While it is relatively rare, the presence of a tumor in the spinal area is extremely serious. These tumors may or may not be painful, which is why it is important to see a spine specialist when back or neck pain persists for more than a week. A tumor can place pressure on nearby nerve roots, causing pain. Spinal cord tumors are abnormal growths of tissue found inside the bony spinal column, which is one of the primary components of the central nervous system (CNS). A tumor that originates in the brain or spinal cord is known as a primary tumor. Benign tumors are noncancerous whereas malignant tumors are cancerous. Since the CNS resides inside rigid, bony quarters (i.e., the skull and spinal column), any abnormal growth, whether benign or malignant, can place pressure on sensitive tissues and impair function.
A large number of primary tumors can be attributed to the out-of-control growth of cells that surround and support neurons. Rarely, primary tumors may result from specific genetic disease (e.g., neurofibromatosis, tuberous sclerosis) or from exposure to radiation or cancer-causing chemicals. Primary tumors are not contagious nor are they preventable at this point and the cause remains unknown.
Pain, sensory changes, and motor problems are common symptoms of a spinal cord tumor. Without treatment, symptoms will usually develop gradually and worsen with time. Tumors inside the spinal cord often cause symptoms over large areas of the body, while tumors outside the spinal cord may grow for some time before causing nerve damage. Other indicators of a spinal cord tumor include back pain, loss of sensation, muscle weakness, incontinence and muscle spasms.
A neurological examination is usually the first test used to diagnose brain and spinal column tumors. Special imaging techniques (computed tomography, and magnetic resonance imaging, positron emission tomography) are also utilized. Laboratory tests include the EEG and the spinal tap. Doctors diagnose the type of tumor by conducting a biopsy, a surgical procedure in which a sample of tissue is taken from a suspected tumor. The tumor may be determined as benign or malignant and if malignant, assigned a number based on degree of malignancy. Based on this, doctors determine how to treat the tumor and predict the likely prognosis for the patient. The following diagnostic tests may be ordered to confirm the location and source of your pain.
Magnetic Resonance Imaging (MRI)
Magnetic Resonance Imaging (MRI) uses a magnetic field and radio waves to generate highly-detailed pictures of the inside of your body. The MRI depicts soft tissues of the muscle and discs as well as nerves. These images help your neurosurgeon provide a more accurate diagnosis. This type of imaging is very safe and usually pain free. In most cases, injections are not required. However, in some situations, a contrast agent may be needed to enhance the ability of the MRI to see into your body.
Myelogram Followed by CT
A myelogram determines any decreases or blockages in the flow of cerebral spinal fluid (CSF) around your spinal column. It is used to diagnose a bulging disc, tumor or changes in the bones surrounding the spinal cord or nerves. A local anesthetic is injected into your lower back to numb the area. A lumbar puncture (spinal tap) is then performed. A dye is injected and a series of X-rays taken. Once the myelogram is completed, you are sent for a CT scan.
Intrathecal CT determines blockages or flow of cerebral spinal fluid around the spinal column. A local anesthetic is injected into the lower back to numb the area. A lumbar puncture (spinal tap) is then performed. A dye is injected. This procedure is followed by a CT scan, which takes a series of detailed pictures of the spinal area.
Electrical testing of the nerves and spinal cord may be performed before, during and after surgery. These tests, called Electromyography (EMG) or Somato Sensory Evoked Potentials (SSEP), assist your neurosurgeon in understanding how your nerves or spinal cord are affected by your condition.
Bone Scan with SPECT
Bone imaging is used to detect infection, malignancy, fractures and arthritis in any part of the skeleton. Bone scans are also accurate for finding lesions for biopsy or excision. The uses of single-photon emission tomography (SPECT) techniques contribute significantly to the diagnostic accuracy of the scan. A small amount of radioactive material (tracer) is used to visualize all the bones in your body. Approximately three hours after the tracer has been injected into a vein, a scan takes place.
Discography is a procedure used to determine the internal structure of your disc. It is performed by using a local anesthetic and injecting a dye into your disc under X-ray guidance. An X-ray and CT scan are performed to view the appearance of the disc composition to determine if its structure is normal or abnormal. In addition to your disc appearance, your doctor will note if you have pain with this injection.
The goal when treating spinal cord tumors is to reduce nerve damage related to compression of the spinal cord. In order to prevent progression it is crucial to administer treatment as quickly as possible. Surgery, radiation, and chemotherapy remain the three most commonly used treatments. Steroids may be prescribed to decrease swelling inside the CNS.