Definition - spinal tumors

Tumors can occur throughout the body, even in or on the spine, especially in the spinal canal, but an appropriate diagnosis is not immediately synonymous with cancer. Every growth is addressed as a tumor but once it is identified, a distinction-between benign tumors (meningiomas and neurinomas), malignant tumors and metastases must be made. When the type of tumor has been clarified through an individual and detailed examination, the appropriate treatment steps begin. A tumor on the spine is classified by its anatomical location into tumors that lie outside the spinal cord (90%), and tumors that lie within the spinal cord but outside the spinal cord (9%). Very rarely occurs with 1%, a tumor that lies directly in the spinal cord.

Bone metastases affects men more than women

The spine is the most common site for skeletal metastases. Spinal metastases are anatomically distributed as follows: thoracic spine (70%), lumbar spine (20%) and cervical spine - (10%). Primary spinal tumors are rare - only about 5% of them take place on the spine. Malignant metastases on the spine (immigration of tumors from other parts of the body) are usually metastases of breast cancer (mamma carcinoma), prostate cancer, lung cancer (bronchial carcinoma), kidney cancer or lymphoma. Unfortunately, bone metastases are very common in fact it is the third most frequent point of metastasis development after the liver and lungs. Two-thirds of all bone metastases affect the spine. Men are more frequently affected by bone metastases than women with a ratio of 4 out of 6. With age advancing bone metastasis is increasingly common.

Causes - cancer cells move through the body

How do the metastases get to the spine? Which are the causes? Do they form directly on the spine? Now, before understanding cancer itself, it's necessary to understand what happens when cells become cancerous.

Our body has different types of cells that normally grow or divide themselves only when it is necessary. This regeneration of the cells is regulated and serves to maintain our body health.

Sometimes cells divide when it is not necessary causing an excessive tissue regeneration. This excess tissue forms a tumor made by benign or malignant cells.

Malignant tumors (carcinomas) mean cancer! It is very common for cancer cells to detach from a malignant tumor and invade the bloodstream or lymphatic system. In this way, cancer cells spread from the original tumor (primary tumor) and form new tumors in other organs. So they leave the tumor and walk through the body until they find a new place to grow.

These colonies, called metastases, are considered the greatest danger in cancer, and usually differ from the original tumor. This makes treatment more difficult. Metastases are responsible for almost 90% for the death of cancer patients.

If doctors could prevent new “colonies” from forming, cancer would have lost much of its terror. But a simple solution will probably not exist. So far, research has shown how complex the development of metastases is.

Even benign tumors can trigger pain and neurological disorders

Unfortunately, there are not classical symptoms that can easily be used to detect a spinal tumor. Regardless of their goodness or malignancy, the growths often restrict the space of the nerve fibers putting pressure on them. Benign tumors usually grow slowly and are often incidental findings during an examination. A benign tumor may also destroy structures and may cause pain in the periosteum, local pressure or tapping pain, rest pain without strain, persistent pain, painful movement restriction of the spine, neurological disorders, bladder and rectal disorders and instability of the spine. In addition to the symptoms caused by the tumor, additional symptoms can occur in a malignant tumor such as fever, enlargement of the lymph nodes, weight loss, night sweats and fatigue. Basically, symptoms depend on the type of tumor and the stage of the disease. In any case, pain in the spine that is not explicable and after a week show no spontaneous recovery should be controlled by a specialist - after all, pain is the most common symptom in 95% of all patients. Motor and autonomic functional limitations are the second most common symptom (85%).

Diagnosis - this is how tumors are classified

An internationally standardized system, the staging system (TNM), ensures a consistent classification of tumors according to size, lymph nodes involvement and possible metastases. This classification is the basis for an optimally successful treatment strategy.

The detailed diagnosis begins with the study of the patient's medical history and neurological examinations. Ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine examination procedures are also needed. Myelography, angiography, biopsy (removal of a tissue sample) and laboratory diagnostics are further important diagnostic tools for initiating an individual therapy and to guarantee the highest quality of treatment. However, blood tests are only helpful in exceptional cases in the diagnosis and serve mainly to exclude other diseases or to notice in the aftercare eventual relapses. What is difficult is to differentiate and diagnose are spinal tumors, especially when it comes to a vertebral fracture that can be caused by infections, traumatic or even by various diseases with subsequent osteopenia (osteoporosis). Furthermore, detailed information on the origin and nature (benign or malignant) of the tumor can be found only limitedly through diagnostic images, in fact to determine which kind of therapy is better, a sample of the tumor is always needed.

Therapy depends on the type, location and size of the tumor

Conservative therapies are used only limitedly to treat tumors. In order to choose the right therapy, information like general health conditions and age of the patient, size and type of the tumor are necessary. When patients are elderly and tumors are small, which means that they do not cause pain, affected people should be controlled periodically. It is necessary to pay attention to their growth and decide when surgery should take place.

Overall, however, a benign spinal tumor should be removed, as it can affect adjacent areas and restrict nerves or other delicate structures. As tumors are not a clearly delineated disease, they usually require interdisciplinary treatments by physicians from various disciplines. The type of surgical removal depends on the nature, location and size of the tumor.

The anatomy of the spine, with its delicate spinal cord and spinal nerves, limits the radical removal of a tumor. If the tumor is unfavorable, it can only be partially removed. However, tumor mass reduction results always in an improved quality of life of the sufferer.

With the help of microsurgery, benign tumors can usually be removed definitively, especially if they are detected early. In concomitant destruction of the vertebral joints, other procedures such as spinal fusion (spondylodesis) are used to restore stability. It works with a spinal fixation system of screws and rods. For example, gentle ("percutaneous") interventions for the back have been recently developed in order to enable rapid rehabilitation and mobilization of the patient in the event of tumor-related instabilities. In case of a necessary removal of the vertebral body and a replacement with a titanium "artificial vertebral body", there are also state-of-the-art surgical options such as thoracoscopy and keyhole access on the abdomen. These reduce discomfort after surgery and allow a faster resumption of patient's daily life.

While benign tumors of the posterior parts of the spine sometimes only have to be surgically removed, metastases with multiple vertebral bodies often require subsequent radiotherapy or chemotherapy.
The aim of every tumor therapy is to increase the quality of life (eg maintaining good mobility), to reduce pain and to avoid neurological deficits, without, however, losing sight of the overall course of events in individual cases.

Prognosis - regular follow-ups are absolutely necessary

Regular follow-up checks every six-months ensure the patient's stability and healing success, enabling rapid interventions when tumor growth resumes.

Timely diagnosis and rapid surgical removals ensure a good prognosis of benign tumors, so that healing of the patient is likely and coupled with a normale life expectancy.

For metastases or malignant tumors on the spine, the prognosis depends on many factors - such as age, general health condition, number and localization of the metastases and degree of malignancy.

Dr. med. Munther Sabarini

Author
Dr. med. Munther Sabarini
Specialist in Neurosurgery

Hans-Heinrich Reichelt

Co-author
Hans-Heinrich Reichelt
Chief Editor of Medizin für Menschen

The Avicenna Clinic in Berlin is always willing to help you

Since the year 2001, the Avicenna Clinic is based in Berlin. Our doctors have at least 25 years of international experience in their respective fields (neurosurgery, spinal surgery, anesthesia, and orthopedics).

If you have severe back pain, a herniated disc or a suspected herniation, please contact us using the following information:

Avicenna Clinic
Paulsborner Str. 2
10709 Berlin

Telephone: +49 30 236 08 30
Fax: +49 30 236 08 33 11
E-Mail: info@avicenna-klinik.de

You can call anytime, write an e-mail or fill out a callback form. Each patient then gets an appointment with a doctor of our clinic, who is a spine specialist (neurosurgeon). Based on MRI images (brought or made in our clinic) and on an in-depth examination, the doctor will discuss with you all the different therapy options or possibly surgery. You can also use our specialists only to obtain a (second) opinion.

If you decide to undertake your therapy and/or surgery in Berlin, we would want to make your stay as pleasant as possible. In our clinic, you are at the center of our attention! You can expect state-of-the-art equipment in all areas - from the operating room to the patient bedroom.

The latest, gentle, minimally invasive treatment procedures are the focus of our clinic. Together we try to find a suitable treatment for your complaints. The actual therapy takes place only after a detailed discussion with the patient, examinations and the diagnostics.

For us, as important as medical care, it is the commitment we take to guarantee our patients a high level of personal care that can, in turn, ensure them a comfortable stay.

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