Spinal Tumors

A spine tumor is either a cancerous (malignant) or non-cancerous (benign) growth that arises from or near any of the structures of the spine, such as the spinal cord itself, the spinal roots, the dural sac that surrounds the spinal cord, or the vertebrae. A spinal tumor may be primary, or originating from the spinal cord, or metastatic, originating from elsewhere in the body.

Spine tumors are usually grouped into three types according to their location: intradural-extramedullary, intramedullary, and extradural. Intradural-extramedullary spine tumors include meningiomas, schwannomas, neurofibromas, and ependymomas. Intramedullary tumors include astrocytomas, ependymomas, and intramedullary lipomas. Extradural spine tumors include metastatic cancer and Schwannomas. While not all of these are malignant, even benign spinal tumors are a cause for concern, as they may impinge on the nerves and cause pain, neurological damage, or even paralysis.

The most common symptom associated with a spinal tumor is neck or back pain; but many people will experience this sort of pain sometime in their lives. The pain is often present at night and worsens with physical activity. The symptoms associated with spinal cord tumors may also vary depending on which segment of the spine is involved. For example, cervical (neck) tumors may cause weakness or numbness in the arms or legs. Thoracic (mid-back) and lumbosacral (low back) tumors may cause weakness or numbness in the chest area or legs.

Other symptoms may include:
Difficulty walking, sometimes leading to falls
Decreased sensitivity to pain, heat and cold
Loss of bowel or bladder function
Paralysis that may occur in varying degrees and in different parts of your body, depending on which nerves are compressed
Scoliosis or other spinal deformity resulting from a large, but noncancerous tumor

Diagnosis:
Dr. Berti begins his patients' diagnosis with a thorough physical examination and a review of their history. He may order imaging studies, including x-rays, CT or CAT scans, MRIs, positron emission tomography (PET) scans, or even nuclear medicine bone scans. A tissue specimen, usually taken via needle biopsy, may be required for an exact diagnosis and the determination of surgical and non-surgical treatment options. These biopsies often require surgery, but may be performed with just a needle and a CT scan or MRI to guide the doctor. Tumors that result from metastases don't require a biopsy if the cancer has already been diagnosed.

Treatments:
Dr. Berti believes in exausting non-surgical options before recommending invasive surgery. Depending on the tumor, the symptoms, and the patient, he may prescribe simple observation, chemotherapy or radiation therapy. For example, there are certain tumors that do not cause major symptoms and do not appear to be aggressive in their behavior. These may be observed and followed with serial imaging (usually MRI). Additionally, some tumor types are sensitive to chemotherapy and/ or radiation therapy. A course of chemo- or radiation therapy may be the first line of treatment in these cases.

Dr. Berti will recommend surgery for various reasons. He may recommend it when progressive motor weakness or loss of bowel or bladder control is present, or he may recommend it to reduce the tumor size.

He will also perform surgery in order to stabilize the spine if it becomes unstable due to the tumor. A few tumors are insensitive to radiation or chemotherapy, so surgery may be the only option.

The following are types of spinal tumors Dr. Berti treats:

Meningioma: A meningioma is a type of tumor that develops from the meninges, the membrane that envelops the brain and spinal cord. Spinal meningiomas account for less than 10% of meningiomas, and are more common in women than in men in later years. Meningiomas are intradural-extramedullary tumors which occur in the thoracic spine. Most meningiomas are considered benign, but that can be misleading, as the growing tumor may compress the nerves and cause pain or nerve damage when they run into the spinal cord. They can also recur and become cancerous.

Treatment: Resection and radiotherapy (such as CyberKnife) are the recommended treatments.

Schwannoma: A Schwannoma, also known as neurinoma or neurilemmoma, is typically a benign tumor which arises from the cells that form the myelin sheath around peripheral nerve fibers (the nerves outside the brain and spinal chord). Schwann cells are cells that cover the nerve fibers involved in conducting nervous impulses in the body. A Schwannoma tumor grows on a nerve, displacing it to the side. It is the most common intradural extramedullary lesion, accounting for 30% of all primary spine neoplasms.

Treatment:
Total microsurgical resection or laminectomy is recommended. (link to appropriate procedures page)

Neurofibroma: A neurofibroma is typically a benign tumor of the cells that support peripheral nerves, or the nerves outside the brain and spinal cord. The cause is unkown. Some symptoms include painless, slow growing mass, electric like shock when affected area is felt (known as "Tinel sign"), usually no neurological problems or loss unless the tumor involves a major motor or sensory nerve or is compressed between the tumor and a rigid structure.

Treatment:
If the neurofibroma is not involved with a major nerve, an operation to remove the nerve containing the tumor is usually the treatment of choice. If a major nerve is involved, doctors may choose to excise the tumor from the nerve, leaving the nerve itself intact, or leave the tumor alone, if it isn't causing any symptoms. Surgery, radiation, and/or chemotherapy may also be used to control or reduce the size of optic nerve gliomas when vision is threatened. Some bone malformations, such as scoliosis, can be corrected surgically.


Ependymomas: One of the most common types of spinal tumors, ependymomas arise from the cells lining the canal in the center of the spinal cord. They are typically non-cancerous, and slow growing. They are found mostly in adults. They can be intradural/extramedullary or intramedullary.

Treatment: An ependymoma is usually removed with surgery, radiation therapy, or a combination of both. (link to appropriate procedures page)

Astrocytomas: Astrocytes are star-shaped glial cells that form part of the supportive tissue for the brain. One of the most common gliomas, the astrocytoma develops on spinal cells called astrocytes and accounts for half of all primary brain and spinal cord tumors. They are more prevalent in adults.

Symptoms vary depending on the location of the tumor, but may include persistent headaches, double or blurred vision, loss of appetite, changes in mood and personality, vomiting, and changes in ability to think and learn, among others.

Treatment:
The main goal of treatment is to remove as much of the tumor as possible without injuring brain tissue vital to a patient's normal function. Even if the tumor is cannot be completely removed, Dr. Berti will perform any of a number of treatments to reduce tumor size; for example, he may opt to surgically resect the tumor via craniotomy to reduce the tumor size. Other treatment options include radiation therapy and chemotherapy.

Because high grade glial tumors have a high incidence of recurrence, Dr. Berti might also use radiosurgical techniques like CyberKnife to complete the removal. He may also opt to use radiosurgery in cases where the tumor is close to critical portions of the brain, for patients who can't tolerate daily radiation doses, or for people who are otherwise not candidates for surgery. Rest assured, Dr. Berti will create the appropriate treatment plan for his patients based on a variety of factors.


Intramedullary lipomas: Intramedullary lipomas of the spinal cord are extremely rare. They are typically associated with spinal dysraphism, or the defective closure of the neural tube. They present in the first two to three decades of the patient's life and affect both sexes equally. Symptoms include ataxia (lack of coordination while performing movements), pain, lower extremity weakness, and sensory disturbances (injured sensory pathways in the spinal cord).

Treatment includes resection and decompression, with an emphasis on decompression, as intramedullary (and extramedullary) lipomas are typically involved with the surrounding nerves. Studies have shown that subtotal removal carries no higher risk of recurrence than total removal.

Metastatic cancer:
Spinal metastases can occur when tumor cells travel from the primary, or original, site of a tumor to another place in the body. Spinal metastases most commonly migrate to the spine. Metastatic spinal tumors are usually extra-dural, growing outside the dura mater in the bones of the spine. Those tumors affect the spinal cord and spinal nerves by causing pressure.

Treatment depends on a variety of factors in the case of metastatic cancer; for example, the number of tumors and the location of the tumors, whether the primary tumor has been cared for, as well as age and general health. Doctors use resection, radiation therapy, and chemotherapy to treat these tumors. Newer types of therapy include stereotactic radiosurgery such as CyberKnife or XRT, depending on the size of the tumor.