Spinal Tumors: Descriptive Overview
What Are Spinal Tumors?
Spinal tumors rarely occur and are either benign or malignant. Some tumors are known to metastasize (spread) via arteries, veins, the lymphatic system, and directly. Malignant tumors of the breast, prostate, lung, and kidney can spread into the spine. Spinal tumors can be dangerous when they cause spinal canal compression, which may lead to neurologic dysfunction (eg, paralysis).
Many patients will present with back pain as the primary symptom. The pain can occur at rest, be worse at night, and may or may not be related to activity. Other symptoms may include sciatica, numbness, paraparesis (slight paralysis), spinal deformity (eg, scoliosis, kyphosis), and fever.
Benign Spinal Tumors
Osteochondroma is a slow growing tumor of the cartilage usually affecting adolescents. It is uncommon and is usually found in the posterior (rear) spine.
Osteoid Osteoma is a small bone tumor (less than 2 cm). It usually affects adolescents causing night pain and may result in spinal deformity.
Osteoblastoma affects children and adolescents. These tumors can be large, aggressive, and painful sometimes causing spinal deformity and paralysis.
Aneurysmal Bone Cysts (ABCs) typically cause pain and swelling usually affecting children and adolescents. These tumors can be large and quite vascular.
Giant Cell Tumor is known to affect children, adolescents and young adults. These tumors can be found at the cervical, thoracic, or lumbar segments of the spine, but are more common in the sacrum.
Hemangioma occurs most often in the thoracic spine. These tumors affect adults and are known to be progressive vascular masses that can cause vertebral collapse and paraparesis (slight paralysis).
Eosinophilic Granuloma is usually seen in the vertebral bodies of children and adolescents. When this tumor is systemic it is termed Histiocytosis X. Rarely do these tumors lead to vertebral collapse and paraparesis. On occasion, they may heal spontaneously.
Malignant Spinal Tumors
Plasmacytoma presents in middle aged and older adults. These tumors are common in the pedicle and vertebral body and may cause paraparesis.
Ewing's Sarcoma is an aggressive tumor affecting adolescents and young adults. In some cases, it may metastasize.
Lymphoma may present in one or more vertebral bodies in middle aged or older adults. Sometimes the lymphatic system is involved.
Chondrosarcoma is a tumor affecting spinal cartilage in middle-aged adults. It grows slowly but can be dangerous. Usually aggressive medical intervention is required.
Osteosarcoma is bone cancer found in adolescents and middle-aged adults. These tumors may metastasize requiring aggressive medical therapy.
Chordoma is usually seen in adults frequently (50%) involving the sacrum, although it can affect other parts of the spine. These tumors often require aggressive medical therapy.
Spine pain does not always indicate tumor presence. However, early medical intervention is always warranted if spine pain does not resolve or if neurologic deficit is experienced.
Comments by Michael G. Fehlings, MD, PhD, FRCSC, FACS
Dr. Bradford presents very good and comprehensive information about spinal tumors. It should be emphasized that primary tumors of the spine are generally uncommon; however, metastatic spinal tumors are more common.
Spinal tumors are an uncommon cause of back pain. Persisting pain, particularly if it is not activity related or if it occurs at night, is a potential red flag that mandates further examination by x-ray, CT or MRI. Primary tumors of the spine are uncommon. Metastatic tumors, which spread from another site of cancer (eg, lung, breast, colon, prostate), are a more common type of spinal tumor. Any patient with a history of cancer who develops back pain should have a workup to exclude a metastatic spinal tumor.