Understanding Spinal Cord Tumors: Types, Symptoms, and Treatment Options

Spinal cord tumors, as explained by Dr. Scott Raffa, a board-certified neurosurgeon specializing in the spine, are abnormal growths of cells that develop within or around the spinal cord. These tumors can disrupt the normal functioning of the spinal cord, leading to pain, loss of sensation, and even paralysis.

Main Types of Spinal Cord Tumors

There are three main types of spinal cord tumors: intramedullary, extramedullary, and extradural. Each type of tumor is classified based on its location relative to the spinal cord.

Intramedullary Tumors

• These tumors originate within the spinal cord itself. They are the least common type of spinal cord tumors and typically arise from glial cells, which support and protect nerve cells. The most common intramedullary tumors are:
• Ependymomas: These tumors develop from ependymal cells that line the central canal of the spinal cord. They are often slow-growing and can occur at any age but are more common in adults.
• Astrocytomas: These tumors are more aggressive and infiltrative than ependymomas. They can occur at any age but are more common in children and adolescents.

Extramedullary tumors

• Extramedullary tumors develop outside the spinal cord but within the dura mater, which is the protective covering of the spinal cord. These tumors are more common than intramedullary tumors and typically arise from nerve roots or blood vessels. The most common extramedullary tumors are:
• Meningiomas: These slow-growing tumors originate from the cells of the meninges, which are the protective layers surrounding the spinal cord. Meningiomas are more common in middle-aged and older women.
• Schwannomas and neurofibromas: These tumor types arise from the nerve sheath cells (Schwann cells) and can cause spinal cord or nerve roots compression. Schwannomas are usually benign, while neurofibromas can be either benign or malignant.

Extradural tumors

• Extradural tumors occur outside the dura mater and account for most spinal tumors. These tumors can be primary (originating from the spine) or secondary (metastatic), meaning they have spread from a cancerous site elsewhere in the body. Common extradural tumors include:
  • Metastatic tumors: The spine is a common site for metastatic tumors from cancers such as breast, lung, prostate, and kidney.
  • Multiple myeloma: This type of blood cancer affects plasma cells, which can form tumors in the bones, including the vertebrae of the spine.
  • Vertebral hemangiomas: These are benign tumors that form from blood vessels within the vertebral bones. Although usually asymptomatic, they can cause spinal cord compression if they grow large enough.

Symptoms of Spinal Cord Tumors

The symptoms of spinal cord tumors can vary depending on the type, location, and size of the tumor. Some common symptoms include:

• Back or neck pain that worsens over time and may be worse at night
• Numbness, tingling, or weakness in the arms, legs, or trunk
• Loss of sensation or difficulty in controlling movements
• Bowel or bladder dysfunction
• Paralysis, either partial or complete

Treatment Options for Spinal Cord Tumors

Treatment for spinal cord tumors depends on the tumor’s type, location, and size and the patient’s overall health. Some common treatment options include:

• Surgery: The primary treatment for most spinal cord tumors is surgical removal. The goal is to remove as much of the tumor as possible while preserving neurological function. In some cases, complete removal may not be possible due to the tumor’s location or involvement with critical structures.
• Radiation therapy: Radiation therapy may be used as a primary treatment for inoperable tumors or as adjuvant therapy after surgery to target any remaining tumor cells. Advances in radiation technology, such as stereotactic radiosurgery, allow for precise radiation delivery to the tumor while minimizing damage to the surrounding healthy tissue.
• Chemotherapy: Chemotherapy can sometimes be used, particularly for metastatic tumors or tumors with malignant components. However, the effectiveness of chemotherapy for spinal cord tumors is limited due to the blood-brain barrier, which restricts the passage of many chemotherapy drugs.
• Targeted therapy and immunotherapy: These newer treatment options target specific cancer-related pathways or harness the patient’s immune system to attack the tumor. While these treatments have shown promise for some types of cancer, their effectiveness for spinal cord tumors is still being studied.
• Monitoring and supportive care: In some cases, particularly with slow-growing tumors or when surgery is not an option, a “watch and wait” approach may be recommended. This involves close monitoring of the tumor and managing symptoms as they arise. Supportive care, such as pain management and physical therapy, can help improve patients’ quality of life.

Surgical Techniques and Preoperative Planning

Surgical removal of spinal cord tumors is a delicate and intricate procedure that requires a skilled neurosurgeon, advanced technology, and a specialized medical team. The primary goal of surgery is to remove as much of the tumor as possible while minimizing damage to the surrounding spinal cord and nerve roots.

Before surgery, a thorough evaluation of the patient’s medical history, neurological status, and imaging studies (such as MRI or CT scans) is conducted. This helps Dr. Raffa understand the tumor’s location, size, and relationship to the surrounding structures. Sometimes, a biopsy may be performed to confirm the tumor’s type and grade. Preoperative planning also includes discussions with the patient about surgery’s risks, benefits, and potential outcomes. Dr. Raffa works closely with other specialists, such as oncologists, radiologists, and physiatrists, to develop a comprehensive treatment plan tailored to the patient’s needs.

Various surgical techniques are used to remove spinal cord tumors, depending on the tumor’s location, size, and type. Some common techniques include:

• Laminectomy: This procedure involves removing a portion of the vertebral bone (lamina) to access the spinal canal and create space to remove the tumor. Laminectomy is commonly used for extramedullary and extradural tumors.
• Partial or complete corpectomy: In this procedure, the surgeon removes part or all of a vertebra, along with the tumor. This technique is typically used for tumors that involve the vertebral body or when a tumor has caused significant spinal instability.
• Microsurgery: During microsurgery, the surgeon uses a high-powered microscope and specialized microsurgical instruments to remove the tumor with greater precision and minimal damage to the surrounding spinal cord and nerves.
• Ultrasonic aspiration: This technique uses ultrasonic vibrations to break up and aspirate (suck out) the tumor tissue. It is particularly useful for removing intramedullary tumors, as it helps preserve the surrounding spinal cord tissue.
• Intraoperative neurophysiological monitoring: This technique involves continuous monitoring of the patient’s neurological function during surgery using electrodes placed on the scalp and extremities. This real-time feedback helps the surgeon avoid causing damage to critical neurological structures.

Patients are closely monitored in the intensive care unit or neurosurgical recovery area after surgery. Pain management, wound care, and close observation of neurological function are essential during this time. The patient may undergo additional imaging studies to assess the extent of tumor removal and to identify any postoperative complications.

Postoperative Care and Recovery

Recovery from spinal cord tumor surgery can vary widely, depending on the patient’s age, overall health, and the type and location of the tumor. Rehabilitation, including physical and occupational therapy, may be needed to help patients regain strength, mobility, and independence.

In some cases, adjuvant therapies, such as radiation therapy or chemotherapy, may be recommended after surgery to target any remaining tumor cells and reduce the risk of recurrence.

Spinal cord tumors are complex and varied, making an accurate diagnosis and appropriate treatment crucial for patient outcomes. Advancements in diagnostic techniques and treatment options continue to improve the prognosis for those affected by spinal cord tumors. Suppose you suspect you may be experiencing symptoms related to a spinal cord tumor. In that case, it is essential to seek medical advice promptly to ensure the best possible outcome.

Dr. Scott Raffa and the spine team at Cantor Spine Center at the Paley Orthopedic & Spine Institute stand as a beacon of hope for those diagnosed with a spinal cord tumor. Trust the expertise that South Florida residents have come to rely on. Schedule your consultation with Dr. Scott Raffa today by calling 561-935-1188 or request an appointment online.