Spinal tumor

Alternative names
Tumor - spinal cord

Definition
A spinal tumor is a growth of cells (mass) within or surrounding the spinal cord.

Causes, incidence, and risk factors

Spinal tumors can occur inside the cord (intramedullary), within the meninges (membranes) covering the spinal cord (extramedullary - intradural), between the meninges and the bones of the spine (extradural), or they may extend from other locations.

Most spinal tumors are extradural. They may be primary tumors originating in the spine, or secondary tumors that are the result of the spread of cancer (metastasis) from other locations - primarily the lung, breast, prostate, kidney, or thyroid gland.

Any type of tumor may occur in the spine, including lymphoma, leukemic tumors, myeloma, and others. A small percentage of spinal tumors occur within the nerves of the spinal cord itself, most often consisting of ependymomas and other gliomas.

The cause of primary spinal tumors is unknown. Some primary spinal tumors are associated with genetic defects. A spinal tumor is much less common than a primary brain tumor.

As it grows, the tumor affects the spinal cord cells, nerve roots, meninges, blood vessels, or the bones of the spine. It causes symptoms because of compression of the spinal cord or nerve roots (similar to spinal cord trauma), invasion of normal cells by the tumor, or ischemia (lack of oxygen) that results from blockage of blood vessels.

Symptoms

The symptoms vary depending on the location, type of the tumor, and the general health of the person. Metastatic tumors (those that have spread to the spine from another site) often progress quickly, while primary tumors often progress slowly over weeks to years.

Intramedullary (within the spinal cord) tumors usually cause symptoms, sometimes over large portions of the body. Extramedullary (outside the spinal cord) tumors may grow for quite some time before causing nerve damage.

     
  • Back pain:       o In any area - middle or low back are most common       o That is worse when lying down       o That is worse with strain, cough, sneeze, etc.       o That may extend to the hip, leg, or feet (or arms)       o That may be diffuse, occurring over all extremities (generalized)       o That may remain localized in the spine       o That progressively worsens       o That is usually severe and not relieved by pain medication  
  • Abnormal sensations, loss of sensation:       o Particularly in the legs       o That may be progressive  
  • Muscle weakness (decreased muscle strength, independent of exercise):       o Particularly in the legs       o That makes walking difficult       o That may get worse (progressive)       o That causes falls  
  • Cold sensation of the legs, cool fingers or hands, or coolness of other areas  
  • Inability to retain feces (Fecal Incontinence)  
  • Inability to keep from leaking urine (Urinary Incontinence)  
  • Muscle function loss  
  • Muscle contractions or spasms (fasciculations)

Signs and tests

A neurologic examination may indicate the location of the tumor. Spastic weakness may be present, with increased muscle tone and abnormal reflexes.

Pain and temperature sensation may be lost simultaneously with - or independently of - other sensation losses. There is often localized spine tenderness on examination of the back, which is more pronounced with epidural tumors.

These tests may confirm spinal tumor:

A CSF (cerebrospinal fluid) examination may be normal, or abnormal but nonspecific. Cytology (cell studies) of CSF sometimes shows tumor cells.

This disease may also alter the results of an ADH test.

Treatment
The goal of treatment is to reduce or prevent nerve damage from compression of the spinal cord. The most important aspect of treatment is that it be given quickly, so any new or unexplained back pain in a patient with cancer should be taken seriously.

Corticosteroids, such as dexamethasone, reduce inflammation and swelling and may temporarily reduce symptoms.

Surgery may be needed to relieve compression on the spinal cord. Some tumors can be completely removed. In other cases, a portion of the tumor may be removed to relieve the pressure on the spinal cord.

Radiation therapy may be used in addition to - or in some cases, instead of - surgery.

Chemotherapy has not been developed that has proven effective against most spinal tumors, but it may be recommended in some cases.

Physical therapy and other interventions may be needed to improve muscle strength and to improve the ability to function independently when permanent neurologic losses occur.

Support Groups
The stress of illness may be eased by joining a support group whose members share common experiences and problems.

Expectations (prognosis)
The outcome varies. Early diagnosis and treatment usually leads to a better outcome. Nerve damage may persist even after surgery. Although permanent disability is likely, treatment may delay the development of major disability and may delay death.

Complications

     
  • Permanent damage to nerves, disability from nerve damage  
  • Life-threatening spinal cord compression

Calling your health care provider
Call your health care provider if you have a history of cancer and suddenly develop severe back pain.

Go to the emergency room or call the local emergency number (such as 911) if new symptoms develop or symptoms worsen during treatment of spinal tumor.

Johns Hopkins patient information

Last revised: December 6, 2012
by Simon D. Mitin, M.D.

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