What is a Spinal Tumor? How Is It Related to Scoliosis?
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Spinal Tumor Overview
A spinal tumor is a mass or growth of cells within the vertebrae of the spine or around the spinal cord. Tumors originating in the spine are rare so this condition needs immediate attention. The rate varies, but primary spinal tumors occur in about 2 to 10 people per million each year. Secondary spinal tumors which metastases from other cancers are much more common, affecting up to 30% of cancer patients.
Where can spinal tumors occur?
- Inside of your spinal cord (intramedullary).
- In the tissues (meninges) covering your spinal cord (intradural-extramedullary).
- Between the meninges and bones of your spine (extradural).
- In the bony vertebrae of your spine.
- Within the spinal canal
A significant proportion of spinal tumors are categorized as central nervous system tumors, highlighting their impact on neurological function.
Tumors are either benign, which are non-cancerous, or malignant. Benign primary spinal tumors account for 0.5% of all newly diagnosed tumors. Although they are non-cancerous, benign spinal tumors can result in other conditions, such as nerve compression, spinal deformity, and compromised bone strength. Benign spinal tumors, such as osteoblastomas or giant cell tumors, do not spread from their original location but may be “locally aggressive.” This means that although they are not cancerous, these spinal tumors can destroy normal bone, result in pathological fractures, and could grow back after surgical treatment.
Specific genetic disorders can lead to the development of benign tumors, which can impact spinal health.
Malignant tumors are cancers that can spread to other parts of the body including the brain and spinal cord. They may arise in the spine or travel to the spine from other parts of the body. These tumors can lead to serious symptoms such as back pain, muscle weakness, and paralysis, emphasizing the importance of understanding their impact on these critical areas.
Malignant primary spinal tumors are rare. The most common malignant tumors arising in the spine are chondrosarcoma, Ewing’s sarcoma, lymphoma, osteosarcoma, and multiple myeloma/plasmacytoma.
Many tumors found in the spine have spread to the spine due to breast cancer, prostate cancer, lung cancer, thyroid cancer, kidney cancer, or cancer of the gastrointestinal tract.
Whether the tumor spreads or not, a spinal tumor can threaten life, irritate or injure the spinal cord and nerves, and cause permanent disability. All types of spinal tumors can be life-threatening or threaten mobility, given the importance of the normal structures (spinal cord and spinal nerve roots) that the spine contains. Blood vessels play a crucial role in the formation and nourishment of various types of spinal tumors, particularly benign tumors like hemangiomas and hemangioblastomas.
Table of Contents
Symptoms
Diagnosing
Treatments
Patients Ask:
What Are the Risk Factors Associated with Spinal Tumors?
Texas Back Institute Responds: People with certain immune disorders or genetic conditions, such as neurofibromatosis 2, are more likely to develop spinal tumors than other people. People with a prior history of cancer, particularly breast, prostate, lung, thyroid, and kidney, have a greater risk of developing a spinal tumor.
What are the Symptoms of Spinal Tumors?
Symptoms of spinal tumors include pain and weakness. Tumor cells, both benign and malignant, can develop around the spinal cord or column, causing physical pressure on the spinal cord and nerves. Most patients complain of constant “aching” or “gnawing” pain at the location of the tumor, mechanical pain around the tumor aggravated by movement, or radiating “shooting” nerve pain (pain that radiates down the arms, legs, or around the chest and belly) related to nerves that are compressed or irritated by the mass.
A spinal cord tumor can also lead to specific symptoms such as muscle weakness and numbness due to its impact on surrounding structures and the flow of cerebrospinal fluid.
Symptoms vary based on location and the size of the mass and could include:
- Pain that worsens at night, preventing sleep
- Experiencing night sweats and chills
- Experiencing weakness in the arms or legs due to compression of the nerves or spinal cord
- Compression that results in problems with urine function, sexual function, or bowel function
- Pain at the tumor site
- Difficulty walking and falls
- Fatigue
Some patients may have a spinal tumor detected by a test and have experienced no symptoms at all.
Patients Ask:
What Are the Signs of a Spinal Tumor?
Texas Back Institute Responds: Persistent pain is often the earliest and most common symptom of a spinal tumor, and this localized pain increases as the tumor grows. Back pain can radiate to other parts of the body if the nerves or the spinal cord become compressed by the tumor. There could be a loss of sensitivity to pain, heat, or cold. Loss of bladder or bowel function is also a serious symptom. Patients may have trouble walking or could experience balance issues. Often, back pain worsens at night.
Patients Ask:
Why is Spinal Tumor Pain Worse at Night?
Texas Back Institute Responds: Pain primarily at night or in the early morning that gets better as you move is often the first symptom of a spinal tumor. This happens because tumors create a great deal of inflammation, and the adrenal gland does not make steroids when we sleep.
How is a Spinal Tumor Diagnosed?
Because the symptoms of a spinal tumor can resemble those of more common conditions, the spine specialists at Texas Back Institute will ask for a detailed medical history and perform both general physical and neurological exams. This may include checking for swelling, tenderness, and other possible sites of involvement, as well as evaluating motion, alignment, and the strength of the arms and legs. Identifying whether a tumor is a primary tumor or metastatic is crucial, as this classification significantly influences the prognosis and treatment strategies.
A neurological examination may also be done and include tests of sensory (temperature, pain, and pressure sensitivity), motor (muscle strength), and reflex functions of the nervous system. Diagnostic imaging of the spinal column is essential to determine the exact location and extent of the tumor, aiding in the formulation of an effective treatment plan.
Patients Ask:
Can an X-Ray Show a Tumor on the Spine?
Texas Back Institute Responds: A spine specialist may order an X-ray during the initial examination to look for tumors or dislocations. Other tests such as bone scans can identify tumors months before X-rays. Diagnostic imaging tests such as computed tomography (CT) scans and magnetic resonance imaging (MRI) may be ordered to see the spinal cord and surrounding areas in detail and determine the extent of the disease. To determine the origin of the tumor and whether it is benign or malignant, a biopsy will be performed. Spinal tumor biopsies are often performed by using a minimally invasive procedure. Doctors use a CT scan to guide the placement of a thin needle to extract a sample of the tumor. A biopsy can be done in the X-ray department by a radiologist or in the operating room by the surgeon. At times, the biopsy is done at the same time as treatment.
Patients Ask:
Can a Spinal Tumor Be Removed?
Texas Back Institute Responds: The goal of surgery is to improve life expectancy and/or quality of life when treating spinal tumors, including metastatic tumors, by reducing pain as well as preserving the use of the arms, legs, bowels, and bladder. Metastatic tumors, which arise from cancer cells spreading to the spine from other parts of the body, often require a focus on palliative care aimed at improving quality of life. Sometimes, this can be accomplished with a minimally invasive outpatient procedure. Other times, extensive spinal decompression and reconstruction is necessary to accomplish this goal. Regardless of the type of surgery you have, the surgical team at Texas Back Institute will work to ensure a seamless relationship with your cancer specialist and radiation oncologist to provide the best care possible for you or your loved one.
(insert graphic or photo image of spine)
What is the Best Treatment for a Spinal Tumor?
Treatment options for spinal tumors depend on the type of tumor and the extent of the disease. If the tumor is benign and causes no symptoms, it may need nothing more than close observation. In such cases, the spine specialists at Texas Back Institute may recommend monitoring the tumor through regular MRI scans.
Most primary spinal tumors, which can be benign or malignant, have various treatment options. Surgery is typically reserved for tumors causing severe pain, spinal curvatures, or nerve compression. If a tumor remains asymptomatic or shows minimal progression, the best course of action may be to watch and wait. Intervention may not be necessary and close monitoring of the tumor will suffice.
Tumors that arise from other sites may be treated with chemotherapy or radiation treatment. Chemotherapy involves using drugs to target and destroy cancer cells. It is administered systemically, meaning it circulates throughout the body via the bloodstream. While chemotherapy may not cure metastatic spinal tumors, it can help shrink the tumor, alleviate symptoms, and improve overall quality of life.
Radiation Therapy and Other Options
Radiation therapy delivers high-energy X-rays or other forms of radiation directly to the tumor site. It helps control tumor growth, relieve pain, and prevent further damage to the spinal cord. Radiation therapy can be especially effective for metastatic spinal tumors.
Most tumors that are causing severe pain, spinal curvatures, or compression of nerves or spinal cord are treated with surgery. Several surgical techniques are employed to reduce tumor size, decompress the spinal cord and nerves of the spine, and stabilize bony elements of the spine in a more normal position. Many times, minimally invasive techniques can be employed to minimize blood loss, infection, and recovery time. Modern techniques even allow for outpatient delivery of computer-guided thermal energy to a spinal tumor to destroy it, performed through a large needle. This can be done in combination with a vertebral augmentation procedure, where bone cement is injected into the affected spinal bone to stabilize it and reduce or eliminate pain.
The Scoliosis Connection to Spine Tumors
Scoliosis is an abnormal sideways curvature of the spine and can sometimes be associated with spinal tumors. Spinal tumors can cause changes in spinal alignment due to their location and growth. If a tumor becomes large enough, it may shift the spine, leading to conditions like the sideways curvature of scoliosis, kyphosis which is excessive forward curvature, or other deformities. The tumor’s impact on spinal alignment depends on its size, location, and proximity to the spinal cord, nerve roots, and vertebrae.
Spinal cord tumors, which are known as intradural tumors, can cause various symptoms, including back pain, loss of sensation, muscle weakness, and difficulty walking. These symptoms may overlap with those seen in scoliosis.
Surgical Advances
Texas Back Institute spine specialists are leaders in all manner of spinal deformity and tumor surgery, including the most innovative minimally invasive, navigated robotic and traditional surgical techniques. The use of robotics in surgery can improve the accuracy and efficacy of surgery for spinal tumors. Seeking care from a physician with experience providing all types of surgical care for tumors of the spine is very important to ensure the best results with the lowest risk of complications.
Four Ways that Robotics Ensure Best Outcomes During Spine Surgery:
- Accurate Imaging and Surgical Planning: Robotics allows surgeons to take images of the patient and plan where the instrumentation should be. Precision is crucial, since spine surgery involves nerves and the spinal cord.
- Precision Instrumentation: Software guides the robotic arm and places the hardware into its proper position with submillimeter accuracy.
- Time: Robot-assisted spine surgery is shorter and more minimally invasive than traditional open surgery.
- Preservation of Muscles: Robot-assisted spine surgery preserves muscles, tendons and ligaments.
Texas Back Institute is recognized around the world for its expertise in spinal deformity and spinal tumor surgery, employing cutting-edge robotic technology to enhance patient outcomes. Dr. Isador Lieberman, a pioneer in robotic surgery at Texas Back Institute, continues to advance this exciting field.
Here are the key components TBI utilizes:
- The SpineAssist® is specifically designed for spine surgery. It offers remarkable accuracy, with precision down to less than half a millimeter. Surgeons pre-plan procedures in 3D based on each patient’s unique anatomy, creating a personalized “surgical blueprint.” During surgery, the robotic arm guides the surgeon, following the preoperative plan.
- Mazor Robotics Renaissance™: This system transforms spine surgery by replacing freehand procedures with highly accurate, state-of-the-art techniques. It’s used for minimally invasive surgery (MIS), scoliosis, and other complex spinal deformities. The goal is to reduce the need for fluoroscopy during surgery, enhancing safety and precision.
Patients Ask:
What is the Recovery Time After Spinal Tumor Removal?
Texas Back Institute Responds: After spine tumor surgery, patients are taken to a recovery area where they are closely monitored as the anesthesia effects wear off. Pain medications are administered to minimize discomfort. The recovery timeline depends on several factors such as the extent of tumor removal, overall health, physical capability, and the amount of post-surgery assistance needed. Most patients begin a rehab or physical therapy program within a week after surgery.
Long Term Prognosis
The prognosis is promising! Post-operative survival after surgery for spinal metastases has improved over the past 20 years, particularly in patients with kidney, breast, lung, and colon tumors metastatic to the spine, according to a retrospective analysis of patients treated at Memorial Sloan Kettering Cancer Center (MSK).
At Texas Back Institute, our goal is to provide the most appropriate and least invasive care to improve the patient’s condition and quality of life. It is a goal that requires specialized expertise and a full range of support services. Click here to set an appointment.
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Frequently Asked Questions
People with certain immune disorders or genetic conditions, such as neurofibromatosis 2, are more likely to develop spinal tumors than other people. People with a prior history of cancer, particularly breast, prostate, lung, thyroid, and kidney, have a greater risk of developing a spinal tumor.
Persistent pain is often the earliest and most common symptom of a spinal tumor, and this localized pain increases as the tumor grows. Back pain can radiate to other parts of the body if the nerves or the spinal cord become compressed by the tumor. There could be a loss of sensitivity to pain, heat, or cold. Loss of bladder or bowel function is also a serious symptom. Patients may have trouble walking or could experience balance issues. Often, back pain worsens at night.
Pain primarily at night or in the early morning that gets better as you move is often the first symptom of a spinal tumor. This happens because tumors create a great deal of inflammation, and the adrenal gland does not make steroids when we sleep.
A spine specialist may order an X-ray during the initial examination to look for tumors or dislocations. Other tests such as bone scans can identify tumors months before X-rays. Diagnostic imaging tests such as computed tomography (CT) scans and magnetic resonance imaging (MRI) may be ordered to see the spinal cord and surrounding areas in detail and determine the extent of the disease. To determine the origin of the tumor and whether it is benign or malignant, a biopsy will be performed. Spinal tumor biopsies are often performed by using a minimally invasive procedure. Doctors use a CT scan to guide the placement of a thin needle to extract a sample of the tumor. A biopsy can be done in the X-ray department by a radiologist or in the operating room by the surgeon. At times, the biopsy is done at the same time as treatment.
The goal of surgery is to improve life expectancy and/or quality of life when treating spinal tumors, including metastatic tumors, by reducing pain as well as preserving the use of the arms, legs, bowels, and bladder. Metastatic tumors, which arise from cancer cells spreading to the spine from other parts of the body, often require a focus on palliative care aimed at improving quality of life. Sometimes, this can be accomplished with a minimally invasive outpatient procedure. Other times, extensive spinal decompression and reconstruction is necessary to accomplish this goal. Regardless of the type of surgery you have, the surgical team at Texas Back Institute will work to ensure a seamless relationship with your cancer specialist and radiation oncologist to provide the best care possible for you or your loved one.
After spine tumor surgery, patients are taken to a recovery area where they are closely monitored as the anesthesia effects wear off. Pain medications are administered to minimize discomfort. The recovery timeline depends on several factors such as the extent of tumor removal, overall health, physical capability, and the amount of post-surgery assistance needed. Most patients begin a rehab or physical therapy program within a week after surgery.
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