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Metastasis to Spine - What You should Know!

Spinal Metastasis Overview:

A spinal metastases is a vague term which can refer to the metastatic diseases to any of the following:

• Vertebral metastases (94%) may have an epidural extension.
• Intradural extramedullary metastases (5%)
• Intramedually metastates (1%)

Nearly 90% of all the spinal neoplasms (cord + vertebral) are considered as a metastatic in origin. Spinal metastasis is common in cancer patients. Following the lung and liver, spine is the third most common site for cancer cells to metastasis. Nearly 5 to 30 percent patients with systemic cancer will have spinal metastasis. This condition is more common in men than in women and adults in the age range of 40-65 years are more vulnerable to it. As per some studies, it is estimated that over 30-70% of patients with a primary tumor have the spinal metastatic disease at autopsy.

In this article, we’ll discuss about metastatic spine tumors, symptoms, diagnosis and treatments.

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Types of Spinal Cord Injuries

• 1.     Complete spinal cord injuries:
  
  It refers to the types of injuries which result in complete loss of function below the site of injury. This condition can result in complete paraplegia or tetraplegia.
• Complete paraplegia:
  It indicates the permanent loss of motor and nerve function at T1 level or below. This will result in loss of movement or sensation in the bowel, legs, bladder and sexual region. The arms and hands retain the normal function.
  
  Some people with this condition have a partial trunk movement which allows them to walk short distances with assistive equipments. In the majority of cases, the complete paraplegics opt for using a self-propelled wheelchair.
• Complete tetraplegia:
  It is characterized by the loss of hand and arm movement. Some tetraplegics require ventilator systems to assist breathing.
  
  Some of the tetraplegics may have the arm and hand movements depending upon the location of injury.
• 2.     Incomplete spinal cord injuries:
  
  This spinal cord injury is more common than the complete injuries and it refers to the types of injuries that result in some feeling and sensation loss below the point of injury. The degree and level of function in the incomplete injuries vary from individual to individual and is dependent completely on the way the spinal cord is damaged.
  
  Generally, the extent of an incomplete injury is determined after the spinal shock has been subsided that means it may take nearly six to eight weeks post injury. The spinal injuries will cause in some feeling but little or no movement or in some movement, but little or no feeling at all. The incomplete spinal injuries are further classified as:
• Anterior cord syndrome: It refers to the damage to the front of the spinal cord and result in impaired temperature, pain and touch sensations below the area of the injury. Some movement can be recovered later.
• Central cord syndrome: It indicates the damage in the center of the spinal cord which causes a loss in the function of arms and some leg movement. Some recovery is possible in this case.
• Posterior cord syndrome: It refers to damage to the back of the spinal cord, causing good muscle power, temperature sensation and pain but may cause poor coordination.
• Brown-Sequard syndrome: This indicates the damage to one side of the spinal cord, causing impaired loss of movement, but preserve the sensation on one side of the body or preserved movement and loss of sensation on the other side of the body.
• Cauda equine lesion: This refers to the injury of the nerves located between the first and second lumbar region of the spine that causes a partial or complete loss of sensation. In some cases, the nerves regrow and the function may be recovered.

Metastatic Spine Tumors:

A spine tumor is an abnormal growth of tissue found in or around the spinal column or cord. A spinal tumor is classified as follows:

• Primary tumors: The tumors, which originate in the spinal tissue are known as primary tumors. They can be either cancerous or non-cancerous. This type of spinal tumor occurs very rarely.
• Secondary tumors: The tumors, which spread to the spine due to cancer which originated elsewhere in the body, are called as secondary tumors. This type of tumor is cancerous and most common type of spinal tumor. More than 90% of the spinal tumors are metastatic, malignant or metastases tumors.

The tumors can grow within the spinal cord, in the vertebrae structures, within the dura (a protective covering around the spinal cord). However, the spinal cord tumors and within the dura i.e. the intradural tumors are rare.

Diagnosis and Treatment of Metastatic Spinal Tumor:

Diagnosis:

A variety of tests, including blood test, physical exam and imaging can help to diagnose a metastatic spinal tumor. A physical exam will include a review of physical and neurological symptoms of the patient and a detailed patient history.

Metastatic tumor imaging: Several imaging modalities are used to evaluate the patients with spinal tumors to determine its location and size. X-ray, Computed Tomography (CT scans) and Magnetic Resonance Imaging (MRI scans) are used to diagnose this condition.

Metastatic spinal tumor biopsy: A biopsy involves extracting a tissue sample from the tumor so that it is examined by a pathologist. In most cases, percutaneous needle biopsy is used to determine which treatment is suitable for the patient.

Treatment of Metastatic Spinal Tumor:

There are several considerations that must be examined to determine the best treatment for metastatic spinal tumor. The treatment plans for metastatic spinal tumor mainly focus on preserving and improving the quality life of a patient.

The goals of treatment for the metastatic spinal tumors are:

• Sedative treatments designed to optimize the quality of a patient’s life and minimize the pain and disability.
• Preserve the neurological function, correct the spinal instability, prevent fracture and improve the general functionality of the patient.
• Support the ongoing cancer treatment of the patient that will bring cancer into remisison.
• Shrink the spine tumor to decrease the burden of tumor.

Symptoms and Treatment of Metastatic Spinal Tumor:

Symptoms:

The most common symptoms of metastatic spinal tumor are back pain that gets worse at night or upon waking. Neurological symptoms like tingling or numbness in the legs or arms, weakness that occurs several weeks or months following the onset of back pain. Patients may experience a single symptom of combination of many symptoms. Some people with this condition do not have any symptoms at all. The metastatic spinal tumor pain tends to be severe. The types of pain caused by the spinal tumor include pain that shoots down the arm or leg and aching pain in the bones.

Next most common symptom of the metastatic spinal tumors is the neurological dysfunction, which includes numbness or weakness, tingling and impaired muscle control in the arms or legs.

Metastatic spinal tumor surgery:

The metastatic spinal tumor removal surgery is indicated for the patients who may benefit from the tumor removal. The surgical procedure will either lessen the severe symptoms related to the spinal tumor or will benefit from removing the cancer. There are two types of surgical procedures for treating the metastatic spinal tumors:

• Open surgery: It is an extensive surgical procedure that requires a larger incision for removing the spinal tumor.
• Minimally invasive surgery: It is a surgical approach that includes creating smaller incisions to remove the spinal tumors. This approach is commonly performed by the surgeons.

Earlier diagnosis and treatment of spinal tumor symptoms will give you better results. Treatments of this condition include a multidisciplinary team consisting of surgeons, medical oncologists, radiation oncologists, physiatrists, diagnostic and interventional radiologists. The medical team at Spine and Neuro Hospital India work closely with the patient and manage individual cases to cosordinate better treatment options.

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