by Paul Saiz, M.D.
Back pain has many faces and most problems of the spine are self-limiting and benign. In fact, 90% of low back pain, for example, will resolve without physician intervention. However, if back pain doesn’t go away, it’s important to obtain an accurate diagnosis so treatment can be initiated. The physician must be able to distinguish between normal degenerative processes, infections, muscular strains, nerve impingements and, finally, a spinal tumor. Thorough history taking in combination with a physical examination and diagnostic imaging, can allow the physician to make the correct diagnosis. If the bad news is there is a tumor involved, we have new advancements in the treatment of osteoporotic compression fractures along with improvements in instrumentation that allow us to treat spine tumors with better outcomes and with less risk.
Historically, treatment of spinal tumors has been difficult and often associated with poor outcomes. About 90% of people who die of cancer will HAVE spine involvement at autopsy. The location and complexity of the spine have made surgical intervention technically challenging. The skeleton is the third most common site of metastasis (spread from the original site of the cancer). The spine is the most common site of skeletal involvement. The most common cancers to affect the spine are usually spread from other organs in the body (lung, breast. prostate, thyroid and kidney) or tumors originating in the blood (myeloma and lymphoma). About ninety percent of people who die of cancer will spinal involvement at autopsy. Interestingly, only about half of these patients will report spine symptoms.
Our spine’s purpose is to facilitate motion (connect the arms to the legs), absorb stress and protect our nerve structures. Any degenerative or infectious process or tumor that compromises any of these functions puts us at risk for pain, instability or nerve damage. Our anatomy and location of other vital organs can make any treatment of the spine complicated.
The most common symptom of a spinal tumor is pain. However, back pain can be common. Fortunately, there are some clues that hint that the discomfort may be more than just arthritic pain. Pain due to a spinal tumor is typically sudden, not always made worse with activity and present at night. Depending on the extent of body destruction, one can also develop instability of the spine, fractures and nerve symptoms. Most patients already know they have cancer by the time Doctor’s identify that their spine is involved. However, 15% of the time physicians may diagnose a tumor in the spine and NOT know where it came from.
Once a pathologic process is suspected in the spine, it’s important to identify other sites of involvement such as the lung or liver. It’s also important to identify the source of the original cancer. Tests include a bone scan, MRI, CAT scan and x-rays. After the diagnostic imaging workup, a biopsy is obtained to verify the diagnosis.
Once the tumor is identified and confirmed, treatment varies depending on the type of the tumor, how many different sites in the body are involved and how much damage has already occurred to the spine. Chemotherapy, radiation treatment or surgery are options, including using these treatments in combination if necessary.
Surgical options vary from a wide, aggressive removal of the tumor and surrounding structures to simple stabilization of a vertebral body with “Kyphoplasty”. The option chosen often depends on the tumor and health of the patient. If symptomatic spinal metastases is present, less than 10% of patients receive surgical intervention.
The primary reason for the hesitancy towards surgery for tumor treatment is based on our experiences in the past. Remember, the spine is a complex anatomical structure. With the advances in surgical technique, newer instrumentation, better understanding of biomechanics, new technology (Kyphoplasty) and increased survival rates; there are more options now available for patients.
The aging process does cause degenerative changes in the spine. Rarely, there can be a cancer (tumor) of the spine. It’s important to recognize the differences between these problems and how to deal effectively with each set of symptoms and findings. For more information and treatment options for degenerative disease of the spine. As life expectancy increases and spine surgery advances, we have more options in treating pain, instability and nerve injury associated with cancer. Having spine cancer is no longer a disease without options.