Spinal Tumors
There are two types of tumorigenesis in the spine. The first is the primary tumors of the spine originating from bone, soft tissue (muscle and ligaments), and nerve tissue. In other words, the tumor originates directly from the spine itself. The second type which constitute the majority of the spine tumors, are tumors coming from other parts of the body and settled in this region, that is, metastasized. Metastatic tumors are often tumors originating from internal organs such as the lung, breast, prostate, kidney, and thyroid, or bone marrow such as multiple myeloma.
The first symptom of spine tumors is often pain. It may occur as low back, back, or neck pain. The pain is usually continuous and blunt and it does not decrease through rest. Night pain, weakness, loss of appetite, and weight loss may be together with low back pain. Pain, numbness, loss of sensation, or loss of strength may occur in the arms and legs if the tumor is of nerve origin or if it is not of nerve origin but compresses the nerve. Patients who are late for treatment may encounter severe conditions such as urinary and fecal incontinence and even paralysis.
The patient may have general cancer symptoms other than pain. Loss of appetite and weight loss may be the first signs. Pain may occur later in some patients, and the tumor may remain asymptomatic in the spine for a long time. Imaging (x-ray, tomography and MRI) and laboratory findings are used for diagnosis. In cases where metastasis is considered to occur, PET and scintigraphy methods are used to detect tumor foci in other parts of the body.
The next step is to determine the pathological type of the tumor, that is, to name it, in order to make the most accurate treatment of the tumor. For this purpose, needle biopsy is performed under local anesthesia by a spine surgeon or an interventional radiologist. However, in some special cases, a piece of the tumor is taken with a surgical method called open biopsy.
The type of tumor and how sensitive it is to drug or radiation therapy (chemotherapy, radiotherapy) are very important when deciding on the treatment of existing cancer. In primary tumors of the spine, that is, tumors originating from the spine, the aim is to destroy the entire tumor, if possible, and not leave a tumor behind. Primary tumors are often surgically removed, and chemotherapy and/or radiotherapy are administered if the tumor is sensitive. The surgical technique is based on the complete removal of the tumor and the filling of the remaining cavity with metal mesh and immobilizing it with screws and metal rods.
In metastatic tumors, that is, in tumors that have come to the spine from elsewhere, since the tumor has already spread to the surrounding area the goal is to shrink the tumor as much as possible without causing fracture and nerve damage in the spine. Depending on the type of tumor, this is done with chemotherapy, radiotherapy or a surgical method.
In some cases, the patient's tumor may not respond to radiotherapy/chemotherapy and the general condition of the patient may not allow major surgical procedures. In such cases, relatively limited and minimally invasive procedures such as vertebroplasty, i.e. cementing, can be performed to reduce pain and prevent fracture formation.