Tumours affecting the spine can either be benign or malignant (cancerous). The commonest type of malignant tumours are metastases, which spread to the spine from other organs such as the lung, prostate, breast or bowel. Fortunately, compared to wear and tear (degenerative) conditions of the spine, tumours of the spine are rare. However, the symptoms may be similar to degenerative conditions.
What are the symptoms?
Severe spinal pain is the most common initial symptom in patients with a spinal tumour. Unlike spinal pain related to degenerative spinal conditions and back sprains, the pain caused by a spinal tumour is usually constant and difficult to treat with simple pain medication and tends to worsen progressively over a few weeks. It may be worse at night when lying down. This is different from degenerative spinal pain, which tends to fluctuate or improve with conservative treatment. Other more generalised symptoms of cancer include tiredness, weakness, poor apetite and weight loss.
If the spinal structure is weakened by tumour growth, the spine begins to bend or collapse and can become unstable. This usually worsens the back pain at the site of the spinal tumour. If the tumour expands or the spine bends excessively, the spinal cord or nerves in the spinal canal may become compressed leading to limb weakness, numbness or pain, and/or bladder problems (Fig 1).
What investigations are required?
An MRI scan of the spine is the most accurate test for detecting a spinal tumour. A CT scan or bone scan is sometimes required to help with the diagnosis.
What is the Treatment for spinal tumours?
The effective treatment of spinal tumour disease depends upon early detection and subsequent management by a multidisciplinary team of Oncologists, Physicians and Spinal Surgeons.
Benign spinal tumours (Fig 2) are often treated by surgical removal. In many cases benign tumours can be removed completely with the likelihood of permanent cure. Malignant spinal tumours cannot usually be removed completely.
Surgery may be recommended for nerve or spinal cord compression with limb weakness, or for structural weakening of the spine causing severe back pain. Surgery is usually provided in conjunction with other treatments such as radiotherapy and/or chemotherapy.
Spinal tumour surgery involves decompression of the spinal cord and nerves by removing as much of the tumour as possible. This is usually followed by reconstruction of the diseased spine using special screws, metal rods and cage implants (instrumented stabilisation).
