain or dysfunction. If a tumor is found in the bone, it will show up on x-ray images. If soft tissue is involved, the MRI will reveal the nature and location of the spinal tumor.
If a spinal tumor is discovered, I will refer the patient to an Oncologist who specializes in treating cancer and can coordinate the patient’s care. The Oncologist will order laboratory tests of the blood and urine, as well as other imagining studies to help determine if the spinal tumor is benign or malignant, and if primary or secondary. They may also order a biopsy of the tumor to learn more about the cell structure of the tumor. The Oncologist will also stage the tumor (1-4 levels of severity) and prescribe the appropriate course of treatment in consultation with the patient.
If the tumor is primary, benign, and the symptoms can be managed conservatively, observation and a “wait and see approach” may be recommended as the best treatment. Follow-up MRI scans would be done every six months to a year to keep an eye on the tumor. If symptoms, such as intractable pain occur and persist, the decision may be made to remove the tumor. The excision of the tumor and any reconstructive work needed can be an extensive surgical procedure.
The pros and cons of surgical tumor removal are relayed to the patient and their family in my discussions prior to a decision for surgery. Tumors that wrap around or are entwined with the spinal cord and nerves, may be difficult or impossible to remove without some or possibly a major neurological deficit as a result. If the tumor affects the spinal bones, I can remove the tumor and then may have to strengthen and realign the vertebrae, depending upon how destructive the tumor was. The tumor may have caused a fracture of one or more of the vertebrae or may have eroded the spinal bones. The complete bone reconstruction is done using bone grafts, rods, pins, plates, and screws to closely recreate the patient’s normal anatomy and mechanical function.
If the tumor is malignant, chemotherapy, radiation therapy or proton-therapy may be used alone or in a combination to try and shrink the tumor. If the tumor can be reduced in size, a subsequent surgery may be able to eradicate the tumor entirely. Surgery for a metastatic tumor is usually done for patients who have longer than 4 months to live, who are experiencing a great deal of pain, and for those for whom tumor removal may prolong life expectancy and improve quality of life. These decisions for surgery need to involve the patient, their families as well as their medical team, as this surgery can be difficult on them all.
Make an appointment with Dr. Carlson or another OSC provider by clicking the “Request Appointment” button below or by calling (757) 596-1900.