Spine Tumor Management

Our team’s focus is to provide prompt access to the latest and most advanced treatment options for patients. We aim to work hard at providing a timely and accurate diagnosis of your condition using a multidisciplinary approach with many if not all of the resources needed for treatment being located on the main campus. Using a multi-disciplinary approach, our goal is to create a personalized treatment plan that maximizes benefits and minimizes risks with the patient’s overall goals in mind. Maximizing a patient’s quality of life is given top priority and multiple factors are considered when trying to determine the best treatment plan or plans for a given patient.

What is a spine tumor?

Spine tumors are a mass of abnormal cells that exist within the bones of the spine and sacrum or within the spinal canal. Tumors can be either benign or malignant; benign tumors do not invade surrounding tissues or spread to other areas of the body. However, they can cause problems when they place pressure on surrounding tissues, such as the spinal cord or nerves. Malignant tumors can invade surrounding tissues, as well as spread to other parts of the body. Spine tumors can be life-threatening and cause permanent disability whether the tumor itself is cancerous or not.

Types of Spine Tumors

Spine tumors are classified as Extradural (outside the dural sac that surrounds the spinal cord) or Intradural (inside the dural sac that surrounds the spinal cord). Extradural tumors can be primary (Arising from the bone or nerve roots) or metastatic (Arising from another site and traveling to the bone). Intradural tumors are further classified as Intramedullary (within the spinal cord itself) or Extramedullary (outside the spinal cord but inside the dura).

Extradural Tumors Primary Nerve and Spinal cord

Spinal Cord Tumors

  • Anaplastic Astrocytoma
  • Dermoid
  • Epidermoid
  • Ependymoma
  • Glioblastoma
  • Lipoma
  • Myxopapillary
  • Ependymoma
  • Paraganglioma
  • Pilocytic Astrocytoma
  • Subependymoma

Nerve Root Tumors

  • Neurofibroma
  • Schwannoma

Dural Based Tumors

(tumors that begin in the tissue that forms the sack containing fluid around the spinal cord and brain)
  • Hemangiopericytoma
  • Meningioma

Primary Bone Tumors

can be benign or malignant. A biopsy is important to identify the typeof tumor and dictates that the appropriate treatment plan.

  • Aneurysmal Bone Cyst (ABC)
  • Angiosarcoma
  • Chordoma
  • Chondrosarcoma
  • Ewing Sarcoma
  • Fibrosarcoma
  • Giant Cell Tumor
  • Hemangioma (Atypical Hemangioma)
  • Hemangiopericytoma (Solitary Fibrous Tumor)
  • Malignant Peripheral
  • Nerve Sheath Tumor (MPNST)
  • Leiomyosarcoma
  • Osteoid Osteoma
  • Osteoblastoma
  • Osteosarcoma
  • Sarcoma

Metastatic Tumors

Start in other places in the body and travel to the spine. Treatment depends on where the tumor came from and how it affects the spine (if there is pain, numbness or weakness, etc.). A coordinated patient-centered multi-disciplinary care plan involving your Medical Oncologist, Radiation Oncologist, Palliative Care Provider, , and Spine Surgeon is essential to provide the highest level of care when treating a metastatic tumor.

The exact cause of spine tumors is unknown, but certain factors can contribute to your chances of developing these types of tumors. Risk factors include:

  • Radiation exposure
  • Family history
  • Prior history of cancer

SYMPTOMS

Symptoms can vary from patient to patient and are in general dependent on the size and location of a spine tumor. Most patients with spine tumors experience one or more of the following most common symptoms at some point in their disease course:

  • Pain (in the neck, back, arms, or legs)
  • Weakness
  • Numbness/tingling
  • Loss of sensitivity to pain, heat or cold
  • Incoordination of hands or feet
  • Difficulty walking or balancing
  • Loss of bowel or bladder control
  • Sexual problems
  • Muscle spasms
  • Back pain, sometimes radiating to your arms, feet, legs or hips

DIAGNOSIS

Whether diagnosed with a spine tumor or experiencing symptoms that suggest a spine tumor, a CT, MRI, PET scan, Bone scan and/or x-rays may be used to detect, diagnose, and determine the exact location and size of the spine tumor as well as determine the appropriate treatment options for a given patient. Imaging also helps to determine the health and stability of your spine, develop the most effective treatment plan, reduce the risk of complications from surgery and/or radiation therapy, as well as determine if a treatment is working.

  • Physical exam: This exam will have a strong focus on walking, muscle strength,
    sensation, reflexes, coordination, eye, vision, mouth movement, and alertness
  • MRI (Magnetic resonance imaging): An imaging technique that uses magnets and strong radio waves to take clear pictures of your spine to differentiate between a tumor and normal tissue.
  • CT scan (Computed tomography) : A CT scan can be helpful to show detailed images of your spine.
  • PET scans (Positron emission tomography) : PET scans allow your care team to identify an active, growing tumor in your spine by injecting a substance that highlights areas of increased activity and performing a CT to detect these areas.
  • Angiogram: A series of X-rays taken using a special dye, help your care team see yourtumor and the blood vessels that lead to it
  • MRA (Magnetic resonance angiography): A special type of MRI that is a less invasive alternative to an angiogram
  • Lumbar puncture (spinal tap): Removes a small amount of fluid that bathes your spinal cord so it can be tested

 

In many cases, a biopsy is necessary to identify and refine the diagnosis of a spine tumor. A biopsy is a procedure in which a small piece of the suspected spine tumor is removed for further examination by a pathologist under a microscope. This can be performed through a needle biopsy usually by our Neuro-radiologists, or can be performed surgically with an open biopsy. Different tests are performed on the suspected tissue to identify to diagnose the spine tumor. . In the majority of cases, the biopsy will guide the treatment plan in combination with a complete understanding of the patient’s condition including symptoms, patient goals, physical examination, imaging, and input from providers in other specialties. The pathologists

TREATMENT

Certain spine tumors are only observed, while others are treated with medications, radiation or surgery. In some cases, surgery may be the only treatment option that a patient will need to treat their spine tumor.

Goals of treatment can include:

  • Removing a small piece of tumor to determine what it is (open biopsy)
  • Relieving symptoms caused by compression through decompression of the spinal cord and/or nerves
  • Stabilizing a spine damaged by a tumor
  • Removing a portion of the tumor to make it safer to perform other treatments like radiation
  • Attempting to remove the tumor in its entirety

The type of treatment you may need depends upon:

  • Type of tumor
  • Size of the tumor
  • Location of the tumor
  • Whether the tumor can be fully removed
  • Whether your tumor can respond to other treatments

Radiation Therapy

Radiation therapy is a common treatment for patients with spine tumors and especially forpatients with spinal metastases. Radiation may be used as a primary treatment, or to treat a spinetumor after surgery. The type of radiation treatment recommended depends upon the stage andlocation of your tumor, and is usually determined by the radiation oncologist. Benefits ofradiation therapy include:
  • Stopping the growth, reducing or even eliminating the tumor
  • Treatment for pain
  • Relieving spinal cord compression or
  • As a treatment to allowing for easier surgical removal
  • Providing a non-invasive, outpatient treatment
Stereotactic Body radiation Therapy (SBRT) or stereotactic radiosurgery (SRS) is a very precisenon-surgical treatment that delivers high dose radiation to the tumor while reducing the radiationdosing to the normal (non-tumor) tissue/organs, blood vessels, and nerves surrounding thetumors. The diagnosis, size and location of the tumor, as well as prior tumor/treatment historyare taken together to form the best treatment plan for a given patient. SBRT/SRS is highly effective and some patients may only require a one treatment while others may require anywherefrom three to five treatment sessions.
Medical systemic therapies for spine tumors can include chemotherapy, immunotherapy,hormone therapy, targeted therapy, and/or therapies to protect your bones. Depending on the typeof tumor, systemic therapies can help control tumor growth and prevent further tumor spread,sometimes alone, or other times in addition to surgery and/or radiation therapy. Your medicaloncologist will help you decide which treatment options are best for you.

Surgical Treatment Options:

Vertebroplasty/ Kyphoplasty : Injection of cement into the bone to provide additional support orstabilize a broken vertebra. In a kyphoplasty, a balloon is inserted in to the bone, inflated in thebone to help create additional space for the cement and also provide additional height to acollapsed vertebra, and then removed before injecting cement into the space created.

Spinal Tumor Radiofrequency Ablation : Using small needle-like incision, a probe inserted into the bone into the center of your tumor andthen a high energy radiofrequency is used to heat and destroys tumor cells within the bone. Thisis most commonly performed to treat tumor-associated pain as well provides local control oftumor growth.

Percutaneous Instrumented Fusion: Through several small incisions, screws are placed into thevertebral bone using CT or x-rays and then a rod is connected to the screws to stabilize the spine.This procedure aims to limit the disruption of tissue, and provide greater stability to your spine.

Spinal Cord/Nerve Root Decompression : If a tumor is compressing the spinal cord or nerve roots, surgery can be performed to remove thetumor if necessary. Surgery can include removal of a part of the bone or the entire bone of yourspine to allow access to the tumor and removal. Successful decompression of the spinal cord maycreate adequate space between the tumor and spinal cord to relieve symptoms, and/or provideadditional safety for other treatments like radiation. Spine tumors can be removed throughsurgery in several ways, such as:If your surgical team can’t remove all of the tumor without harming your spine, they will takeout as much of the tumor as possible. This is called debulking surgery. Reducing the size of atumor through surgery can help lower the pressure on the spine and relieve some of yoursymptoms.

Stabilization: In cases where the bone is removed to access the tumor, it can either be put backinto place with the use of small screws and plates, or replaced with a prosthesis or graft. If yourspine is unstable from the tumor, or will become unstable through the surgical procedure toaccess the tumor, rods and screws can be used to stabilize your spine.

Intra-operative Neuro-monitoring: We also use in surgery technology to monitor yourneurologic function in order to reduce the risk of injury to your spinal cord.

Plastic surgeons are an integral part of the care team who assist in complex back operations anduse special techniques to provide the most cosmetic and high quality closure of the surgicalincision. The inclusion of plastic surgeons helps with a significant reduction in wound healingcomplications such as infection and opening of the wound, which allows a quicker return toadjuvant therapies such as radiation and chemotherapy.

Types of interventional pain management treatments include injections, intrathecal infusions,nerve blocks, radiofrequency ablations, and spinal cord stimulation.

We have a multi-disciplinary team to treat your spine tumor with specialists across the manymedical disciplines including:

  • Neurosurgeons and Orthopedic
  • Surgeons
  • Medical Oncologists
  • Radiation Oncologists
  • Palliative Care Providers
  • Plastic surgery
  • Anesthesiologists
  • Interventional Pain Providers
  • Neuro-radiologists
  • Physical Therapists
  • Nutritionists
  • Pathologists
  • Social Workers and Case Managers