Tumors of the spine are predominantly diagnosed as metastatic deposits of a range of malignant diseases, including breast, lung, prostate, kidney, GI tract and thyroid cancer [1] [2]. In fact, up to 97% of spinal neoplasms are secondary tumors, whereas numerous benign and malignant (chordomas, osteosarcomas, multiple myelomas, lymphomas) primary spinal tumors are rare clinical entities [1] [3]. Neoplasms can develop at virtually any location in the spine, and studies have shown variable data regarding the age of onset [1] [3] [4]. Primary tumors are more commonly reported in the pediatric population [4], while metastatic spinal neoplasms are diagnosed in late adulthood [1] [3] [5]. In terms of clinical presentation, localized pain is the hallmark of a spinal neoplasm [1] [4] [5] and the pain is usually gradual in onset and becomes particularly unpleasant at night. Many patients report that the pain becomes constant later [1] [4]. The pathogenesis of pain involves several theories, including pathological fractures, nerve damage, and cortical expansion as a result of bone remodeling [1] [4]. Additional symptoms that might be encountered in spinal neoplasms are waist and back pain, a kyphotic posture if a fracture has occurred, as well as aggravation of symptoms during standing or walking, fever, weight loss, and associated neurologic complaints [1] [5].

• Back Pain

  Symptoms Back pain (new onset back pain is most common presenting symptom) Worse at rest, lying supine May awaken patient at night Later changes Weakness (75%) Autonomic or sensory symptoms (50%) Urinary Incontinence VII. [fpnotebook.com]

  Lumbar disc disorders and low-back pain: Socioeconomic factors and consequences. J Bone Joint Surg Am. 2006;88 Suppl 2:21. Patel AT, Ogle AA. Diagnosis and management of acute low back pain. [cancercarewny.com]

  Valsalva maneuvers, such as coughing, sneezing, or straining, may exacerbate radicular back pain from cord compression, but this occurs with other causes of mechanical back pain as well. [emedicine.medscape.com]

  He was seen in clinic shortly after discharge with complaints of severe back pain and right sided weakness. MRI of the spine was ordered. [theassr.org]

  The following symptoms and signs may suggest spinal tumors: Progressive, unexplained, or nocturnal back or radicular pain Segmental neurologic deficits Unexplained neurologic deficits referable to the spinal cord or nerve roots Unexplained back pain in [merckmanuals.com]

• Leg Weakness

  Emergence of leg weakness, paresthesias in the lower extremities, and/or bowel or bladder dysfunction in patients with a history of cancer should evoke immediate concern for cord compression. [emedicine.medscape.com]

  Two weeks after radiation to T8 lesion, her back pain got worsened too intolerable to opioid and her leg weakness progressed to grade 2-3. [omicsonline.org]

• Spine Pain

  The type of pain can provide important information about the tumor. Pain mainly when you sit or stand usually means that the tumor is causing weakness or instability in the bones of your spine. [mskcc.org]

• Urinary Hesitancy

  Paraplegia and bowel or bladder disturbances (eg, constipation, urinary hesitancy, retention, incontinence) are usually late findings except in conus medullaris syndrome, in which sphincter dysfunction and saddle anesthesia may emerge early in the course [emedicine.medscape.com]

• Urinary Retention

  Intramedullary spinal teratoma presenting with urinary retention: Case report and review of the literature. Neurosurgery. 1999;45:379-385. Krupp LB, Banwell B, Tenembaum S, et al. [appliedradiology.com]

• Abnormal Reflex

  Neurological deficits secondary to compression of the spinal cord or nerve roots also can be part of the presentation: The degree of neurological compromise can vary from slight weakness or an abnormal reflex to complete paraplegia, depending on the degree [patient.info]

The diagnosis of a spinal neoplasm may be difficult to attain without an obvious clinical presentation, which is why physicians must conduct a thorough physical examination and obtain a detailed patient history in order to raise clinical suspicion. The patient's age, history of malignant disease, and both the course and progression of symptoms should be covered during the patient interview [1] [4] [5]. Imaging studies, however, are the cornerstone for achieving the diagnosis of a spinal neoplasm, with plain radiography being a useful initial method, as up to 80% of benign and 40% of metastatic tumors can be seen on spinal X-rays [1]. Because of its limited efficacy, it is now considered as a useful adjunct to more superior studies, primarily computed tomography (CT) and magnetic resonance imaging (MRI) [1] [4] [6]. These two procedures are able to identify the exact location of the tumor, define the extent of local tissue destruction, and provide key information for obtaining a biopsy sample, which is vital for determining the exact tumor type [1] [5] [6]. In addition to CT and MRI, bone scintigraphy and positron emission tomography (PET) are also regarded as potentially useful tools in the diagnostic workup of spinal neoplasms [1].

Treatment for children is usually different than treatment for adults. (See the PDQ summary on Adult Central Nervous System Tumors Treatment for more information about the treatment of adults.) [cancer.gov]

Side effects of treatment in children Children can have long term side effects after treatment for a spinal tumour. The more severe the symptoms of weakness or paralysis before treatment, the more likely these may carry on after treatment. [cancerresearchuk.org]

Your radiotherapy team use this scan to plan your treatment. At the beginning of each treatment session, you lie in the same position but under the radiotherapy machine. The treatment itself only takes a few minutes. [macmillan.org.uk]

We have rehabilitation and pain management experts ready to assist you after treatment. We can help you with the pain, numbness, weakness, and loss of mobility that may result from a spine tumor or its treatment. [mskcc.org]

"Treatment patterns of children with spine and spinal cord tumors: national outcomes and review of the literature". Childs Nerv Syst. 33 (8): 1357–1365. doi : 10.1007/s00381-017-3433-y. [en.wikipedia.org]

Key message: Ependymomas are a group of CNS tumours with moderately good prognosis, though higher grade tumours have slightly poorer survival. The prognosis for spinal ependymomas is better than that for cerebral tumours. [ncin.org.uk]

- Metastatic Tumors of the spine: - carcinoma of the breast, kidney, or multiple myeloma may have relatively good long term prognosis; - metastatic carcinoma of the prostate or lung may have poor 1 year survival; - patients w/ combination of spinal [wheelessonline.com]

However, plans of care must factor account for prognosis and medical co-morbidities for maximal improvement in outcomes. DOI: https://doi.org/10.5430/cns.v1n2p14 Refbacks There are currently no refbacks. [sciedupress.com]

Diffuse astrocytomas are generally faster growing than ependymomas and typically have a worse prognosis. [pmj.bmj.com]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

If there is no focal cord expansion or considerable mass effect, non-neoplastic etiologies should be considered first. Cysts can be tumoral or nontumoral. [appliedradiology.com]

The prevailing patterns of care and neurosurgical challenges in the treatment of spinal tumors are best determined by local epidemiological data in conjunction with wider population based analyses. [scitechnol.com]

Epidemiology Epidural Spinal Cord Compression occurs in 5% of cancer patients III. Causes: Benign Primary spinal tumors IV. Causes: Malignant Primary spinal tumors Sarcoma Multiple Myeloma (most common in adults) V. [fpnotebook.com]

Epidemiology Frequency United States Metastatic lesions that involve the spinal cord affect about 5-10% of patients with cancer. [3] Approximately 15% of all primary CNS lesions arise from the spinal cord, with an estimated incidence rate of 0.5-2.5 cases [emedicine.medscape.com]

Generalizability was enhanced by a multicenter, international group of oncologists who reviewed cases that represented the established epidemiological profile of metastatic spine disease. [ro-journal.biomedcentral.com]

Pathophysiology Metastatic spinal cord compression usually follows hematogenous dissemination of malignant cells to the vertebral bodies, with subsequent expansion into the epidural space. [emedicine.medscape.com]

High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults. [cancercarewny.com]

[…] most common primary tumor of spine) - chordoma - osteosarcoma - hemangioma - giant cell tumor of bone : sacrum; - eosinophilic granuloma - produces vertebra plana on lateral x-ray; - observe unless it causes a deficit - low dose xrt may be helpful to prevent [wheelessonline.com]

Corticosteroids to prevent spinal cord compression Excision, radiation therapy, or both If patients have neurologic deficits due to spinal cord compression, corticosteroids (eg, dexamethasone 100 mg IV, then 10 mg orally 4 times a day) are begun immediately [merckmanuals.com]

1. Ciftdemir M, Kaya M, Selcuk E, Yalniz E. Tumors of the spine. World J Orthop. 2016;7(2):109-116.
2. Choi D, Crockard A, Bunger C, Harms J, Kawahara N, Mazel C, Melcher R, Tomita K. Review of metastatic spine tumour classification and indications for surgery: the consensus statement of the Global Spine Tumour Study Group. Eur Spine J. 2010;19:215–222.
3. Clarke MJ, Mendel E, Vrionis FD. Primary spine tumors: diagnosis and treatment. Cancer Control. 2014;21(2):114-123.
4. Kelley SP, Ashford RU, Rao AS, Dickson RA. Primary bone tumours of the spine: a 42-year survey from the Leeds Regional Bone Tumour Registry. Eur Spine J. 2007;16(3):405-409.
5. Slipman CW, Patel RK, Botwin K, et al. Epidemiology of spine tumors presenting to musculoskeletal physiatrists. Arch Phys Med Rehabil. 2003;84(4):492-495.
6. Patnaik S, Jyotsnarani Y, Uppin SG, Susarla R. Imaging features of primary tumors of the spine: A pictorial essay. Indian J Radiol Imaging. 2016;26(2):279-289.