Spine tumors can be placed into two categories: primary spine tumors and metastatic spine tumors. Primary spine tumors are lesions that arise directly from the vertebra and can be either benign or malignant. Metastatic spinal tumors are the result of tumor cells from a distant site that migrate to the spine and continue to grow there. This section is divided by these two broad categories.
PRIMARY SPINAL TUMORS:
General: Tumors of the spine comprise 0.04% of all tumors and about 10% of all bony tumors. The age of presentation is highly predictive of a benign versus malignant lesion. If they present under the age of 21 tumors are typically benign. 70% of malignant tumors occur in patients 21 years and over. The location may also suggest malignancy. The majority of benign lesions occur in the posterior aspect of the vertebrae (pedicle, lamina, spinous process), whereas malignant lesions have a predilection for the vertebral body (anterior).
Pain is by far the most common complaint. Pain that awakens a patient at night is especially concerning. Pain can be the result of tumor invasion, development of deformity, instability of the spine, muscle spasm, or fracture of the spine. Patients may also present with pain at a specific location on the spine, or the pain could be referred to a distant site. Neurologic symptoms are rarely the presenting complaint. However, nearly 70% of patients will manifest weakness by time of definitive diagnosis. Approximately 20% of patients with spinal tumors will develop spinal cord compression and symptoms to accompany this.
Symptoms of spinal cord compression include weakness in the arms or legs (depending on location of lesion), problems with balance and coordination, change in gait pattern (how a patient walks), and in cases of cervical spine tumors a noticeable deterioration in hand function, ability to get ready in the morning, problems buttoning shirts, and a change in handwriting. Select patients may experience urinary retention or bowel and bladder incontinence, along with decreased sensation in these areas.
A more common neurologic complaint is burning, aching or shooting pains in a specific nerve distribution that often is painful, and can become progressively worse.
Your spine surgeon will conduct a thorough interview as well as physical exam to determine if the symptoms you are experiencing are consistent with those previously described, and if they warrant further investigation with x-ray, MRI, CT or other imaging studies.
X-rays are useful to visualize the spine as a whole, however, they are not very sensitive for small lesions. Typically over 30-50% of bone has to be overtaken by tumor before the x-ray is positive.
CT scans are useful for outlining bony anatomy and far more sensitive than x-ray. MRI is the most sensitive and specific test and shows the relationship of the lesion to other vital structures such as blood vessels and nerves.
Bone scan is occasionally indicated to differentiate tumor from infection or to identify other lesions that may be yet unrecognized and warrant further investigation.