A spinal tumor is an abnormal mass of tissue within or surrounding the spinal cord and/or spinal column. These cells grow and multiply uncontrollably, seemingly unchecked by the mechanisms that control normal cells. Spinal tumors can be benign (non-cancerous) or malignant (cancerous). Primary tumors originate in the spine or spinal cord, and metastatic or secondary tumors result from cancer spreading from another site to the spine.
Spinal tumors may be referred to by the region of the spine in which they occur. These basic areas are cervical, thoracic, lumbar and sacrum. Additionally, they also are classified by their location in the spine into three major groups: intradural-extramedullary, intramedullary and extradural.
Incidence and Prevalence :Intracranial (brain) tumors account for 85 to 90 percent of all primary central nervous system (CNS) tumors. Primary tumors arising from the spinal cord, spinal nerve roots and dura are rare compared to CNS tumors that arise in the brain. Overall prevalence is estimated at one spinal tumor for every four intracranial lesions. About 10,000 Americans develop primary or metastatic spinal cord tumors each year.
Intramedullary tumors are rare, accounting for only five to 10 percent of all spinal tumors. Benign tumors such as meningiomas and neurofibromas account for 55 to 65 percent of all primary spinal tumors. Meningiomas most frequently occur in women between the ages of 40 and 70. Metastatic spinal tumors are the most common type of malignant lesions of the spine, accounting for an estimated 70 percent of all spinal tumors.
Nonsurgical treatment options include observation, chemotherapy and radiation therapy. Tumors that are asymptomatic or mildly symptomatic and do not appear to be changing or progressing may be observed and monitored with regular MRIs. Some tumors respond well to chemotherapy and others to radiation therapy. However, there are specific types of metastatic tumors that are inherently radioresistant (i.e. gastrointestinal tract and kidney), and in those cases, surgery may be the only viable treatment option.
Indications for surgery vary depending on the type of tumor. Primary spinal tumors may be removed through complete en bloc resection for a possible cure. In patients with metastatic tumors, treatment is primarily palliative, with the goal of restoring or preserving neurological function, stabilizing the spine and alleviating pain. Generally, surgery is only considered as an option for patients with metastases when they are expected to live 12 weeks or longer, and the tumor is resistant to radiation or chemotherapy. Indications for surgery include intractable pain, spinal-cord compression and the need for stabilization of impending pathological fractures.
The typical hospital stay after surgery to remove a spinal tumor ranges from 2 to 14 days, depending on the patient's case. A required period of post-surgery physical rehabilitation may involve a stay in a rehabilitation hospital for a period of time. In other cases, physical therapy may take place at an outpatient facility or at the patient's home. The total recovery time after surgery may be as short as three months or as long as one year, depending on the complexity of the surgery and the patient's overall health.
Outcome depends greatly on the age and overall health of the patient and on whether the spinal tumor is benign or malignant, primary or metastatic. In the case of primary tumors, the goal is to remove the tumor completely, leading optimally to the potential cure of the malignancy. In the case of metastatic tumors, the goal is almost always palliative, with treatment aimed at providing the patient with an improved quality of life and possibly prolonged life expectancy.