Spine Tumors

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A spinal tumor is a growth that develops on the bones of the spine. Like other bone tumors, they are examined in two basic groups. The first of these is primary tumors formed by bone cells ; The second is tumors that occur when tumors occurring in another part of the body, called secondary tumors, metastasize and spread to the spinal cord.

Metastases in the spine often originate from prostate, breast, lung and kidney cancers, and they are more common than primary tumors of the spine.

Primary tumors of the spine are divided into two as benign (benign) and malignant (malignant). The spine encloses the spinal cord, which is a very important organ; For this reason, even benign tumors can cause serious health problems by putting pressure on the spinal cord when they grow.

Spinal Tumors

Tumors of the spine, forming the spine and spinal cord; They are tumors that consist of parts such as bone, nerve or soft tissue and can develop due to the structure of any of them. These tumors can settle in areas of the spine such as the neck, back, waist and coccyx. Tumors can originate in two ways. The first of these is tumors arising from the cells that make up the structure of the spine and spinal cord, and the second is; They are called primary tumors.

Spinal Tumors The second type of tumor is the tumors that develop in the spine due to the spread of tumors developing in other parts of the body (breast, prostate, etc.) and are called metastatic tumors. (figure-2)

What Are Spinal Cord Tumors?

Early diagnosis of spinal cord tumors greatly reduces the risk of stroke. Surgical treatment results of these benign and slow-growing tumors are quite successful.

About 20 percent of central nervous system tumors are located in the spinal canal. According to their location, spinal cord tumors are grouped as extradural (outside the spinal cord), intraduralextramedullary (inside the spinal cord but outside the spinal cord) and intramedullary (inside the spinal cord and inside the spinal cord). 66 percent of intradural tumors are extramedullary and 33 percent are intramedullary .

intradural schwannoma – neurofibromas and meningiomas account for 90 percent of extramedullary tumors ; the remaining 10 percent is ependymoma , dermoid , epidermoid , angioma lipoma, metastasis,

arachnoid cyst, chordoma , melanoma , myxoma and sarcoma. Ependymomas and astrocytomas constitute the largest part of intraspinal cord tumors .

Symptoms

Symptoms of Spine Tumors

Symptoms of spinal tumors can vary depending on their location and whether they affect the nerves and spinal cord. Most spinal tumors cause severe back or leg pain.

As a result of the growth of the tumor in the spine, a compression occurs in the spinal cord. Depending on where the tumor presses, symptoms such as numbness in the arms or legs, loss of strength, and difficulty in walking may occur.

What Are the Symptoms of Spinal Tumors?

The most common symptom seen in spinal tumors is pain that occurs in the relevant region of the spine and spreads more or less (such as neck, low back pain). Pain may occur especially at night and may increase with physical activity.

If the tumor originates directly from the spinal cord or if the tumor originating from the spine puts pressure on the spinal cord, signs of spinal cord compression can be seen. These vary depending on where the press is. While numbness is seen in the arms and legs and chest area, symptoms such as loss of strength in the hands, arms and legs and difficulty in walking may occur.

Symptoms of Spinal Cord Tumors

Among the symptoms of spinal cord tumors, it first presents with pain and numbness in the arms and legs. progressive weakness, loss of sensation, and urogenital and anorectal dysfunction is the most important signs and symptoms. These signs and symptoms progress very slowly. However, depending on the nature of the tumor, rapid worsening can also be seen.

Some Tumor Types

Schwannoma / Neurofibroma

It originates from the nerve sheath. They can be seen all over the nervous system. The primary characteristics of these intraduralextramedullary (intra-spinal membrane but extra-spinal) tumors are slow growth and benign nature.

Meningiomas

These tumors, which originate from the spinal cord membrane, are more common especially in the dorsal region and in women. They are mostly benign and grow slowly.

Phylum Ependymoma

These tumors, which grow from the lower end of the spinal cord, are clinically and surgically considered as extramedullary .

Astrocytomas

These tumors localized in the spinal cord are mostly seen in childhood. Although most of them are benign, they have very tight connections with the spinal cord.

Ependymomas

The most common intramedullary tumors in adults, they are usually well circumscribed and non -infiltrative .

Diagnostic Methods

In spinal tumors, the patient's history is taken by the doctor and a physical examination is performed. If the doctor suspects a spinal tumor, he may request CT (computed tomography ), MRI (magnetic resonance imaging), scintigraphy or PET/CT examinations from the patient.

If a tumor is detected in the patient, biopsies performed under local anesthesia can be performed to find out the location and type of the tumor.

Treatment Methods

What Are the Surgical Options for Spinal Tumors?

Surgical treatment of spinal tumors is partial or complete removal of the tumor. The decision on this issue should be made by the surgeon. The criteria that the surgeon will consider when making a decision ; criteria such as tumor type, spread, malignancy, whether it is sensitive to chemo -radiotherapy, neurologic risk ratio, and life expectancy. By evaluating these criteria , risk-benefit ratios and other possible treatment options will be presented to the patient.

implants ( instrumentation ) by evaluating the damage caused by the tumor itself or the surgery to be performed on the spine and the resulting abnormal mobility . These attempts can be made from the front or back of the spine, and sometimes from both sides.

In some benign tumors, only the part of the tumor is scraped out and the remaining space is filled with bone or bone cement.

In malignant tumors, the tumorous tissue is extensively removed and metallic fixation - instrumentation is applied to the spine. In addition, a metal cage filled with bone is placed in the anterior part of the spine, which is removed with the tumor. In metastatic tumors, the tumor vertebra can be filled with bone cement or removed and instrumentation -cage procedure can be applied.

The hospital stay after surgery can last from 3 to 10 days, and physical therapy and rehabilitation may be required for a certain period of time. The length of stay in the hospital may vary depending on the necessity of physical therapy, its duration and whether it can be done at home. Chemotherapy or radiotherapy may be required after surgical treatment for some tumors . The application of these treatments can also affect the overall recovery time.

Total recovery time can vary from 3 months to 1 year depending on how complex the surgery is.

What are the Non-Surgical Treatment Methods for Spinal Tumors?

Non-surgical treatment methods for spinal tumors are observation, chemotherapy and radiation treatments. Benign tumors that do not cause serious symptoms and do not spread aggressively can be followed up with frequent imaging methods (usually MRI). In addition, malignant primary tumors or metastases of the spine may be sensitive to chemotherapy or radiotherapy. In this type of tumors, chemotherapy or radiotherapy may be the first treatment methods of choice.

When is Surgery Necessary in Spinal Tumors?

Primary malignant tumors originating from the spine itself are usually treated with surgery as soon as they are detected. The aim is to remove the malignant tumor cells from the environment as soon as possible.

primary malignant or metastatic tumors cause progressive neurological loss or loss of stool-urine control in a short time.

Surgical treatment may be required to fix the deteriorated vertebra in patients with abnormal spinal motion caused by the tumor.

Another situation where surgery may be necessary is when the tumor is not sensitive to chemotherapy or radiotherapy and does not respond to these treatments.

Surgical treatment of spinal tumors is partial or complete removal of the tumor. Your surgeon should make the decision on this matter. The criteria your surgeon will consider when making a decision ; criteria such as tumor type, spread, malignancy, whether it is sensitive to chemo -radiotherapy, neurologic risk ratio, and life expectancy. These criteria will be evaluated and the risk-benefit ratios and other possible treatment options will be presented to you.

In some benign tumors, only the part of the tumor is scraped out and the remaining space is filled with bone or cement. (figure-3)

In malignant tumors, the tumorous tissue is extensively removed and metallic fixation - instrumentation is applied to the spine. In addition, a metal cage filled with bone is placed in the anterior part of the spine, which is removed with the tumor. In metastatic tumors, the tumor vertebra can be filled with cement or removed and instrumentation -cage procedure can be applied.

can vary from 3 months to 1 year, depending on how complex the surgery is.

What is Long-Term Follow-up in Spine Tumors?

Depending on the type of tumor, your doctor will follow you for a certain period and intervals. Follow-up is usually done with radiographs and MRI. There may be a chance for the tumor to recur and it depends on the type.

Spinal Cord Tumors Treatment

The main treatment for these tumors is surgery. However, since these tumors are mostly benign and have a slow course, it is important to schedule the surgery correctly.

Sometimes it can be seen that tumors that are seen incidentally can remain unchanged for years and do not cause a neurological change. Patients who are at risk of neurological deterioration or who have signs and symptoms on admission need surgery. In aggressive and malignant tumors, radiation therapy is added to the treatment.