Spine tumors can occur outside of the spinal sac (extradural), inside the spinal sac but outside of the spinal cord (intradural) and/or inside the spinal cord (intradural intramedullary). They can occur anywhere along the spine and spinal cord: in the neck (cervical), mid-back (thoracic) and/or the lower back (lumbosacral). Spinal tumors can be benign (non-cancerous) or malignant (cancerous).
Signs and symptoms
Spinal tumors can cause the following symptoms:
- Back pain at the tumor’s location
- Numbness or tingling in the arms or legs
- Loss of function (weakness or paralysis) in the arms and/or legs
- Bowel and bladder dysfunction due to involvement of or pressure on the spinal cord or spinal nerves
Other conditions can cause the same symptoms, so it is important to check with your doctor for an accurate diagnosis. Only a doctor experienced in recognizing the exact combination of symptoms that indicate an intradural tumor can make a firm diagnosis.
Diagnosis of an intradural tumor starts with a physical exam and medical history. Other procedures and tests may be needed to diagnose a tumor, including magnetic resonance imaging (MRI), computed tomography (CT) and stereotactic biopsy . Stereotactic biopsy is done to make the correct diagnosis and determine possible treatment options.
A customized treatment plan is put together for you based on:
- The tumor’s location and size
- Your age and general health
- Your tolerance for treatment
- Your preferences
Treatment for an intradural tumor may include one or a combination of the following options:
Observation. If the tumor is not causing issues or symptoms, it can be observed and reevaluated.
High-dose chemotherapy. During this procedure, very high doses of chemotherapy (medicines designed to treat cancer) are given to the patient, usually by intravenous (IV) line.
Radiation. This treatment uses high-energy particles or waves to kill cancer cells by damaging their DNA.
Open microsurgery. Surgery is recommended to improve symptoms, prevent further loss of function and make a diagnosis. Surgery can usually cure benign tumors. Surgery cannot cure malignant tumors, but can help preserve function. The surgery is typically done by a neurosurgeon. The surgical approach for a spinal tumor is usually by way of an incision made on the back of your neck or on the back. The exact location of the incision depends on the location of the tumor. After making the incision, bone and ligament are removed to gain access to the spinal canal, which contains the spinal cord and spinal nerves. These are covered by a layer of dura . The number of levels opened depends on the location and size of the tumor. After opening the bone and exposing the dura, the tumor is removed if it is located in the epidural space. If it is inside the dura or spinal cord, a high-powered microscope is used to help remove the tumor. This will help make the surgery as safe as possible and enable the neurosurgeon to remove as much of the tumor as is safely possible. If the tumor is inside the dura, the dural membrane is opened. Then, using very fine instruments, the tumor is separated and carefully removed from the dura, spinal cord and/or nerve roots. If the tumor is inside the spinal cord, special nerve monitoring equipment is used to locate the midline of the spinal cord. An incision is then made in this space to get to the tumor. Special instruments are used to suction the tumor away from the spinal cord while using nerve monitoring to perform the surgery as safely as possible. After the tumor is removed, the dura is carefully closed with suture. The bone is returned to its normal position and attached with tiny titanium plates and screws. The incision is closed with sutures beginning with the muscles next to the spine, followed by all other layers and skin. Sometimes, a tumor cannot be fully removed because it may cause more harm and loss of function to remove the entire tumor than to leave a small amount behind.
Followup care includes regular monitoring for worsening of symptoms, effectiveness of treatment and, if the tumor was removed, recurrence of the tumor by means of follow-up MRI studies.