Spinal tumours-Symptoms and diagnosis

Spinal tumours may be rare, but they can cause severe symptoms and disabilities. The diagnosis of spinal tumours can be quite delayed at times. The symptoms depend upon the site of origin of tumour within the spinal canal. These tumours can easily be diagnosed with an MRI scan of the suspected level of spine.

Spinal tumours are relatively infrequent tumours. But they cause a lot of disabilities and functional impairment, which may be out of proportion to the size of the tumour depending upon the location of the tumour. 

Spinal tumours can be broadly classified depending upon the location of the tumour, into cervical spine tumours, Dorsal spine tumours, Lumbar spine tumours and Sacral tumours. 

These tumours are also classified based upon their relation to the Duramater or Dura, which is the outermost layer covering the nerves and spinal cord. The duramater is located inside the bony, Central canal. The other important word in understanding this classification is  medulla,  which refers to the spinal cord. So based on this concept, the tumours can be classified as:

Extra-dural or tumours that occur outside the dura. These are mostly metastases,  or tumours which come to spine after originating from some other part of the body.

Intra-dural tumours or Spinal cord tumours occur on the inside of the Duramater. These are further divided into Intra-dural extra-medullary or IDEM tumours which occur outside the spinal cord, and Intra-medullary tumours or IM tumours which occur within the spinal cord. 

This way of classifying the tumour is important because it tells us a lot about the type or nature of tumour, best treatment, and long term outlook after treatment. 

What are the symptoms of spinal tumours?

Symptoms of spinal tumours depend upon the site of spine of tumour and the location of tumour in relation to the duramater. Spinal tumours may present with varied symptoms in different combinations.

Pain is one of the commonest complaints in spine tumours. The pain may be because of local destructive process arising from pain sensitive structures like duramater or because of compression of nerves. In tumours located outside the duramater, pain is the most common symptom. Pain is localised, made worse by all movements, is not relieved by rest and is often worst at night. 

Pain from compression of the nerves goes down into the limbs along with the nerves. Pain is usually sharp and shooting in nature. Pain gets worse with walking or exertion. Pain at night prevents sound sleep and gets worse with time. Sometimes pain may be in form of a band like sensation over the torso. 

Tingling or other abnormal sensation– Tumours can produce a lot of abnormal sensations like tingling, ‘Cotton wool’ sensations, pins and needles, and even loss of sensations . 

Difficulty in walking is another very common complaint in patients with spinal tumour. The difficulty in walking can be because of muscle weakness, stiffness or loss of sensations caused by damage of nerve fibres that transmit position and orientation sensations of the body. That is why repeated falls are also very common in such tumours. 

Urinary bladder or bowel symptoms are also very frequent in these patients. The symptoms occur more frequently in tumours within the spinal cord. The symptoms may cause spontaneous passage of urine called Urinary incontinence, incomplete evacuation of urine, need to pass urine at short intervals, inability to hold urine for longer periods and  sometimes even complete inability to pass urine.

How is a diagnosis of spinal tumour made?

You should definitely visit a doctor if you experience more than one of the symptoms mentioned above or if problems are progressing. The most important part of making the correct diagnosis is a good clinical examination, by which a doctor have some provisional diagnosis in mind and will order tests accordingly. 

Magnetic Resonance imaging or MRI is the best modality for imaging of spine. MRI produces three dimensional images of body structures and tissues using magnets and computer algorithms. An MRI can easily show the spinal cord, nerve roots, as well as the tumours. It can also specify the location and nature of the tumour as well MRI also provides valuable data for the surgeon to plan the surgery. Contrast injection may be required to delineate the tumour more clearly.

Computerised Tomography or CT scans are more useful to delineate the bony elements of the spine. Is is helpful in tumours with involve the bone and when spinal instability is suspected because of destruction of bone from the tumour. CT Myelography is a modality, in which CT scan is done after injecting contrast into the cerebrospinal fluid or CSF through a lumbar puncture. This is helpful for patients in whom MRI can not be done, like patients with a cardiac pacemaker. 

PET CT scan is a special kind of CT scan which is usually done in cancer patients to look for the extent of spread of the disease. It gives the location of all the tumour deposits from the primary site of origin. It is helpful in spinal metastasis and planning for surgery, as  any major spine surgery in cancer patients is advisable if the likely survival is more than six months. CT may also be used to take a biopsy from the extradural tumours in order to confirm the diagnosis and rule out an infection like tuberculosis. 

X-rays are not very useful nowadays and were used in the past to look for indirect signs of spinal tumours like erosion of part of spinal vertebra in benign lesions like Neurofibroma. Now X-rays are used only to assess stability and alignment of the spine. 

What other tests may be required in patients with Spinal tumours symptoms?

Besides the above mentioned tests to diagnose the spinal tumours, doctor may also order some tests to assess the damage and ascertain the likely reversibility of damage to end organs. 

Pulmonary function tests is to determine the functional impairment of respiratory system in cervical spine tumours. This is done to look for functional reserve as ventilator may be required for patients with cervical spine tumours and significant impairment of respiratory reserves.

Urodynamics study may be required for urinary system impairment pre-operatively and may guide therapy directed towards better rehabilitation following surgery. 

What are the  causes of Spinal tumours?

In most of the cases, no underlying condition can be found. However, certain conditions are linked to increased occurrence of spinal tumours. 

Neurofibromatosis is a hereditary disorder which is associated with increased occurrence of tumours related to the nerves. These are more common in the type 2 variant of the disease. The tumours are mostly Neurofibromas or Meningiomas, which occur as intra-dural extra medullary tumours. 

Von Hippel-Lindau disease or VHL is another rare, multi-system disorder with increased occurrence of tumours with very high blood flow called Hemangioblastomas in the brain, retina and spinal cord.

Previous history of cancer is associated with increased risk of spinal metastases, as spine may get involved with disease in a variety of tumours, especially lung, breast, prostate and Multiple myeloma.  

About the author– Dr. Harnarayan Singh is a Neurosurgeon practising in Gurugram, India.

Disclaimer- This article is meant for only general public awareness and education. The text can not substitute expert medical advice. Please consult your doctor if you experience these symptoms.