Cervical Spine Tumors
Neoplasms of the spine can be classified as primary tumors or metastatic tumors. Metastatic is a common term used to describe the spread of a cancer from some other site in the body. The spinal column is one of the most common locations for cancer to metastasize to. Metastatic tumors of the spine are the most common tumors of the spine, and are normally treated without surgery unless there is consequential spinal instability or neurologic concession. The majority of metastatic lesions are treated with chemotherapy and/or radiation therapy that is defined for the primary cancer type. Primary tumors of the spine can be benign or malignant (cancer), and can be additionally subdivided into intradural and extradural neoplasms. Intradural means that the tumor is beginning from or within the dural sac (sac containing the spinal cord and nerves). Extradural tumors are often neoplasms infiltrating the bony structure of the vertebrae, but can also occur within the epidural space. Intradural tumors are further classified as intramedullary or extramedullary, and specify whether or not a tumor is appearing from within the spinal cord itself (intradural-intramedullary), or from the covering of the spinal cord (intradural-extramedullary). Generally, primary spine tumors are uncommon and include almost .04% of all tumors and 10% of all bone tumors.
Extradural Tumors
Benign
· Osteochondroma, Osteoid Osteoma, Osteobalstoma, Osteobalstoma, Aneurysmal Bone Cyst, Hemangioma, Giant Cell Tumor, Eosinophilic Granuloma and Angiolipoma
Malignant
· Multiple Myeloma, Solitary Plasmacytoma, Osteosarcoma, Chondrosarcoma, Ewing’s Sarcoma, Chordoma and Lymphoma
Intradural-Extramedullary Tumors
· Meningioma, Lymphoma, Schwannoma and Ependymomas
Intradural-Intramedullary Tumors
· Astrocytoma, Ependymoma, Hemangioblastoma, Lipoma, Dermoid, Epidermoid, Neuroblastoma, Oligodendrolioma, Cholesteatoma, Subependymoma and PNET
Causes
Neoplasms and cancer are defined as an atypical cellular response that causes cells to develop at an uninhibited rate, or in an unusual site, or both. The original cause of cancer and tumors is frequently unidentified. At times, patients with acknowledged exposure to a cancer-causing agent may be recognized (asbestos, radiation, etc). Cancer is known to spread to the spinal column often, and occurs through the bloodstream or the lymphatic system.
Symptoms
Neck pain is the most common presenting indicator of patients with a cervical spine tumor. Patients frequently have unrelenting pain, as well as night pain, that are not relieved by rest or usual actions. Patients may have neck stiffness and reduced range-of-motion. Patients may have weakness or numbness if the tumor is progressive and causing neurologic compression or irritation. In addition, patients may have constitutional symptoms such as low-grade fever, night sweats, fatigue, malaise, and/or loss of appetite, amid others.
Physical Findings
The physical findings for patients with a spine tumor are restricted. Patients may exhibit tenderness and spasm with lessened cervical range-of motion, but not normally. The neurologic examination will usually be normal unless the spinal tumor is complex and causing neurologic compression or irritation.
Imaging Studies
Plain x-rays of the cervical spine permit the physician to measure the general spinal alignment and bony integrity, and may show a bone-forming or bone-destroying neoplasm if the lesion is great enough. A magnetic resonance imaging test (MRI) with gadolinium is frequently suggested and necessary to correctly identify the size and degree of the neoplasm, and whether it has extended into the spinal canal. Spine tumors can be distinguished from pyogenic spine infections because neoplasms influence the vertebral body primarily and typically do not affect the disc, whereas pyogenic vertebral osteomyelitis preferentially damages the endplate and intervertebral disc. A computed tomography (CT) scan may also be ordered as it permits doctors to better visualize details of the bony anatomy better than an MRI test. A CT-myelogram (dye is injected within the thecal sac) may offer further diagnostic information, particularly when assessing intradural neoplasms. A bone scan is a test often requested when cancer is suspected, and can conclude if there are other lesions in the bones throughout the entire body.
Laboratory Tests
Laboratory tests are frequently ordered when a neoplastic work-up is needed. A complete blood count (CBC) with differential, metabolic panel, serum protein electrophoresis (SPEP), urine protein electrophoresis (UPEP), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) tests is normally ordered when evaluating a tumor. Laboratory tests may verify the diagnosis of lymphoma, leukemia, multiple myeloma, or infection. A PPD skin test should also be placed to test for tuberculosis, which can mimic a spinal tumor.
Diagnosis
The diagnosis of a spine tumor may be postponed, primarily because the initial signs and symptoms are slight and physicians do not originally suspect it. Patients with "red flags" (symptoms suggesting infection or tumor, such as unrelenting pain, night pain, fevers, chills, night sweats, weight loss, etc) must be properly assessed with imaging and laboratory tests to prove the diagnosis.
Treatment Options
The treatment of a neoplasm of the cervical spine depends on a number of aspects: the patient's age and related medical conditions, the type, grade, and stage of the neoplasm, the severity of a patient's symptoms, and the severity of neurologic compression and bony damage. In contrast to the thoracolumbar spine, metastatic tumors of the cervical spine are more liable to cause instability and/or neurologic compromise and are more frequently treated surgically. Benign primary bone tumors are often treated by surgical tumor resection; however, some benign tumors may be treated conservatively and observed if there is nominal pain and there is no indication of spinal instability or neurologic compression. Malignant primary spine tumors are frequently treated by surgical resection and adjuvant chemotherapy and/or radiation. Surgical treatment often consists of neurologic decompression, fusion, and instrumentation in addition to tumor resection. An anterior or posterior surgical method, or at times a combined approach, may be used depending on where the tumor is positioned and where the neurologic compression is most prominent.
Neoplasms of the spine can be classified as primary tumors or metastatic tumors. Metastatic is a common term used to describe the spread of a cancer from some other site in the body. The spinal column is one of the most common locations for cancer to metastasize to. Metastatic tumors of the spine are the most common tumors of the spine, and are normally treated without surgery unless there is consequential spinal instability or neurologic concession. The majority of metastatic lesions are treated with chemotherapy and/or radiation therapy that is defined for the primary cancer type. Primary tumors of the spine can be benign or malignant (cancer), and can be additionally subdivided into intradural and extradural neoplasms. Intradural means that the tumor is beginning from or within the dural sac (sac containing the spinal cord and nerves). Extradural tumors are often neoplasms infiltrating the bony structure of the vertebrae, but can also occur within the epidural space. Intradural tumors are further classified as intramedullary or extramedullary, and specify whether or not a tumor is appearing from within the spinal cord itself (intradural-intramedullary), or from the covering of the spinal cord (intradural-extramedullary). Generally, primary spine tumors are uncommon and include almost .04% of all tumors and 10% of all bone tumors.
Extradural Tumors
Benign
· Osteochondroma, Osteoid Osteoma, Osteobalstoma, Osteobalstoma, Aneurysmal Bone Cyst, Hemangioma, Giant Cell Tumor, Eosinophilic Granuloma and Angiolipoma
Malignant
· Multiple Myeloma, Solitary Plasmacytoma, Osteosarcoma, Chondrosarcoma, Ewing’s Sarcoma, Chordoma and Lymphoma
Intradural-Extramedullary Tumors
· Meningioma, Lymphoma, Schwannoma and Ependymomas
Intradural-Intramedullary Tumors
· Astrocytoma, Ependymoma, Hemangioblastoma, Lipoma, Dermoid, Epidermoid, Neuroblastoma, Oligodendrolioma, Cholesteatoma, Subependymoma and PNET
Causes
Neoplasms and cancer are defined as an atypical cellular response that causes cells to develop at an uninhibited rate, or in an unusual site, or both. The original cause of cancer and tumors is frequently unidentified. At times, patients with acknowledged exposure to a cancer-causing agent may be recognized (asbestos, radiation, etc). Cancer is known to spread to the spinal column often, and occurs through the bloodstream or the lymphatic system.
Symptoms
Neck pain is the most common presenting indicator of patients with a cervical spine tumor. Patients frequently have unrelenting pain, as well as night pain, that are not relieved by rest or usual actions. Patients may have neck stiffness and reduced range-of-motion. Patients may have weakness or numbness if the tumor is progressive and causing neurologic compression or irritation. In addition, patients may have constitutional symptoms such as low-grade fever, night sweats, fatigue, malaise, and/or loss of appetite, amid others.
Physical Findings
The physical findings for patients with a spine tumor are restricted. Patients may exhibit tenderness and spasm with lessened cervical range-of motion, but not normally. The neurologic examination will usually be normal unless the spinal tumor is complex and causing neurologic compression or irritation.
Imaging Studies
Plain x-rays of the cervical spine permit the physician to measure the general spinal alignment and bony integrity, and may show a bone-forming or bone-destroying neoplasm if the lesion is great enough. A magnetic resonance imaging test (MRI) with gadolinium is frequently suggested and necessary to correctly identify the size and degree of the neoplasm, and whether it has extended into the spinal canal. Spine tumors can be distinguished from pyogenic spine infections because neoplasms influence the vertebral body primarily and typically do not affect the disc, whereas pyogenic vertebral osteomyelitis preferentially damages the endplate and intervertebral disc. A computed tomography (CT) scan may also be ordered as it permits doctors to better visualize details of the bony anatomy better than an MRI test. A CT-myelogram (dye is injected within the thecal sac) may offer further diagnostic information, particularly when assessing intradural neoplasms. A bone scan is a test often requested when cancer is suspected, and can conclude if there are other lesions in the bones throughout the entire body.
Laboratory Tests
Laboratory tests are frequently ordered when a neoplastic work-up is needed. A complete blood count (CBC) with differential, metabolic panel, serum protein electrophoresis (SPEP), urine protein electrophoresis (UPEP), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) tests is normally ordered when evaluating a tumor. Laboratory tests may verify the diagnosis of lymphoma, leukemia, multiple myeloma, or infection. A PPD skin test should also be placed to test for tuberculosis, which can mimic a spinal tumor.
Diagnosis
The diagnosis of a spine tumor may be postponed, primarily because the initial signs and symptoms are slight and physicians do not originally suspect it. Patients with "red flags" (symptoms suggesting infection or tumor, such as unrelenting pain, night pain, fevers, chills, night sweats, weight loss, etc) must be properly assessed with imaging and laboratory tests to prove the diagnosis.
Treatment Options
The treatment of a neoplasm of the cervical spine depends on a number of aspects: the patient's age and related medical conditions, the type, grade, and stage of the neoplasm, the severity of a patient's symptoms, and the severity of neurologic compression and bony damage. In contrast to the thoracolumbar spine, metastatic tumors of the cervical spine are more liable to cause instability and/or neurologic compromise and are more frequently treated surgically. Benign primary bone tumors are often treated by surgical tumor resection; however, some benign tumors may be treated conservatively and observed if there is nominal pain and there is no indication of spinal instability or neurologic compression. Malignant primary spine tumors are frequently treated by surgical resection and adjuvant chemotherapy and/or radiation. Surgical treatment often consists of neurologic decompression, fusion, and instrumentation in addition to tumor resection. An anterior or posterior surgical method, or at times a combined approach, may be used depending on where the tumor is positioned and where the neurologic compression is most prominent.
Information from Etna Interactive
