Thoracic & Lumbar Spinal Tumours

The spinal cord stretches from the base of your brain, through the backbone, to your lower back. A spinal cord tumour is an uncontrolled growth of tissue that develops within the spinal cord or surrounding bones, and can be cancerous (malignant), spreading to other parts of the body or noncancerous (benign), remaining as a stationary lump. Spinal cord tumours are classified based on their location in relation to the three protective layers surrounding the spinal cord. Two main types of spinal cord tumours include:

• Intramedullary tumours: found in the nerve cells within the spinal cord
• Extramedullary tumours: develop from the cells supporting the spinal cord

Causes of spinal cord tumours are not very clear. They may be inherited, caused due to a genetic defect or may occur due to exposure to certain chemicals. Tumours from various other parts of the body can also spread to the spinal cord. All types of spinal tumours can cause complications due to the proximity of the spinal cord and nerves.

Symptoms

Symptoms of spinal cord tumours vary based on the type and location of the tumour and may include:

• Back pain radiating to various parts of your body
• Reduced sensitivity to pain, heat and cold
• Reduced or loss of sensation in your arms and legs
• Weakness of muscles in different parts of your body and/or twitching
• Loss of bowel movement and bladder function

Diagnosis and Treatment Options

Spinal tumours are difficult to diagnose due to the similarity of symptoms to other conditions. When you present with the above symptoms, your doctor thoroughly reviews your medical history and performs a complete physical and neurological examination. Imaging tests such as MRI and CT scans, and biopsy (examination of a small tissue extracted from the spinal cord) are confirmatory tests that may be ordered to locate the exact position of your tumour and determine the type of tumour.

Treatment for spinal cord tumour is aimed at complete destruction of the tumour and is based on your age, overall health and type of tumour. Some of the treatment options include:

• Monitoring: Your doctor suggests frequent monitoring of your spinal tumour if it is diagnosed at a very early stage, even before the development of symptoms. This is indicated for the elderly, in whom surgical treatments can pose severe health risks.

• Surgery: The surgical removal of the tumour is most often the treatment of choice. Tumour excision is performed using high-powered microscopes, while monitoring the functioning of the surrounding nerves and blood vessels in order to reduce the risk of damage to these tissues. Your surgeon may use high-frequency sound waves to first breakdown the tumour into fragments, which can then be easily excised. However, if your tumour cannot be removed completely, surgery will be combined with radiation and/or chemotherapy.

• Radiation therapy: High energy radiation is used to destroy remnants of spinal tumours after surgery, for those that cannot be treated with surgery or metastatic cancers that have spread from other parts of your body to the spinal cord. Stereotactic radiosurgery (SRS) is a technique where a high dose of radiation is precisely targeted on a tumour to treat it. Radiation treatment may cause side effects such as nausea and vomiting.

• Chemotherapy: This treatment involves the use of drugs to destroy the tumour cells or restrict their growth. Chemotherapy can also be used in combination with radiation therapy. It may pose side effects such as nausea, fatigue and hair loss.

Recovery

Your back will most likely feel stiff or sore for a period of time and you may find it hard to sit still for long periods. It might also be difficult to lift and bend without causing pain. Pain medication helps to relieve the pain.

Recovery differs between patients and surgeries. As a general guide recovery may include the following:

• Five to seven days in hospital
• No heavy lifting for the first few weeks or so (and graduated lifting restrictions thereafter)
• Some time off work in order to recover
• You may need to return to work on restricted duties for a period of time
• You may not be able to drive for 4 to 6 weeks
• No swimming for 4 to 6 weeks
• Physiotherapy
• Pain medication
• Rehabilitation depending on the surgery
• A back brace is sometimes required
• You may need to meet with an Occupational Therapist