Symptoms, Diagnosis and Treatment of Spinal Cord Tumors
Spinal cord tumors are tumors that arise from the tissues of the spinal cord. The term spine tumor refers to tumors that arise from the coverings of the spine including the vertebral bones. Spinal cord tumors are relatively rare, as are most spine tumors other than metastatic tumors. Spinal metastases occur in upwards of 10 percent of patients with cancer.
The most common spinal cord tumors (or intramedullary tumors) are ependymomas, astrocytomas and hemangioblastomas. The next group of spine tumors is known as intradural-extramedullary tumors. These tumors are located within the covering of the spinal cord (the dura) but outside the substance of the spinal cord itself. The most common intradural-extramedullary tumors are meningiomas and neurofibromas. A third group of tumors are the primary bone tumors. These are uncommon and rarely need surgical intervention. Some examples of primary bone tumors are chordomas, osteoblastomas, osteoid osteomas, aneurysmal bone cysts and vertebral hemangiomas. Finally, metastatic tumors are quite commonly seen.
Symptoms
The most common symptom of a spinal cord or spine tumor is pain. The pain can be located near the level of the tumor or it may radiate around the side, down the arm or down the leg. The latter complaints are related to pressure on the nerve roots that come off of the spinal cord. Symptoms may be very similar to a disc herniation. Eventually, loss of strength may be seen. Sensory loss is also common. In the case of an intramedullary tumor, so-called dissociated sensory loss is common. In these cases, there is loss of sensitivity to pain and temperature below the tumor but preserved sensitivity to light touch. Gradual pressure on the spinal cord can cause spasticity. Loss of bowel and or bladder control are important signs of pressure on the spinal cord or the lower spinal nerves (called the cauda equina).
Symptoms may come on gradually and then suddenly become more severe. This is particularly true in metastatic disease.
Diagnosis
As always, a careful history and physical examination are the first steps in diagnosis. The diagnosis of a spinal cord tumor may be slow because back pain is common and spinal cord tumors are rare. It is not unusual for some time to pass before a diagnosis is made. The invention of the MRI scanner has made it much easier to diagnose spinal cord and spine tumors. Frequently an MRI is the only test necessary to make a diagnosis. In some cases, however, a CT scan and or a nuclear medicine bone scan may be helpful.
Treatment
The treatment of a spinal cord or spinal tumor depends on the symptoms and the imaging studies (MRI scan, CT scan, bone scan). In some cases of primary bone tumors, all that may be needed is observation. In most cases of intramedullary, intradural-extramedullary and metastatic tumors more aggressive intervention will be indicated. In general, the intramedullary and intradural-extramedullary tumors are treated with surgical resection. Metastatic tumor treatment depends on the state of the cancer, the neurological condition of the patient and the appearance of the imaging studies. In some cases, treatment may consist of steroid medication and radiation therapy. In cases where severe compression of the spinal cord or spinal nerves exists, decompression along with stabilization (fusion) may be necessary. Each case must be evaluated on an individual basis.