Spinal Tumors: Frequently Asked Questions

Timothy Ryken, M.D.
Department of Neurosurgery
University of Iowa Hospitals and Clinics

Creation Date: June 2000
Last Revision Date: June 2000
Peer Review Status: Internally Peer Reviewed

Thank you once again for the opportunity to address your medical concerns. Spinal cord tumors are relatively infrequent but are equally devastating as tumors occurring in the brain. We did not discuss the large variety of different tumor types in much detail and perhaps can revisit this on a subsequent session. Many neurosurgeons care for spinal cord tumors on a routine basis and will provide you with the best information on individual conditions. Thank you very much, and I look forward to visiting with you next month at this time.

This evening's topic is even more diverse than my last two sessions on brain tumors. The category of spinal tumor encompasses a very broad spectrum of disease. Every level of the spinal column can be affected by tumors involving the bones, the spinal cord tissue, or the coverings of the spinal cord. These can be malignant or benign and can present with a great variety of symptoms. Depending on the age of the patient, the type of tumor most encountered varies substantially. The most common problem in elderly patients is metastatic cancer spreading to the spinal column, while in young adults and children the benign tumors are more common. With that brief introduction, I would be happy to entertain questions.

How does gene therapy relate to spinal tumors either presently or in the future?

A very insightful question. The majority of gene therapy in the central nervous system has focused on the brain and tumors of the brain. I believe the spinal cord is even a better model for gene therapy because the ability of genetic material to penetrate the tissues is much shorter in the spinal cord than in the brain. Virtually, any disease in which the genetic defect can be understood can be treated with genetic type therapy theoretically. The difficulty is that our understanding of the genetic defect is very rudimentary in most cases. We hope to see gene therapy and related approaches have their first impact in areas of common problems such as spinal cord tumors or related conditions.

How are spinal tumors commonly treated?

The treatment of spinal cord tumors can be divided into several approaches. The first issue is attempting to relieve the symptoms that the tumor is causing. This may require surgery for tumor removal or possibly for stabilization of the spine. The second issue relates to accurately diagnosing the type of tumor present, and this will dictate whether additional therapy is necessary. These may include surgery, radiation, and less commonly chemotherapy.

I am wondering if you can address treatment of syringomyelia, although this is a cyst, not a tumor.

Syringomyelia is a very challenging condition in many cases. In the simple sense, it refers to a fluid collection within the substance of the spinal cord. The first challenge when addressing the patient with syringomyelia is to ensure that a tumor or other treatable condition is not present. Unfortunately, most cases of syringomyelia result from minor trauma or appear on their own without any known cause. While a variety of surgical approaches have been attempted, including decompression or drainage of the cavities, there has not been a single approach that has resulted in improvement in all cases.

Can spinal tumors ever be caused by injury of spinal cord due to car wreck injury, a bruised and stretched spinal cord injury?

Trauma is not typically associated with the development of spinal tumors. Direct injury is far more likely to be the cause of neurologic problems following spinal cord injury.

Is there an age group more commonly affected by spinal tumors?

Spinal cord tumors occur in all age groups, and the most common involvement of the spine by cancer or tumors in general results from the metastatic spread of cancer cells throughout the body. Because of the large blood supply of the vertebral column, tumor cells lodging in the spinal column are unfortunately quite common. The type of tumor occurring in young adults or even children is less likely to be metastatic and more likely to be a primary tumor meaning it has started in the location in which it is diagnosed. Many of the primary tumors are benign and can be treated either with observation or surgical excision.

Is there a role for radiation in spinal tumor treatment?

Radiation is used primarily to treat conditions in which cells are dividing faster than normal. The faster cells are dividing, the more likely it is for radiation to be effective. Therefore, just as in malignant tumors throughout the body, radiation can be a useful therapy in the treatment of spinal tumors. At the University of Iowa, we are fortunate to be working on a type of accurately focused radiation, which may be particularly effective for radiation treatment in the spine where we hope to maximally treat the tumor and protect the spinal cord.

Can a doctor determine if the tumors are benign just by looking at a MRI?

The best answer for this question is that the only certain way of making a diagnosis is to obtain a tissue sample. Even then, there is always a chance of not obtaining a diagnosis. Nonetheless, the radiographic appearance of many tumors on MRI scanning is so characteristic that the radiologist may be quite comfortable labeling a tumor benign.

Are any of the radiosurgery machines (accuray, brainlab, gamma knife) being developed for spinal use?

The type of image-guided radiation that is necessary to guide delivery for extracranial radiation is available theoretically on any of the commercially available image guided surgery systems. However, radiation delivery to non-fixed structures limits the accuracy to motion occurring during the radiation. This extracranial technique is the main focus of the developing radio surgery program at the University of Iowa.

Once you have been diagnosed with tumors, how often should you be reevaluated, and can they cause pain and discomfort?

It depends upon the type of tumor. If you have any concerns, you should discuss this with the doctor who provided you with the diagnosis. All of the spinal tumors can cause pain and discomfort.

Well theory I understand but you can't stuff a spine into a Leksell helmet. I meant more on a practical level, for example the movability of John Adler's machine, are they working for spine yet?

Very well put. I am laughing thinking of cramming a spine into the gamma knife unit. Although I was answering on a more superficial level, you are correct. I can't get into a proprietary discussion. However, I can tell you that a very workable extracranial localization system is nearing completion at the University of Iowa under the direction of Dr. Buatti and colleagues.

Very nice to hear! I really am interested in the technology, actually you and I have interacted before...I was recently the managing editor of Neurosurgery.... but now am with www.Radiology.com

Very nice to hear from you as well. Please feel free to contact me through the University of Iowa, and I am sure Dr. Buatti would be happy to follow up as well.

This may have nothing to do with it but I am just a laymen. Have you heard of facet syndrome, and does it mirror anything to do with spine tumor problems?

Facet syndrome is usually diagnosed when patients have spine pain which is worse when bending backwards and is usually associated with degenerative changes. It does not mean that a spinal tumor is present. In fact, although spinal tumors can cause neck and back pain, facet syndrome is much more common.

If I have numbness that comes and goes in my arm, is this more likely a pathology in the spine or pinched nerve?

Numbness radiating down the arm and the distribution of a particular nerve is very usefully information for the physician seeing such a patient. Unfortunately, numbness can come about from compression anywhere along the course of the nerve. As a neurosurgeon dealing with spine conditions, I typically would exclude pathology in the spine before moving out along the course of the nerve to make a diagnosis.

See related Patient Topics Bones, Joints and Muscles, Brain and Nervous System, Spinal Cord Diseases or Spinal Diseases.

See related Provider Topics Bones, Joints and Muscles, Brain and Nervous System or Spinal Diseases.

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