Spinal Tumors: Diagnosis and Non-Surgical Treatment

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The patient's medical status is evaluated with particular attention given to back pain and neurologic deficit. Although back pain is often the primary symptom, some patients present with paraparesis (slight paralysis), spinal deformity (e.g. scoliosis, kyphosis), and malaise.
Doctor in consultation with male patientThe patient's medical status is evaluated with particular attention given to back pain and neurologic deficit. Plain radiographs (x-rays) may demonstrate the presence of a spinal tumor. A CT Scan and/or MRI can provide further tumor detail including neural elements (e.g. spinal canal).

An angiogram demonstrates the vascularity of the tumor (e.g. blood supply). Further, a biopsy of the tumor is necessary to establish the diagnosis (e.g. tumor type, benign or malignant).

Staging classifies neoplasms (abnormal tissue) according to the extent of the tumor including bony and soft tissue involvement, and spinal canal intrusion. A whole body Technetium-99 bone scan is required and may include a chest x-ray, and CT scan of the lungs and abdomen.

The above findings and results from laboratory tests (e.g. complete blood count, urinalysis) are compared to the patient's symptoms to confirm the diagnosis.

A coordinated multidisciplinary approach is used to treat spinal tumors. The expertise of a neuroradiologist, pathologist, angiographer, oncologist, and spinal surgeon may be combined during the patient's treatment. The type of tumor, neurologic deficit, spinal deformity (e.g. scoliosis), bony involvement, prior treatment, patient's medical status, pain, and life expectancy are considered prior to treatment.

Aggressive tumors may require surgical resection (partial removal) or excision (complete removal). Others require non-surgical treatment that may include bracing, radiation, chemotherapy, or embolization. Some tumors require both surgery and non-operative treatment. Analgesics are given for pain.

If pain is difficult to manage, a pain management specialist may be consulted. Steroids may be prescribed to reduce edema (swelling) that can occur around tumors. Bracing may be used to control pain and provide spinal stability. Radiation and/or chemotherapy may shrink tumors. The dose and frequency of radiotherapy (e.g. radiation) is carefully calculated to destroy cancer cells while preserving healthy cells. Chemotherapy drugs can be administered orally or intravenously.

Surgery may be indicated when:

(1) Pain is unresponsive to non-operative treatment.

(2) Neurologic deficit progresses.

(3) A specimen is needed (open biopsy).

(4) The tumor requires debulking (reduce size) to decompress neural elements (e.g. nerves).

(5) Vertebral destruction exists

(6) Spinal stabilization is necessary.

Wound healing and the risk of infection are concerns which factor into surgical decision-making. The patient's immunity, nutritional health and pulmonary (e.g. lungs) status are evaluated:

(1) If the patient has recently undergone radiation or chemotherapy, their white blood cell count may be too low to fight infection and could compromise healing.

(2) Cancer can affect appetite and eating, which may lead to weight loss and deterioration of general health.

(3) Good pulmonary function is needed to properly oxygenate blood to augment wound healing.

Whether the treatment course is non-operative or surgical, periodic follow-up visits with the treating physician(s) is essential.

Commentary 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 (e.g. 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.

Updated on: 08/21/18
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Spinal Tumors: Surgery and Recovery
Michael G. Fehlings, MD, PhD, FRCSC, FACS
Professor of Neurosurgery
Department of Surgery
University of Toronto
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