Επικοινωνία

Spinal Tumors

Tumors – Spinal Cancer

Metastasis of cancer to the spine is a common progression in advanced cancer, given that almost all cancers metastasize to bones, mainly the spine. At the same time, there are several primary spinal tumors, which can be benign or malignant.

Classification of Spinal Tumors

Neoplasms are divided into benign and malignant. Benign neoplasms do not destroy surrounding tissues but only the bone, and their most common aggressiveness is difficulty in complete removal. Malignant neoplasms have the ability to spread to other organs, i.e., metastasize.

Another way to classify spinal tumors is as primary or secondary. Primary tumors originate from the spine itself; they are very rare and can be benign or malignant. Secondary tumors originate elsewhere and metastasize to the spine; they are by definition malignant. The most common secondary tumors are lung cancer, breast cancer, prostate cancer, and kidney cancer.

What are the symptoms?

Almost all patients with advanced cancer will develop spinal metastases, but only half of them will have symptoms. Symptoms caused by spinal tumors depend on many factors, such as the location, growth rate, pressure on the spinal cord or nerves, and disruption of spinal stability.

The most common symptoms are:

Back pain – spinal pain that does not improve with lying down or even worsens at night
Radiating pain to the legs or arms
Weakness, numbness, clumsiness, or difficulty walking
Bladder or Bowel Dysfunction: In cases of severe spinal cord compression.

Symptoms may appear gradually or suddenly.

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Spinal Cancer: How is it diagnosed?

Diagnosis is mostly based on patient history, physical and neurological examination, and primarily MRI.

Typically, lab tests (tumor markers) do not help much in diagnosis. Blood tests and kidney and liver function tests reflect the overall condition of the patient, usually in advanced disease stages. Protein electrophoresis and sedimentation rate can assist in diagnosing blood neoplasms such as multiple myeloma, and measuring certain enzymes, like PSA or acid phosphatase, helps in prostate cancer monitoring.

Radiological Examination

MRI is the main imaging test for diagnosing spinal tumors. It is sensitive and specific and can differentiate fractures due to osteoporosis, metastasis, or spinal infection.

Other imaging studies:

X-rays show the spine’s architecture but need at least 50% bone loss to detect metastasis.
Bone scan (scintigraphy) can show spinal fractures related to metastasis and possibly other sites but is not very specific (cannot clearly differentiate fractures from arthritis).
CT scan shows bone details, and combined with myelography (contrast injected into the spinal canal), it can be very effective, otherwise of limited use.

Spinal Biopsy

Biopsy is necessary for primary tumors, while for metastatic tumors, the origin is usually known. A small tumor tissue sample is taken and examined microscopically.

Biopsy can be done via fine needle or a thicker needle called a trocar. Fine needle biopsy is performed with high precision under CT guidance, while trocar biopsy is usually done in the operating room under general anesthesia.

Treatment – Management

Treatment requires a multidisciplinary approach involving spine surgeons, neuro-radiologists, pathologists, oncologists, and pain specialists. The final treatment depends on symptoms, cancer type, aggressiveness, response to radiation, neurological status, and overall patient health.

Most patients need a combination of surgical and non-surgical treatments depending on tumor type (benign or malignant), stage, treatment goals (curative or palliative), life expectancy, and general health.

Radiation Therapy

Radiation is the primary treatment for metastatic spinal cancers. It damages the DNA of malignant cells, thereby inhibiting their ability to multiply and leading to their death. Radiation therapy is indicated for malignant and metastatic tumors, particularly when surgical removal would risk compromising the patient’s neurological integrity. In contrast, benign tumors are typically treated with surgical excision whenever feasible.

It is important to emphasize that not all tumors respond equally well to radiation. For instance, melanoma and colorectal cancer metastases are particularly resistant, while thyroid and kidney cancers show moderate sensitivity.

Surgical Treatment

The goals of surgery are to reduce pain, stabilize the spine, and protect neurological function, regardless of whether the tumor is benign or malignant. Even after surgical removal, some tumors may require additional radiation or chemotherapy.

The main surgical indications for spinal tumors are:

The need for a direct biopsy
Imminent risk of neurological injury due to spinal cord or nerve compression
Spinal instability or persistent pain unresponsive to conservative treatment such as radiation

During surgery, the tumor is removed and neural elements are decompressed. Often, spinal stabilization is necessary using instrumentation such as rods and screws (spinal fusion hardware), cages, or bone cement—materials that function as structural support so the spine can bear the body’s weight without causing pain.

Complete tumor resection is required in cases of primary tumors or solitary metastases. These surgeries are technically complex. In metastatic disease, complete removal with clear margins is rarely necessary, and residual tumor often remains.

Bracing

Bracing helps stabilize the spine and reduce pain. For the thoracolumbar spine, a thoracolumbosacral orthosis (TLSO) brace is used. For cervical spine involvement, a soft or rigid neck collar may be sufficient, while tumors in the upper cervical spine may require a Halo-vest for more rigid immobilization.

Chemotherapy

Chemotherapy treats and helps control cancer progression. In the case of metastatic spinal tumors, chemotherapy is usually adjuvant (supportive), since the primary treatment is radiation or surgery.

Pain Management

Pain therapy alleviates symptoms and improves the patient’s quality of life. It may include anti-inflammatory drugs, analgesics, intravenous narcotics, and morphine.

Benign Spinal Tumors

Osteoid Osteoma

This is a small tumor usually found in the vertebral arch. It can cause significant pain that worsens at night and typically responds well to nonsteroidal anti-inflammatory drugs (NSAIDs). Treatment usually involves surgical removal or radiofrequency ablation.

Osteoblastoma

This tumor can be larger than osteoid osteoma, sometimes behaving more aggressively and may invade adjacent structures. Surgery is often required, and the prognosis is generally good.

Giant Cell Tumor

Although considered benign, giant cell tumors are locally aggressive and tend to recur after removal. They can occasionally transform into malignant tumors. Complete surgical resection is the treatment of choice.

Hemangioma

Hemangiomas are common benign vascular tumors of the spine, often found incidentally. They are usually asymptomatic but may cause pain or neurological symptoms if large or located in critical areas. Treatment is usually conservative unless symptoms develop.

Malignant Spinal Tumors

Chordoma

A rare malignant tumor arising from remnants of the notochord, mostly found at the base of the skull or sacrum, but can occur along the spine. It grows slowly but is locally aggressive and tends to recur after treatment. Surgery with wide excision and sometimes radiation therapy are the main treatments.

Chondrosarcoma

This cancer develops from cartilage cells and is rare in the spine. It is slow-growing but resistant to chemotherapy and radiation; thus, complete surgical excision is essential.

Osteosarcoma

A highly malignant tumor that forms bone tissue and is rare in the spine. It grows rapidly and spreads early. Treatment involves aggressive surgery and chemotherapy.

Ewing’s Sarcoma

An aggressive tumor mainly affecting children and young adults, often in the pelvis or long bones but can involve the spine. Treatment includes chemotherapy, radiation, and surgery.

Plasmacytoma and Multiple Myeloma

These are cancers originating from plasma cells, commonly affecting the spine. Multiple myeloma is systemic, while plasmacytoma is localized. Treatment includes radiation therapy, chemotherapy, and sometimes surgery to stabilize the spine.

Summary

The presence of a spinal tumor can severely affect a patient’s quality of life due to pain, neurological deficits, or spinal instability. Early diagnosis and multidisciplinary management are crucial to optimize treatment outcomes. Imaging, biopsy, and understanding the tumor type and patient’s overall condition guide treatment decisions, which range from conservative management to aggressive surgical excision combined with chemo/radiotherapy.

Χειρουργός Σπονδυλικής Στήλης

Ο Χειρουργός Σπονδυλικής Στήλης/ Σκολίωσης Δρ. Ηλίας Χαρ. Παπαδόπουλος γεννήθηκε και μεγάλωσε στην Αθήνα. Αποφοίτησε με Άριστα από την Ιατρική Σχολή Αθηνών το 1994 και στη συνέχεια ειδικεύτηκε στην ορθοπαιδική, στην Α’ Ορθοπαιδική Κλινική του Πανεπιστημίου Αθηνών.