Nearly 24,000 malignant tumors of the brain or nervous system are diagnosed each year. Tumors of the spine may affect the bones, ligaments, muscle, tendons, and nerves leading to severe disability, including pain or paralysis, or potentially even death.
At Yale Medicine, we understand the landscape of evidence-based medicine, with tools such as our spine registry that allows us to assess treatment results and help improve patient outcomes. Our neurosurgeons use advanced surgical techniques and technology to provide comprehensive care for patients with spinal tumors, enabling us to provide a higher level of care than what is available in other community hospitals.
“We treat each patient as if they were in our family. I would never offer surgery or treatment to a patient that I would not readily give to myself or a loved one,” says Joseph Cheng, MD, MS, Professor of Neurosurgery at Yale School of Medicine, and Director of the Neurosurgery Spine Fellowship program at Yale.
What are the types of spinal tumors?
Primary spinal tumors are growths that start inside the spine. They can be either inside the spinal cord, off of a nerve route, in the cartilage of the spinal column, or in the dura, which is the lining around the spinal cord.They may be any type of tumor, including leukemia, lymphoma, or myeloma.
Secondary tumors are those cancers that started somewhere else (usually the breast, prostate or lung) and then metastasized, or spread, to the spine.
What are the symptoms of spinal tumors?
While symptoms vary, they usually involve pain of some sort. For some patients, that can mean:
- Back pain that is either specific to a certain area (axial pain) or shooting or traveling pain (radiant pain)
- Musculoskeletal pain from pinched nerves or sciatica
- Neuropathic pain, which can include numbness, weakness, twitching, and loss of control
- Difficulty with urination (incontinence)
- Spinal deformities
Those symptoms, of course, can also point to many other conditions. Still, if they persist or worsen, tell your physician immediately—especially if you have a history of cancer.
What are the risk factors for spinal tumors?
Because so many spinal tumors are metastatic—meaning they start somewhere else in the body—patients who already have primary tumors are at higher risk of developing spinal tumors.
Smokers already have a higher risk of lung cancer. A significant percentage of them can have a metastatic tumor in the spine.
How are spinal tumors diagnosed?
Neurosurgeons at Yale Medicine will begin by taking a patient’s history, performing a physical exam, and then performing a series of tests to get a clear image of the spine.
Our specialists may order tests such as a spinal magnetic resonance imaging (MRI) scan, which can produce an adequate image, especially if we take an image with intravenous gadolinium, which lights up some tumors so we can see them better. If more detail is needed, we can also do a computerized tomography (CT) scan or a spinal X-ray.
Sometimes to determine the best treatment options for the patient, which may include things such as radiation, chemotherapy, surgery, or a combination of these, a biopsy of the spinal tumor may be performed.
How are spinal tumors treated?
For primary spinal tumors, which tend to be found around the spinal cord, within the spinal cord, or in the spinal canal—the cavity that runs through the vertebrae to hold the spinal cord—we can usually perform surgery to get the best possible outcome for the patient.
Surgeons will perform a resection, a procedure that removes and destroys the tumor. We are often able to get a total resection and that patient is cured. There may be no need if a tumor can be totally resected for radiation or chemotherapy, which target tumor cells and kill them or slow their growth. In order to treat metastatic tumors, our doctors consider many variables. If the tumor has not weakened the spine, we can bypass surgery and treat it with targeted radiation called stereotactic radiosurgery or chemotherapy.
We will choose to operate if the patient is suffering from neurological compression, which means the tumor is pinching the spinal cord or nerve. The compression can cause instability, where the tumor has weakened the bone, causing a fracture or spinal deformity, where the tumor has impaired the spine to the point where it develops a scoliosis or abnormal curvature. In addition to relieving the nerve or spinal cord compression within the spine, the Yale Medicine neurosurgeon may need to reconstruct the spine with bone graft and hardware to allow the patient to carry their body weight through the area of surgery.
After the surgery, oncologists can treat the patients with chemotherapy or radiation, which will each be more effective now that the pressure on the spine has been relieved.
What is recovery like?
The typical hospital stay, post spinal surgery, can range from two days to two weeks.
Rehabilitation and physical therapy are often a key part of recovery, especially if a tumor has already caused nerve damage that may persist after treatment. This is in addition to follow-up treatments with radiation and chemotherapy.
What makes Yale Medicine's approach to spinal tumors unique?
Our team is made up of medical oncologists, neuro-oncologists, radiation oncologists, orthopedic surgeons, neurosurgeons, and neurologists.
The team works together to develop the best treatment for each patient, from the cellular level to the extended family.