Spinal Tumor: What It Is, Causes, Symptoms, and Treatment

Tumors form as a result of uncontrolled reproduction and growth of certain cells in any tissue or organ of the body.

Tumors form as a result of uncontrolled reproduction and growth of certain cells in any tissue or organ of the body. This proliferation and growth cannot be stopped or slowed down by the body's functional self-regulation mechanisms. However, not all tumors that form in the body are necessarily malignant (cancerous). There are also benign (non-cancerous) tumors. The terms tumor and cancer are often confused in everyday life, but in reality, only malignant (cancerous) tumors are referred to as cancer. Spinal tumors account for 20% of tumors within the Central Nervous System. Their frequency varies among populations, but they can occur at a rate of 2-10 per 100,000 people.

What Is the Function of the Spinal Cord?

What Is a Spinal Tumor?

Spinal tumors are tumors that occur in the bones, nerves, or other soft tissues that make up the spine and spinal cord. They can be classified as primary (originating in the spine) or metastatic (spread from another cancer).

Primary tumors develop due to the cells that make up the structure of the spine and spinal cord, while metastatic tumors occur when a previously formed tumor in another part of the body spreads uncontrollably to the spine.

Tumors can also form outside the spinal cord membrane, in the area between the membrane and the spinal cord, or within the spinal cord itself. Most tumors outside the spinal membrane are metastases from tumors formed in other areas of the body. Though not definitive, tumors originating from the spinal cord itself, its membranes, or the nerves are usually benign (non-cancerous).

Tumors are classified into three categories based on their location: extradural (located outside the spinal cord membrane), intradural extramedullary (located inside the spinal cord membrane, but outside the nerves), and intradural intramedullary (located inside the spinal cord membrane, inside the nerves). Extradural tumors are the most common.

Metastatic spinal tumors are most commonly seen in men aged 45-65. As with other diseases, early diagnosis plays a critical role in the treatment of spinal tumors.

What Are the Symptoms of a Spinal Tumor?

The duration of symptoms can vary depending on the person, the location of the tumor, and the speed of its growth. If not diagnosed and treated on time, the tumor grows and exerts pressure on the spinal cord, causing back pain.

The problems depend on which nerve the tumor presses on, leading to specific symptoms. Different symptoms may appear in the neck, back, or lower back.

• Severe pain in the neck, back, and lower back that does not go away even with rest (pain initially worsens with activities like coughing, sneezing, or straining, but as the condition progresses, the pain persists even at rest).
• Tingling or numbness in specific areas of the body (for example, if the tumor is in the neck, numbness may occur in the arms and legs; if the tumor is in the back or lower back, numbness may only affect the legs).
• A sensation of coldness in the body.
• Muscle weakness or atrophy in different limbs, such as arms or legs.
• Difficulty walking due to numbness and muscle weakness.
• Loss of control over the bowels or bladder, leading to incontinence, difficulty holding, or straining.
• Spinal deformities, such as scoliosis or kyphosis, due to tumor pressure.
• In advanced stages, sexual dysfunction may occur.
• Serious symptoms, such as paralysis, may occur, with paralysis in the arms and legs if the tumor is in the neck or in the legs if it is in the back or lower back.

What Are the Causes of Spinal Tumors?

How Is a Spinal Tumor Diagnosed?

The patient’s complaints and examination are important. Afterward, imaging techniques are used to determine the location of the tumor. In patients followed for cancer, PET CT is crucial for detecting metastasis to the spine. An MRI of the entire spine or the specific spinal region where the pain is most intense may be requested. In bone tumors, a CT scan is necessary. In these patients, electrophysiological tests like EMG (Electromyography) and SEP (Somatosensory Evoked Potentials) can support the diagnosis of how well the nerves are functioning.

To diagnose the condition, it is essential to pay attention to symptoms such as severe pain in the back, neck, and lower back. These pains can be so intense that they can wake patients from sleep at night.

How Is a Spinal Tumor Treated?

Spinal tumors are generally benign (non-cancerous), but malignant cases can also occur. The treatment for spinal tumors depends on the location of the tumor, its type, the symptoms it causes, and the patient’s personal characteristics. As with any disease, early diagnosis is crucial for successful treatment.

Surgical Treatment:
Microsurgery performed in a hybrid operating room increases the success of surgery for these patients. Today, this technique allows for the successful surgery of patients who previously could not undergo surgery or who experienced severe complications (such as paralysis) after surgery.

In the case of benign tumors, complete removal of the tumor through microsurgery often results in a cure.

For malignant tumors, there are several surgical options. After discussions at the neuro-oncology council, the best treatment option is presented to the patient. Following microsurgery in the hybrid operating room, radiation therapy and chemotherapy may be given according to the pathology results.

Depending on the patient’s condition and spinal involvement, surgeries such as simple surgical separation, stabilization with screws, and vertebroplasty (bone cement injection) may be added.

In our clinic, we perform microsurgery using minimally invasive techniques (which cause minimal damage to tissue and bone, opening a small window in the bone). During surgery, we utilize many technological devices in the hybrid operating room, such as a fluorescent microscope (which highlights the tumor), neuromonitorization (which monitors nerves going to the arms and legs during surgery), O-arm CT (a CT device used during surgery), and neuronavigation.

Radiation Therapy:
Radiation therapy aims to reduce pain or control tumor spread. With CyberKnife technology, radiation that was once impossible can now be delivered to the nervous system without causing damage. Radiation surgery can be performed after surgical operations or independently. In some cases, chemotherapy and radiation therapy may be combined to treat the tumor.

Chemotherapy:
The choice of medication used in chemotherapy is determined by the type of tumor and its potential for spread, as assessed by the specialist. It can be administered after surgery or radiation therapy. Sometimes, the specialist may choose to start chemotherapy directly in the initial phase, considering the tumor's condition.

Physical Therapy:
Physical therapy is recommended in the post-operative period to help the patient regain muscle strength and return to daily life. It is a process that involves both physiotherapists and doctors. It can last for 3 to 6 months, with treatment applied in general periods.

Pain Management:
Tumors can sometimes cause severe pain. In rare cases, pain management may be necessary before or after surgery.

Early diagnosis of the disease is critical for treatment. Therefore, severe pain in the back, neck, or lower back should not be ignored. If these symptoms are noticed, do not hesitate to seek care at the nearest healthcare facility.