Acıbadem Comprehensive Spine Center
SPINAL DISORDERS SPINAL TUMORS

Spinal Tumors


Omurga TümörleriSpinal tumors are tumors that may develop from any of the components that constitute the spine, for example bone, nerve, and soft tissues. These tumors may be located anywhere along the spine, such as the neck, back, lower back-coccyx. Tumors may have two origins. In the first group are tumors which originate from cells that constitute the structure of the spine and spinal cord, and they are named primary tumors (figure 1)

The second group are tumors which develop as a result of the spread of tumors in other parts of the body (e.g. breast, prostate, etc.) and they are metastatic tumors. (figure 2)

Omurga Tümörleri


What are the symptoms of spinal tumors?


The most common symptom in spinal tumors is pain which occurs in the involved part of the spine and radiates upwards or downwards (such as neck or lower back pain). The pain may occur especially during the night and may increase with physical activity. In cases where the tumor arises directly from the spinal cord, or when a tumor originating from the spine makes a compression on the spinal cord, signs of spinal cord compression may be observed. These differ according to the site of compression. Numbness in the arms and legs, numbness in the chest, loss of strength in the arms and legs, and difficulty during walking may occur.

How is the diagnostic process in spinal tumors?


The diagnostic process in spinal tumors begins with history and physical examination. Patients may have a history of previous cancer or cancer under treatment. If your doctor suspects a tumor, he or she may request studies such as direct X rays, CT, and MRI. Sometimes scintigraphy or PET may be requested to understand if there is an involvement in other parts of the body.

If the imaging methods have shown the presence of tumor, the next step will be making a biopsy to learn the type and source of the tumor. Most of the time this is performed by spinal surgeons or interventional radiology specialists under local anesthesia using a needle or trocar. An open biopsy may be preferred in some conditions. If the source and type of the tumor can be determined by biopsy, it will help in determining the subsequent treatments.

What are the surgical options in spinal tumors?

What are the nonsurgical treatment methods in spinal tumors?


Nonsurgical treatment methods are observation, chemotherapy, and radiation therapy. Benign tumors that do not cause serious symptoms and without aggressive spread may be followed by imaging methods (often MRI) performed frequently. Also malignant primary spinal tumors and their metastases may be sensitive to chemo or radiotherapy. Chemo or radiotherapy may be the first choice in these types of tumors.

When is surgical treatment necessary in spinal tumors?


In primary malignant tumors that originate from the spine itself, surgical treatment is often preferred as soon as the tumor is detected. The aim is to remove the malignant tumor cells from the area as soon as possible. Surgical treatment may be also necessary if the primary malignant or metastatic tumors cause progressive neurologic deficit or rapid loss of stool and urine control. Surgical treatment may be necessary when the tumor significantly distrupts the strength of the spine, or also to stabilize the vertebrae that are disrupted due to the abnormal spinal movement. Another condition where surgery may be needed is the insensitivity of the tumor to chemo or radiotherapy, and lack of response to these treatments.


The surgical treatment of spinal tumors is total or partial removal of the tumor. This decision must be made by your surgeon. The criteria which your surgeon will consider when making a decision are: tumor type, spread, benign or malignant nature, sensitivity or resistance of the tumor to radiotherapy, neurologic risk rate, and expected survival. These factors will be evaluated and cost to benefit ratios and other possible treatment options will be presented to you.

Destruction in the spine caused by the tumor itself or the surgery, and the resultant abnormal mobility will be evaluated. Fixation of the spine (instrumentation) with metal implants may be necessary. These interventions can be performed either on the front or back sides of the spine, and sometimes both.

Omurga Tümörleri In some benign tumors, only the part containing the tumor is removed by curettage, and the resulting cavity is filled with bone or cement. (figure 3)

 

 

 

 

 

 

 

 

 



Omurga TümörleriIn malignant tumors, the tumoral tissue is removed widely and metallic fixation-instrumentation is applied to the spine. Also, a metal cage filled with bone is inserted to the front part (anterior) of the vertebra which is removed along with the tumor. In metastatic tumors, filling the tumorous vertebra with cement, or removing the vertebra followed by  instrumentation – cage procedure may be performed. (figure 4)

Length of stay in the hospital may range from 3 to 10 days, and physical therapy or rehabilitation may need to be performed for a period of time. The length of stay in the hospital differs depending on the necessity of physical therapy, its duration, and whether it can be performed at home or not. In some tumors, chemotherapy or radiotherapy may be necessary after surgical treatment. The application of these treatments may also affect the total recovery time.

The total recovery period changes between 3 months and 1 year depending on the complexity of surgery.

How is the long term follow up performed in spinal tumors?


Your doctor will follow you up for a certain period of time and with intervals depending on the type of tumor. The follow up is often performed with radiographs and MRI. There is a recurrence risk for the tumor which changes according to the type.

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