Spinal neoplasms are rare in clinical practice, and more than 95% are recognized as metastatic tumors. A gradual onset of localized pain that is often present during the night and at rest is the typical symptom. The diagnosis can be made through imaging studies, such as computed tomography, magnetic resonance imaging, and bone scintigraphy. In addition, a biopsy is necessary to confirm the underlying subtype and assist in determining the tumor stage.
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  . 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  . Neoplasms can develop at virtually any location in the spine, and studies have shown variable data regarding the age of onset   . Primary tumors are more commonly reported in the pediatric population , while metastatic spinal neoplasms are diagnosed in late adulthood   . In terms of clinical presentation, localized pain is the hallmark of a spinal neoplasm    and the pain is usually gradual in onset and becomes particularly unpleasant at night. Many patients report that the pain becomes constant later  . The pathogenesis of pain involves several theories, including pathological fractures, nerve damage, and cortical expansion as a result of bone remodeling  . 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  .
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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 [symptoma.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]
References: Acute low back pain. EBSCO DynaMed website. Available at: . Updated November 22, 2013. Accessed November 26, 2013. Bratton RL. Assessment and management of acute low back pain. Am Fam Physician. 1999;60:2299-2309. Chronic low back pain. [cancercarewny.com]
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]
Pain mainly when you sit or stand usually means that the tumor is causing weakness or instability in the bones of your spine. Pain primarily at night or in the early morning that gets better as you move is often the first symptom of a tumor. [mskcc.org]
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   . 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 . 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)   . 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   . 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 .
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