Tumors of the spine can be categorized as primary tumors or metastatic tumors. Metastatic is a general term used to describe the spread of a cancer from some other location in the body. The spinal column is one of the most common sites for cancer to spread (metastasize) to. Metastatic tumors of the spine are the most common tumors of the spine and are routinely treated without surgery unless there is resultant spinal instability or neurologic compromise. The majority of metastatic lesions are treated with chemotherapy and/or radiation therapy specific to the primary cancer type. Primary tumors of the spine can be benign or malignant (cancerous) and can be further subdivided into intradural and extradural neoplasms. Intradural means that the tumor is arising from or within the dural sac, or the sac containing the spinal cord and nerves. Extradural tumors are often neoplasms infiltrating the bony structure of the vertebrae, but can also arise within the epidural space. Intradural tumors are further classified as intramedullary or extramedullary and indicate whether or not a tumor is arising from within the spinal cord itself (intradural-intramedullary) or from the coverings of the spinal cord (intradural-extramedullary). Overall, primary spine tumors are rare and comprise approximately .04 percent of all tumors and 10 percent of all bone tumors.
How is it diagnosed?
The diagnosis of a spine tumor may be delayed, primarily because the early signs and symptoms are subtle and clinicians do not initially suspect it. Patients with symptoms suggesting infection or tumor, such as unrelenting pain, night pain, fevers, chills, night sweats and weight loss must be appropriately evaluated with imaging and laboratory tests to confirm the diagnosis.
The treatment of a neoplasm of the thoracolumbar spine depends on a number of factors: the patient’s age and associated medical conditions, the type, grade and stage of the neoplasm, the severity of a patient’s symptoms, the severity of neurologic compression and bony destruction. As previously stated, metastatic tumors are often treated without surgery unless there is resultant spinal instability or neurologic compromise. Benign primary bone tumors are often treated by surgical tumor resection. However, some benign tumors may be treated conservatively and observed if there is minimal pain and there is no evidence of spinal instability or neurologic compression. Malignant primary spine tumors are often treated by surgical resection and adjuvant chemotherapy and/or radiation. Surgical treatment often includes neurologic decompression, fusion and instrumentation in addition to tumor resection. An anterior or posterior surgical approach, or at times a combined approach, may be utilized depending on where the tumor is located and where the neurologic compression is most prominent.