Orthopaedic Oncology

Intradural spinal tumors are tumors within the spinal fluid sac and can be within the spinal cord (intramedullary) or outside of the spinal cord (extramedullary). Extramedullary spinal tumors are far more common than intramedullary tumors.

The most common extramedullary spinal tumors are meningiomas and schwannomas and they are both generally benign tumors.

• Meningiomas arise from arachnoid cells within the tissues of the spinal cord.
• Schwannomas are tumors that arise from Schwann cells.

The most common intramedullary spinal tumors are ependymomas, astrocytomas, and hemangioblastomas. These tumors arise from various cells present in the spinal cord.

Patients with intradural tumors generally have some neurological symptoms: pain, weakness, sensory loss, difficulty with walking, paralysis, or loss of bladder and bowel functions.

Metastatic spinal tumors originate somewhere else in the body such as the breast, lung, liver, or prostate and then spread to the spine. After the lung and the liver, the skeleton is the most common site of spread of cancers that begin in organs. Metastases to the lung and liver are often not detected until late in the course of disease because patients experience no symptoms. In contrast, cancer that spreads to the bone is generally painful when they occur.

A cancer patient who experiences any pain, especially in the back, legs, and arms, should notify his or her doctor immediately. Pain that occurs without activity (i.e., walking or lifting an object) is particularly concerning. Nocturnal pain in the spine is a common feature.

Metastatic spinal tumors are very common and can cause fractures and/or compression of the spinal cord or nerves. Over one million people are diagnosed with cancer in the U.S. each year. Between 10 and 30% will have symptomatic spread of cancer to the spine when they are diagnosed.

Primary spinal column tumors originate within the spine and are quite rare. Primary spinal tumors can either be benign or malignant. Some of the benign primary spinal tumors include:

• Osteoid Osteoma
• Osteoblastoma
• Aneurysmal Bone Cyst (ABC)
• Giant Cell Tumor

Some of the malignant primary spinal tumors include:

• Osteosarcoma
• Chondrosarcoma
• Chordoma

Treatment for a spinal tumor may include surgery, radiation therapy, chemotherapy or other medications. Surgery can range from a minimally invasive procedure such as vertebroplasty or kyphoplasty to complex reconstruction depending on the severity of cancer involvement.

Radiosurgery is another non invasive treatment option now being used to treat spinal tumors. Radiosurgery allows the physician to deliver a high dose of precisely targeted radiation by using computers to focus radiation beams on tumors with pinpoint accuracy and from multiple angles.