This is a 63 year-old man with metastatic melanoma to the C5 vertebral body. This slow growing tumor was compressing the spinal cord, which resulted in arm pain and numbness in the hands.
This is an x-ray 12 months after the procedure. I performed a C5 Corpectomy with circumferential tumor resection and posterior spinal instrumentation.
A spinal tumor is a growth of cells (mass) in or surrounding the vertebral column and spinal cord. The most common malignant spinal tumor is metastatic disease from a distant cancer.
Any type of tumor may occur in the spine, including:
A small number of spinal tumors occur in the nerves of the spinal cord itself. Most often these are ependymomas and other gliomas.
Tumors that start in spinal tissue are called primary spinal tumors. Tumors that spread to the spine from some other place (metastasis) are called secondary spinal tumors. Tumors spread to the spine most commonly from the breast, prostate, lung, and other areas.
The cause of primary spinal tumors is unknown. Some primary spinal tumors occur with genetic defects.
Spinal tumors can occur:
- Inside the spinal cord (intramedullary)
- In the membranes (meninges) covering the spinal cord (extramedullary - intradural)
- Between the meninges and bones of the spine (extradural)
Or, tumors may extend from other locations. Most spinal tumors are extradural.
As it grows, the tumor can affect the:
- Blood vessels
- Bones of the spine
- Nerve roots
- Spinal cord cells
The tumor may press on the spinal cord or nerve roots, causing damage. With time, the damage may become permanent.
The symptoms depend on the location, type of tumor, and your general health. Tumors that have spread to the spine from another site (metastatic tumors) often progress quickly. Primary tumors often progress slowly over weeks to years.
Tumors in the spinal cord usually cause symptoms, sometimes over large portions of the body. Tumors outside the spinal cord may grow for a long time before causing nerve damage.
Symptoms may include:
Abnormal sensations or loss of sensation:
- Especially in the legs (may be in the knee or ankle, with or without shooting pain down the leg)
- Cold sensation of the legs, cool fingers or hands, or coolness of other areas
- Back pain:
- Gets worse over time
- In any area -- middle or low back are most common
- Is usually severe and not relieved by pain medication
- Is worse when lying down
- Is worse with strain, cough, sneeze
- May extend to the hip, leg, or feet (or arms), or all extremities
- Fecal incontinence
- Inability to keep from leaking urine (urinary incontinence)
- Muscle contractions, twitches, or spasms (fasciculations)
- Muscle function loss
- Muscle weakness (decreased muscle strength not due to exercise):
- Causes falls
- Especially in the legs
- Makes walking difficult
- May get worse (progressive)
Exams and Tests
A neurological examination may help pinpoint the location of the tumor. The surgeon may also find the following during an exam:
- Abnormal reflexes
- Increased muscle tone
- Loss of pain and temperature sensation
- Muscle weakness
- Tenderness in the spine
These tests may confirm spinal tumor:
- Spine MRI with contrast
- Cerebrospinal fluid (CSF) examination
- Cytology (cell studies) of CSF
- Spinal CT
- Spine x-ray
Treatment depends on tumor type and location. The goal of treatment is to reduce or prevent nerve damage from pressure on (compression of) the spinal cord.
Treatment should be given quickly. The more quickly symptoms develop, the sooner treatment is needed to prevent permanent injury. Any new or unexplained back pain in a patient with cancer should be thoroughly investigated.
Nerve damage often continues, even after surgery. Although some amount of permanent disability is likely, treatment may delay major disability and death.
- Life-threatening spinal cord compression
- Loss of sensation
- Permanent damage to nerves, disability from nerve damage