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Lumbar Spine Tumors

Are all Spine Tumors Cancer?

A tumor is human tissue which grows significant more than what is expected of that specific tissue. As the growths continues

Spine tumors can be benign (non-cancerous) or malignant (cancerous). The great majority of spine tumors are benign and slow growing. They are not considered to be malignant (cancerous).

What are metastatic malignant (cancerous) Spine Tumors?

Malignant (cancerous) spine tumors are most often metastatic, i.e. they spread to the spine from a cancer in another part of the body. The most common sites where these malignant (cancerous) tumors come from are:

  1. Breast Cancer
  2. Lung Cancer
  3. Kidney Cancer
  4. Prostate Cancer

 

These cancerous tumors are called the “Primary Cancer” which then spreads (metastasizes) to the spine.

What are primary Cancerous Spine Tumors?

A minority of spine cancers are called ‘primary’, meaning they originate in the spine itself. The most common primary spine cancer is called ‘osteosarcoma’, a type of bone cancer which occurs mostly in younger adults.

Can benign tumors of the Lumbar Spine still cause problems?

There are certain types of spine tumors which occur in or around the spinal cord, cauda equina, or spinal nerves. Most of them are benign but cause problems because of their location. Even though they are not cancerous, they can result in compression of the spinal cord, cauda equina or spinal nerves, which may require surgery. They are classified by their location with regard to the spinal cord and the dura (lining of the spinal cord). Below are some examples of these types of tumors:

1. Meningiomas

           -form in the membrane surrounding the spinal cord

           - mostly benign but some can be malignant (cancerous)

2.    Nerve Sheath tumors

      - arise from the sheath surrounding the spinal nerves

      - usually benign

      - examples are Schwannomas and Neurofibromas

 

3. Tumors in the spinal cord

      - most common in the neck (cervical spine)

      - usually benign

       - may require surgery due to their size or location compressing part of the spinal cord

       - most common type is astrocytoma and ependymomas

What Symptoms do Spine Tumors cause?

  1. Benign Tumors

Benign (noncancerous) Spine Tumors often do not produce symptoms unless they cause pressure on other structures of the spine.

Here are some examples of symptoms benign tumors of the spine can cause:

  1. Localized pain
  2. Numbness or weakness in the arms or legs
  3. Stiffness or reduced mobility of the spine
  4. Spasms of the spine muscles
  5. Pain with motion of the spine

      2. Malignant (cancerous) Spine Tumors

The majority of malignant (cancerous) spine tumors present with pain, but some present with neurological problems. Here are some of the symptoms of spine cancers:

  1. Localized pain in the spine which is worse during the night, and morning
  2. Weakness or numbness in the arms or legs
  3. Spine pain associated with weight loss, night sweats, lack of appetite.
  4. Cold sensation in the arms or legs
  5. Spine pain that is worse when lying down
  6. Incontinence of urine or bowel
  7. Severe fatigue, nausea, chills
  8. Spasms of the spine muscles, arms or legs

How do Spine Specialists make the diagnosis of a spine tumor?

Spine specialists use a patient history, a targeted physical examination, and other spine tests to determine if a patient has a Spine Tumor.

  1. History

A patient history of recent weight loss, night sweats and sudden symptoms of spine pain or a neurological problem of the spine are suspicious for a malignant Spine Tumor.

      2. Physical examination

Here are some common physical examination techniques used by doctors to diagnose involvement of the spinal cord from a spinal tumor:

  1. Gait evaluation
  2. Sensation testing in the legs
  3. Strength testing (motor) in the legs
  4. Reflex testing in the legs
  5. Babinski’s Test
  6. Ankle Clonus Test
  7. Valsalva test

                 3. Imaging

The diagnosis of a spine tumor typically requires spine images. Here are some examples:

  1. X-Rays

Spine X-Rays show the bone anatomy of the spine. Some bone tumors can be seen on an X-Ray, especially if the tumor is causing destruction of a vertebra.          

      2. MRI Scans

MRI scans are often used in the diagnosis of a spine tumor, sometimes in combination with other types of spine imaging. MRI technology can show tumors in bone, and the softer structures such as the spinal cord and spinal nerves.

           3. CT Scans

CT Scans are excellent in looking for spine tumors in the bones of the vertebrae. However, they may not show tumors in the softer structures such as the spinal cord or spinal nerves.

          4. Nuclear Bone Scans

Nuclear bone scans can show spinal tumors which involve the bones of the vertebrae. This study can show the activity of tumors within the bones of the spine. However nuclear bone scans do not produce images showing the details of the tumors or softer structures such as the spinal cord or spinal nerves.

      5. Pet Scans

Pet scans are an excellent method to detect spine tumors. They are often combined with an MRI scan to show as much of the anatomy as possible.

      6. Electromyogram/Nerve Conduction Study (MG/NCS)

In some instances of spinal cord tumors, an EMG/NCS study is performed to help assess the status of the Neurological System when a Spine Tumor is diagnosed.

How are Spine Tumors treated?

The treatment of spine tumors depends on a variety of factors:

  1. Benign tumors

Benign tumors are sometimes just watched with imaging scans, such as CT or MRI scans at certain time intervals. Other times, if the tumor is benign but growing fast and pushing on the spinal cord or spinal nerves, it may have to be surgically removed.

Some of these tumors which occur inside the spinal cord may not be removable due to the high likelihood of causing more damage to the spinal cord during surgery. However this is highly dependent on the type of tumor and its exact location.

      2. Malignant (cancerous) tumors

The treatment of malignant (cancerous) tumors depends on a number of factors. If the tumor is metastatic, the treatment may depend on how the primary cancer (where it originates from. i.e. breast cancer metastasizing to a vertebra) is best treated.

If a tumor in a vertebra does not seem to weaken it to a point of potential collapse, then chemotherapy, and/or radiation may be the best treatment.

If the tumor is likely to collapse the vertebra, surgery may have to be performed. This surgery may remove some or all of the involved part of the vertebra, placing a metal cage in its place. Finally, screws and rods may be needed to secure the diseased segment and allow it to fuse together. There are many surgical techniques depending on the type of vertebrae and cancer involved.

Here are some of the surgeries done for Lumbar Spine Tumors:

  1. Lumbar Vertebrectomy/Corpectomy
  2. Lumbar Laminectomy Decompression