Spinal Tumors

A spine tumor is a benign or malignant tumor that appears anywhere in the spine. Usually, we see tumors in the thoracic (middle of the back) and lumbar (lower back) regions. Within the spinal column, tumors typically appear in one of your vertebrae, the bones that make up your spine. Tumors can be primary, when they originate in the spine itself, or secondary, when it starts elsewhere and migrates to your spine. Spine tumors rarely affect the intervertebral disc.

Risk factors for spine tumors include advanced age, personal or family history of cancer, and smoking. If you have a history of cancer and experience pain or weakness in your spine, or if you are older, smoke, or have a family history of cancer, you should see your doctor to check for a spine tumor. Children with a distinct, focused pain in their spine also need to be examined.

Typically, a spine tumor causes pain in the spine itself. You can feel pain in your cervical (neck), thoracic (middle of the back), or lumbar spine (lower back). Tumors can also cause pain, numbness, or weakness in your arms or legs by pressing on the nerves of your spinal cord. Unlike the pain associated with degenerative disc disease, you usually feel pain from a spine tumor while you are resting at night, and often in the middle of your back.

You can prevent some tumors by maintaining a healthy lifestyle. We do not know a lot about preventing spine tumors. Early detection of a spine tumor is the best known step to successful treatment.

Diagnosis and Treatment

When you arrive at Mount Sinai, a spine tumor specialist will conduct a thorough physical examination to diagnose your condition and evaluate your level of urgency. Weakness is a typical a sign of urgency, and if that is the case, we usually recommend a magnetic resonance imaging (MRI) and possibly surgery or other treatments. We can sometimes treat pain and numbness by more conservative means.

We may need to gather additional information by performing a diagnosticspinal angiography to better assess the blood vessels of the tumor itself and determine whether it is an abnormal development in blood vessels in the spine instead of a traditional spine tumor.

If your doctor detects a tumor, our spine tumor team will evaluate the extent to which the tumor has spread. A team of surgeons, cerebrovascular surgeons, oncologists, radiation specialists, and rehabilitation specialists will then formulate your treatment plan. Treatment can consist of surgery, radiation, chemotherapy, or some combination of these modalities. Typically, we also use pain medications, steroids, and physical therapy. We focus on treating the tumor as effectively as possible, while improving your quality of life and allowing you to maintain your normal function.

Tumors often compromise your spine. We may use metal instruments, such as screws and rods, to stabilize your spine. We take into account your overall medical condition when developing a treatment plan. We may also provide one or more pre-operative embolization sessions to help reduce the vascularity of the tumor in preparation for successful spinal surgery.

Whether we use a minimally invasive procedure or traditional "open" surgery depends upon the location of your tumor, your symptoms, and your MRI findings. At Mount Sinai, we use minimally invasive techniques for many of our spine tumor surgeries. These techniques are well-tolerated and allow for a quicker recovery time than open surgery. The most common procedures are:

• Fusion involves stabilizing any vertebrae (bones of the spine) that are "unstable" (have too much abnormal motion). We usually do this by implanting titanium screws and rods through either an "open" or minimally invasive procedure.
• Instrumentation is the process of implanting metal screws and rods into your spine to stabilize it. We usually use titanium, which allows patients to safely undergo postoperative MRIs if needed.
• Laminectomy is the removal of bone, ligament, or disc to allow access to a spine tumor. We can perform a laminectomy through "open" or minimally invasive techniques.
• Minimally invasive diskectomy/fusion refers to procedures done through smaller incisions, with a shorter hospital stay, less post-operative pain, and quicker recovery. It is not appropriate in every case or for every patient.
• Combination minimally invasive surgery and radiation or chemotherapy can be tailored to the particular tumor of the spine, either metastatic or primary. When appropriate, we may also perform resection of the tumor.
• Sacrectomy is a technically challenging surgery to remove the last bone of the spine (sacrum) in an effort to cure certain aggressive types of tumors.
• Vertebrectomy/corpectomy is the surgical removal of the vertebra (bone) that contains the spine tumor.