Diagnosis of a Spinal Tumor
Physical and neurological exams, lab work, imaging studies, biopsy
Back pain is the symptom that usually prompts a patient to see their doctor. Sometimes, evidence of a spinal tumor may be found incidental to a work up for a different disorder. Similar to the diagnosis of other types of spinal problems, the process begins with the patient's detailed medial history and a physical and neurological examination. During the physical exam, the doctor learns about the patient's general health, daily medications, supplements and vitamins taken, fitness level and lifestyle.
Besides checking your vital signs (eg, breathing, blood pressure), the doctor may:
- Palpate (feel) the spine
- Check the spine for abnormal curvature, localized pain, muscle spasm
- Evaluate reflexes, sensation, and range of motion
- Determine muscle strength and tone
- Observe you walking (rhythm), walking on your heels, standing on tip toes
Questions the Doctor May Ask You
- Where is your pain?
- Does your pain spread (radiate) into your arms, legs, or elsewhere?
- Does pain or symptoms interrupt sleep?
- Do you have trouble walking, climbing stairs, and walking downhill?
- Do you experience weakness in your arms or legs?
- Any bowel or bladder difficulties?
- Have you recently fallen or been in an accident?
- What makes your symptoms worse?
- Does changing position (eg, resting) help to relieve symptoms?
- What treatment have you tried and with what success?
Your Doctor May Order Blood Tests
Certain blood tests help your doctor determine if pain and other symptoms are caused by an infection or possibly a spinal tumor.
Imaging studies are tests such as x-rays, MRI (magnetic resonance imaging), CT scan (computed tomography), and/or myelogram. MRI, CT and myelography may include an injection of a contrast dye to highlight the spinal cord and nerve structures.
A PET scan (Positron Emission Tomography) is called nuclear imaging because it entails the use of a radiotracer (radioactive material) injected into your body. The scanner and computer work together to measure the amount of radiotracer your body absorbs. Also, the test produces pictures of your organs and tissues and helps your doctor to see these structures and measure their function.
Lumbar Puncture (Spinal Tap)
A lumbar puncture or spinal tap is an image-guided (e.g. x-ray, not CT) procedure. A special needle is passed into the spinal canal to collect a sampling of your cerebrospinal fluid (CSF). CSF is a clear fluid that delivers nourishment, removes waste and cushions the brain and spinal cord. The CSF collected during a spinal tap is microscopically evaluated by a laboratory pathologist for any abnormalities, including cancer cells.
What is a biopsy?
Needle biopsy, or percutaneous needle biopsy, is a technique to capture tumor cells for microscopic testing. Local anesthesia is administered and the entire procedure is performed using x-ray or CT-guidance. This means the doctor can see and guide the needle into the tumor. It is not unusual for the doctor to take more than one sample of the tumor. Similar to other procedures, your doctor will explain what to expect including possible risks or complications.
What does it mean to stage a spinal tumor?
Staging means to identify the tumor and see if (and how far) it has spread. If the tumor has not caused spinal instability, staging is valuable to determine the risk for vertebral collapse (fracture), and the need for surgical intervention to prevent or treat spinal fracture. This type of information is important to help your doctor recommend the best course of treatment.
How Your Doctor Uses Test Results
All of the results from your physical and neurological examinations, blood work-up, imaging studies, and biopsy findings are reviewed and compared. Then the diagnosis is made. Identifying the type of spinal tumor is essential for the next step—treatment.