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
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
Diagnosis: Dr. Berti
begins his patientsí 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 donít require a biopsy if the cancer has already been
Treatments: Dr. Berti believes in exhausting 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
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 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.
Resection and radiotherapy (such as Cyberknife) are the recommended
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 ďTinel signĒ), 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.
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 isnít 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
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.
The main goal of treatment is to remove as much of the tumor as
possible without injuring brain tissue vital to a patientís 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 canít 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.
Radiosurgery, craniotomy, CyberKnife
Intramedullary lipomas: Intrtamedullary 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 patientís 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
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
Click here to the study.
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.
To read more on metastases, click on the links below: