Overview
Vertebral tumours, which are also known as extradural tumours or spinal tumours, are a type of spinal tumors that affect the bones or vertebrae of the spine. Tumours that affect the vertebrae more often than not would have spread from cancers that would have originated in other parts of the body, such as prostate, breast, lung or kidney.
There are also tumours that originate from the spinal cord and the most notable ones include chordoma, chondrosarcoma, plasmacytoma and Ewing’s sarcoma.
Be it benign or malignant, vertebral tumours can be detrimental and if not treated immediately, they may lead to permanent disability.
Symptoms
Back pain, especially in the lower and middle back, is the most common symptom both in benign and malignant tumours. This pain spreads beyond the back to the hips, lower limbs and arms and gradually aggravates. Some of the key symptoms associated with the vertebral tumours include:
- Loss of sensation or muscle weakness in the legs, arms or chest
- Stiff neck or back
- Pain and/or neurologic symptoms (such as tingling)
- Difficulty walking, which may cause falls
- Decreased sensitivity to pain, heat and cold
- Loss of bowel or bladder function
- Paralysis, which occurs varying degrees and in different parts of the body, depending on which nerves are compressed
- Scoliosis or other spinal deformity caused due to a large and/or destructive tumour
Causes
The exact cause for primary spinal tumours is not known. A few experts believe it to be a genetic defect. However, it is not known whether such genetic defects are inherited or simply develop over time. Or, they might be caused by something in the environment, such as exposure to certain chemicals.
Most vertebral tumours are metastatic, which means they have spread from tumours in organs elsewhere in the body.
Diagnosis
Vertebral tumours sometimes may be overlooked because their symptoms resemble those of more common conditions. For that reason, it’s especially important for the doctor to know the complete medical history of the patient and perform both general physical and neurological exams. Vertebral tumours sometimes may be overlooked because their symptoms resemble those of more common conditions. For that reason, it’s especially important for the doctor to know the complete medical history of the patient and perform both general physical and neurological exams.
If the presence of a vertebral tumour is suspected, one or more of the following tests can help confirm the diagnosis and pinpoint the tumour’s location:
Spinal Magnetic Resonance Imaging (MRI): MRI is usually the preferred test method to diagnose vertebral tumours. A contrast agent that helps to highlight certain tissues and structures may be injected into a vein in the patient’s hand or forearm during the test. Some people may feel claustrophobic inside the MRI scanner or find the loud thumping sound inside to be disturbing. Earplugs, televisions or headphones can be used to help minimise the noise. Mild sedatives are frequently used to relieve the anxiety of claustrophobia.
Computerised Tomography (CT) Scan: This test uses a narrow beam of radiation to produce detailed images of the spine. Sometimes, it may be combined with an injected contrast dye to make abnormal changes in the spinal canal or spinal cord easier to see. CT scan may be used in combination with MRI.
Biopsy: Often, the only way to determine the type of tumour is to examine a small tissue sample (biopsy) under a microscope. The biopsy results will help determine treatment options. The method used to obtain the biopsy sample can be critical to the success of the overall treatment plan. In most cases, a radiologist will conduct a fine-needle biopsy to extract a small amount of tissue, usually under the guidance of X-ray or CT imaging.
Bone Scan: Bone scan is a diagnostic test that uses Technetium-99. This scan is helpful as an adjunct for identification of bone tumours (such as primary bone tumours of the spine), infection, and diseases involving abnormal bone metabolism.
If the presence of a vertebral tumour is suspected, one or more of the following tests can help confirm the diagnosis and pinpoint the tumour’s location:
Spinal Magnetic Resonance Imaging (MRI): MRI is usually the preferred test method to diagnose vertebral tumours. A contrast agent that helps to highlight certain tissues and structures may be injected into a vein in the patient’s hand or forearm during the test. Some people may feel claustrophobic inside the MRI scanner or find the loud thumping sound inside to be disturbing. Earplugs, televisions or headphones can be used to help minimise the noise. Mild sedatives are frequently used to relieve the anxiety of claustrophobia.
Computerised Tomography (CT) Scan: This test uses a narrow beam of radiation to produce detailed images of the spine. Sometimes, it may be combined with an injected contrast dye to make abnormal changes in the spinal canal or spinal cord easier to see. CT scan may be used in combination with MRI.
Biopsy: Often, the only way to determine the type of tumour is to examine a small tissue sample (biopsy) under a microscope. The biopsy results will help determine treatment options. The method used to obtain the biopsy sample can be critical to the success of the overall treatment plan. In most cases, a radiologist will conduct a fine-needle biopsy to extract a small amount of tissue, usually under the guidance of X-ray or CT imaging.
Bone Scan: Bone scan is a diagnostic test that uses Technetium-99. This scan is helpful as an adjunct for identification of bone tumours (such as primary bone tumours of the spine), infection, and diseases involving abnormal bone metabolism.
Treatment
Early detection is the key to treat vertebral tumours successfully without any serious complications. Therefore, it is important for the patients not to ignore any symptoms associated with the spinal tumours. Treatment options for vertebral tumours include surgery, radiation therapy, chemotherapy, medications or sometimes just monitoring.
Ideally, the goal of vertebral tumour treatment is to completely get rid of the tumour. But, this might be complicated by the risk of permanent damage to the spinal cord or surrounding nerves. Doctors also must consider the patient’s age, overall health, the type of tumour, and whether it is primary or has spread or metastasised to the spine from elsewhere in the body. Treatment options for most vertebral tumours include:
Monitoring: Some tumours may be discovered before they cause symptoms — often when a patient is being evaluated for another condition. If small tumours are noncancerous and aren’t growing or pressing on surrounding tissues, watching them carefully may be all that’s needed. This is especially true in older adults for whom surgery or radiation therapy may pose special risks. During the observation, the doctor will likely recommend periodic CT or MRI scans at an appropriate interval to monitor the tumour.
Surgery: Surgery is often the treatment of choice for tumours that can be removed with an acceptable risk of spinal cord or nerve injury. Newer techniques and instruments allow neurosurgeons to reach tumours that were once considered inaccessible. Sometimes, surgeons may use a high-powered microscope in microsurgery to make it easier to distinguish a tumour from healthy tissue. Doctors can also monitor the function of the spinal cord and other important nerves during surgery, thus minimising the chance of them being injured. In some instances, an ultrasound might be used during surgery to break up tumours and remove the fragments. But even with advances in surgical techniques and technology, not all tumours can be totally removed. Sometimes, surgery might be followed by radiation therapy, chemotherapy or both. Recovery from spinal surgery may take weeks or longer, depending on the procedure or complications, such as bleeding and damage to nerve tissue.
Radiation Therapy: This may be used following an operation to eliminate the remnants of tumours that can’t be completely removed, treat inoperable tumours or treat those tumours where surgery is too risky. It may also be the first-line therapy for some vertebral tumours. Radiation therapy may also be used to relieve pain when surgery is too risky. Medications may help ease some of the side effects of radiation, such as nausea and vomiting. Sometimes, the radiation therapy regimen may be adjusted in such a way to help prevent damage to surrounding tissue from the radiation and improve the treatment’s effectiveness. Modifications may range from simply changing the dosage of radiation to using sophisticated techniques such as 3-D conformal radiation therapy. A specialised type of radiation therapy called proton beam therapy also may be used to treat some vertebral tumours such as chordomas, chondrosarcomas and some childhood cancers when spinal radiation is required. Proton beam therapy is better at targeting the radioactive protons to the tumour site without damaging the surrounding tissue as in traditional radiation therapy.
Chemotherapy: It is a standard treatment for many types of cancer, chemotherapy uses medications to destroy cancer cells or stop them from growing. The doctor can determine whether or not chemotherapy is beneficial for the patient, either alone or in combination with other therapies.
