Primary Spinal Tumors

Using advanced testing and biopsy techniques, only your doctor can properly diagnose a spinal tumor. However, back or neck pain that never goes away, wakes one up from sleep, or is present at rest are concerning features that deserve more investigation. Unintentional weight loss, new numbness, weakness, nerve pain, or change in bowel/bladder function are also signs that you should consult your doctor.

Only a specialist in spine oncology should treat a primary spine tumor. Fortunately, experts such as Dr. Colman understand that treating spinal tumors requires an experienced team of multi-disciplinary providers including surgeons, medical oncologists, radiation oncologists, radiologists, pathologists, and others. Dr. Colman meets regularly with his team as part of a “tumor board” to discuss challenging cases and optimize patient outcomes. Modern techniques in systemic medication, radiation, and surgery are combined to provide the best patient outcomes.

Chordoma

Chordoma is a rare, slow-growing malignant tumor that arises from remnants of an embryonic structure involved in the development of the spine called the notochord. These tumors most commonly occur in the sacrum, skull base, and less frequently in the cervical, thoracic, or lumbar spine. Chordomas are characterized by their locally aggressive nature and a tendency to infiltrate adjacent tissues, including bone and neural structures, which can complicate treatment. Symptoms vary based on the tumor’s location but often include pain, neurological deficits, or dysfunction of nearby organs. The primary treatment for chordoma involves complete surgical resection with the goal of achieving wide margins to reduce the risk of recurrence. This is often supplemented by radiation therapy, particularly proton beam therapy, which offers targeted radiation with minimal damage to surrounding tissues. Due to their complex location and resistance to conventional chemotherapy, chordomas require a multidisciplinary approach for effective management, emphasizing the importance of early detection and specialized care to improve outcomes and quality of life for patients.

Chondrosarcoma

Chondrosarcoma is a type of cancer that originates in the cartilage cells, typically occurring in the bones and soft tissues. It is the second most common type of primary bone cancer, predominantly affecting adults over the age of 40. Chondrosarcomas are generally slow-growing and may present with pain, swelling, or a palpable mass, although they can be more aggressive depending on the grade of the tumor. Treatment ideally involves complete surgical resection with a wide margin of normal tissue, since these tumors tend to be resistant to chemotherapy and radiation therapy.

Ewing Sarcoma

This is an aggressive malignant bone tumor that primarily affects children and adolescents, typically between the ages of 10 and 20. Ewing sarcoma in the spine is a rare and particularly challenging form given the critical structures and functions involved in this area. When it affects the spine, it can cause back pain along with neurological symptoms such as numbness, weakness, or even paralysis, depending on the tumor’s location and size. The tumor can compress the spinal cord or nerve roots, leading to significant complications. Treatment usually includes a multidisciplinary approach with chemotherapy to shrink the tumor, followed by surgery to remove it and possibly radiation therapy to target any remaining cancer cells. If the tumor can not be completely excised, definitive radiotherapy is often considered. Managing Ewing sarcoma in the spine requires careful planning to balance effective cancer treatment with the preservation of neurological function and structural stability of the spine.

Osteosarcoma

Osteosarcoma of the spine is an aggressive malignant form of bone cancer that presents unique clinical challenges due to the spine’s critical functions and complex anatomy. Osteosarcoma of the spine often manifests with back pain, which may be accompanied by neurological symptoms such as numbness, weakness, or extremity pain if the tumor compresses the spinal cord or nerve roots. Treatment for spinal osteosarcoma usually requires a multidisciplinary approach. Neoadjuvant (before surgery) chemotherapy is often administered initially to stop the tumor from growing, followed by surgical resection aimed at complete removal of the cancer while preserving as much spinal stability and function as possible. Given the spine’s delicate structure, surgical intervention can be complex, often necessitating the expertise of spinal oncologists such as Dr. Matthew Colman to minimize the risk of neurological damage and maintain structural integrity.

Intradural tumors

Intradural tumors of the spine are neoplasms located within the dural membrane that surrounds the spinal cord and nerve roots. These tumors can originate within the spinal cord itself or arise from the nerve roots or the surrounding meningeal tissues. Common types of intradural tumors include meningiomas, schwannomas, and ependymomas. Patients typically present with symptoms such as localized back pain, radicular pain radiating along the distribution of the affected nerves, sensory deficits, muscle weakness, and, in severe cases, bowel or bladder dysfunction. Treatment often involves surgical resection, which aims to remove the tumor while preserving neurological function. Depending on the tumor type and location, adjunctive therapies such as radiation or chemotherapy may be considered.

Benign primary spinal tumors

Although non-cancerous, some primary benign spinal tumors can be locally aggressive and are often treated similarly to malignancy using techniques of complete resection. The most common forms of these tumors include giant cell tumor of bone, osteoblastoma, and aneurysmal bone cyst. Other benign primary spinal tumors such as fibrous dysplasia, hemangioma, osteoid osteoma, and others may require no treatment or may be treated with minimally invasive techniques.