Low back pain usually resolves 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 typical degenerative processes, muscular strains, nerve impingements, infections, and finally, a spinal tumor. Through a thorough evaluation including physical examination and diagnostic imaging, the physician can acquire enough information to efficiently make the correct diagnosis. In the rare event that there is a tumor involved, our latest techniques allow us to treat spine tumors with better results and less risk.
Historically, treatment of spinal tumors has been universally associated with a poor outcome. 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 have spinal involvement at autopsy. Interestingly, only about half of these patients will report spine symptoms.
The main function of the spine is to facilitate motion, absorb stress and protect our nerve structures. Any degenerative, infection, or tumor that compromises any of these functions usually leads to pain, spinal instability or nerve compression. The anatomy and location of other vital organs can make any treatment of the spine complicated.
The most common symptom of a spinal tumor is severe localized pain. However, back pain is common as we age. Fortunately, there are some clues that hint that the discomfort may be more than just the typical arthritic type of pain. Spinal tumor pain is often sudden in its occurrence, not always made worse with activity. It commonly wakes patients up at night and is often worse at night. Unexplained weight loss is also a warning sign of tumor. Depending on the extent of bony destruction, one can develop instability of the spine, fractures and nerve symptoms.
Most patients with a spine tumor have an underlying cancer of the breast, lung or prostate. However, as many as 15% of those may have metastatic disease but not know of the underlying cause. Once a pathologic process is suspected in the spine, it's important to identify whether it is from another area of the body, or whether it started in the spine. Other common sites of involvement include the lung or liver. Tests include blood work, bone scan, MRI, CAT scan and x-rays. After the diagnostic imaging workup, a biopsy is obtained to verify the diagnosis.
Once the precise diagnosis confirmed at biopsy, 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 cement. The option chosen often depends on the type of tumor and health of the patient. If symptomatic spinal metastatic disease is present, less than 10% of patients need surgical intervention.
The primary reason for the hesitancy towards surgery for spine 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, and increased survival rates, there are more options now available for patients.
One of the new options available for the treatment of spinal tumor is kyphoplasty. This procedure is done through 2 small 1/4 inch incisions through the skin. A small hollow tube is placed into the involved vertebra allowing for a balloon tipped catheter to be inserted. Once the balloon is within the vertebral body, it is inflated to restore the height of the vertebra that collapses due to tumor destruction of the bone. The balloon is then removed, and cement is placed into the vertebra. The cement hardens within minutes providing immediate stabilization to the vertebrae. The surgery takes approximately 30 minutes per level, and the patient is able to return home after an overnight stay in the hospital.
The benefits of kyphoplasty are tremendous. The patient may be up walking right after surgery. Also, the spinal tumor pain is gone immediately. Patients that have been wheelchair bound because of spinal tumor pain are able to begin physical therapy to strengthen back and leg muscles. There are no restrictions after the surgery and normal activities may be resumed.
Fortunately, spinal tumor is an uncommon cause of back pain. However, it is important to recognize the symptoms of tumor. 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.