Tumours of the spine and the spinal cord: Malignant and benign forms with manifestations

A neoplastic disease, i.e. a tumour, can affect the spine, or any part of it ranging from the vertebrae, the intervertebral discs, the spinal cord and other nearby structures, as well as from the neck to the tailbone.

A tumour may originate and grow directly out of the spinal cord, or it may grow into the spine from the surrounding area. It may also be caused by another oncological disease which is metastatising.

metastasis = secondary tumour site which is separate from the primary tumour. 
to metastasise = to spread by blood, lymph or direct contact around the body. 

So, a tumour can be primary or secondary.

In connection with oncological diseases, we come across names such as tumour, neoplasm, or cancer and a number of specific names for tumours.

The following article provides a general overview of this broad issue: Are a tumour and cancer one and the same thing?

The exact cause of a tumourous growth is unclear.

The multifactorial influence of internal and external risk factors is also taken into account.

Internal influences include genetics or heredity, gender, race, age.

External influences include environmental pollution, poor lifestyle, diet, medication, smoking or alcohol and others.

The symptoms are diverse and depend, for example, on the type and size of the finding or its location. The course is also variable and different for each disease, although certain features of cancer are common.

The issue of treatment is complex and is greatly influenced by early detection, which increases the success of therapy.

The spine and the spinal cord

The spine is perfectly adapted to its numerous functions. An important example is the protection of the spinal cord. It forms a bone box that perfectly protects it from injury and environmental influences.

Spine = columna vertebralis. 
Spinal cord = medulla spinalis. 

The spine is composed of smaller bones called vertebrae. The individual sections are divided by shape, size and location.

Number of vertebrae = 33 to 34.

From this point of view, the spine is divided into individual sections:

1. the cervical section is composed of 7 cervical vertebrae - vertebrae Cervicales, designated as C1 to C7
   • it is attached to the skull by the first cervical vertebra C1 called the atlas
2. the thoracic section is composed of 12 thoracic vertebrae - vertebrae Thoracicae, Th1 to Th12
   • the thoracic vertebrae are connected to the ribs
     • they form the thorax and protect vital organs such as the heart or lungs
3. the lumbar section consists of 5 lumbar vertebrae - vertebrae Lumbales L1 to L5
   • has the most massive vertebrae and intervertebral discs
   • it withstands high pressures of everyday life
4. the sacral section consists of 5 to 6 sacral vertebrae - vertebrae Sacrales, S1 to S5 (S6)
   • together they form the os sacrum, i.e. the sacrum
   • it connects to the lumbar part with SI joints and forms the pelvis
5. the coccyx is composed of 4 to 5 coccygeal vertebrae, vertebrae Coccygeae Co1 - Co4 (Co5)
   • it has an important function in stability, posture and movement
   • there is more information in the article on coccydynia

One usually finds the above nomenclature and abbreviations in connection with the spine and back pain, or in medical documentation.

The spinal cord could be said to be a continuation of the brain.

It connects the central nervous system (CNS, i.e. the brain) and the rest of the body. Information from the periphery, that is, from the rest of the body outside the CNS, passes into the brain, where they are processed and evaluated.

The nerve impulses also run in both ways through the spinal cord to the appropriate parts. Therefore, it functions as a signal transmitter and a reflex as it carries signals to some important reflexes.

It runs from the first cervical vertebra C1 to approximately the second lumbar vertebra L2 in the spinal canal. The continuation of the spinal cord is a bundle of nerves which is referred to as the horse's tail, and therefore the cauda equina.

As the body grows, the spinal cord grows more slowly than the skeleton. 
It is about 40 to 50 centimeters long.
It is about 1 centimeter wide.
It weighs about 30 to 50 grams.

It is enveloped by the meninges or membranes of the spinal cord, just like the brain.

The meninges are:

1. dura mater spinalis - a thick membrane
2. arachnoidea spinalis - a spider web-like membrane
3. pia mater spinalis - a delicate membrane

The spinal cord contains white and gray matter.

White matter is on the surface. It functions as a relay, as it carries the nerve pathways up and down the body. White matter is divided into three funiculi or columns.

1. The anterior column carries signals from the brain to the body, the muscles. They are also called efferent - motor nerve fibres. They contain axons.

2. The posterior column carries signals from the receptors to the brain. They are also called afferent - sensory nerve fibres. They contain dendrites.

3. The lateral column contains both types.

The nerve cells or neurons of the grey matter or grey column are stored in the shape of the letter H, resembling a butterfly's wings. It consists of the anterior, posterior and lateral grey column.

The anterior grey columncontains motor neurons whose function is to move muscles. They carry nerve impulses to the muscles.
The lateral grey columns contain fibres of the autonomic or vegetative nervous system.
The posterior grey columns contain connective nerve fibres that carry information to the spinal cord and brain. They have a sensory function.

Through the centre of grey matter runs the central canal of the spinal cord - canalis centralis.

The spinal roots are divided into anterior and posterior roots. They converge to form the spinal nerve.
The anterior roots contain motor and posterior roots contain sensory fibers.

The spinal cord is divided into segments depending on which spinal nerves it contains. There are 31 pairs of spinal nerves, 8 pairs of cervical nerves, 12 pairs of thoracic nerves, 5 pairs of lumbar nerves, 5 pairs of sacral nerves and 1 pair of coccygeal nerves.

Abnormal pressure on the spinal roots or spinal nerves is described by a condition called radiculopathy or pinched nerve.

If you read on, you will find more interesting information about: 
spinal tumours 
and their cause 
about the symptoms of oncological diseases of the vertebral column. 
diagnosis and treatment options. 

Spinal tumours and spinal cord tumours

The spine and its surroundings contain a variety of tissues and structures: the nervous system, bones, soft tissues, lymphatic tissues and the thoracic or abdominal area.

This is a rather large region that can be affected by a number of tumourous growths. They can have a primary or a secondary character.

It is reported that 55% of all tumours are located outside the outer membrane of the spinal cord, i.e. above the dura mater.

These are mostly metastases of another oncological disease.

Primary tumours almost always form in the inner area under the thick membrane, i.e. the dura mater.
In up to 90% of cases, they are benign, i.e. non-cancerous.

Table: differentiation of tumours according to anatomical location

The incidence of spinal cord tumours is lower than the incidence of brain tumours.
They present about 15-20% of all CNS tumours.
The primary spinal cord tumour is reported to have an incidence of 1.1 in 100,000 inhabitants.

Why tumours grow is not clear.
The influence of several factors is assumed = multifactorial basis.
These factors are divided into external and internal.

Some external factors are:

• environmental impact
• pollution
• smoking
• alcohol
• diet
• overall lifestyle
• medication
• injury
• radiation
• chemicals
• viruses such as HPV and cervical cancer

Some internal factors are:

• genetic predisposition
• heredity
• obesity
• sex
• race
• age

In the primary type of spinal tumour, the tumour tissue grows directly from the spinal area. It can grow from the spinal cord, its membranes, spinal roots, vertebrae, as well as the surrounding soft tissues of the spine.

The secondary type of spinal tumour is caused by another oncological disease whose primary location is further away from the spine.

The primary location cannot be detected in approximately 10% of cases.

So, it is not a pathological outgrowth on the spine, but so-called metastases.
Tumourous cells can be transmitted by the bloodstream, lymph or directly - by contact, overgrowth.

The most common examples of metastases are those arising from breast, prostate, lung, kidney, bowel and rectal cancer, lymphoma, sarcoma (bone tumour, bone and soft tissue cancer) or brain tumours.

It is reported that the proportion of metastases is divided by the following percentages: 
70% in the chest area,
20% in the area of the sacral and lumbar area, 
10% in the cervical spine segment. 

Table: some types of spinal tumours

One of the first symptoms is...

Pain

The area of pain depends on the location of the tumour.
The pain can be local, as in tumours located outside of the spinal cord, but also diffuse and poorly demarcated.

Sufferers sometimes describes it as pain along side of the body.
However, the pain is similar to that of other causes of back problems.
The sufferer says that its is caused by heart or abdominal problems.

You may also want to read: vertebrogenic algic syndrome.

The pain may be of a stabbing, burning or stinging character.

The intensity of pain is usually high, especially in the case of a malignant, i.e. cancerous type. Intense pain in intradural tumours is more common.

The pain can be felt below the source of the injury.

In this case, radiating or radicular pain is also associated.

Pain radiates along the damaged spinal nerve on one side, i.e. unilaterally. Radicular pain almost always occurs in an intramedullary tumour type and thus in a tumour that originates directly from the spinal cord.

The spinal nerve or spinal cord can be damaged directly or as a result of pressure.

The pain may persist for a long time, up to several years prior the occurrence of radiating pain, muscle weakness or sensitivity. In other cases, it occurs acutely, lasting several minutes.

Other symptoms

The pain does not always occur isolated. It is accompanied by other unpleasant sensations. In some cases, the pain is even reported to occur as initial problems.

Examples are tingling or pricking sensations and similar symptoms called paresthesias. Motor impairment is usually associated only at a later stage.

Red flags

In the case of spinal pain with a possible occurrence of tumourous growth, so-called red flags, or alarming symptoms, are displayed.

Warning signs are:

• low back pain and back pain
• persistent pain
• feeling of tightness in the chest or abdomen
• increasing weakness and stiffness of the lower limbs
• walking deterioration and gait problems
• impaired sensitivity of both or one of the lower limbs
• impaired sensitivity of both or one of the upper limbs
• bladder emptying disorder - micturition (urination)
• defecating disorder - bowel movement
• sexual dysfunction, impotence, erectile dysfunction
• bolesť v noci, ľahu, ktorá budí zo spánku

Symptoms that may occur depending on the area of the spine

The epicone is part of the spinal cord just above its end part,
at the height of L1 = spinal cord segments L4 and S2. 
The cone is the end part of the spinal cord from which the cauda equina departs, 
at the height of L1 - L2 = spinal cord segments S3 and S5.

In oncological diseases of the back, the following symptoms are generally reported:

• pain in the back, sacral and lumbar area, between the shoulder blades or the neck
• persistent pain
• painkillers do not always work or alleviate it
• paresthesias or skin discomfort, such as tingling, numbness, burning, stinging of the skin and other sensations
• muscle weakness
• mobility disorders of the lower and upper limbs
• impaired gait
• muscle cramps
• pain radiating to the upper or lower limbs
• sensitization disorders on the skin, reduction or total lack thereof
• urinary and bowel incontinence, i.e. bowel disorders
• loss of ability to control limb muscles, paralysis
  • paresis - lighter degree, movement is impaired to varying degrees
  • plegia or paralysis - loss of motor function
• weakness
• severe and unexplained weight loss
• unnatural curvature of the spine 
• increase in body temperature
• sexual dysfunction
• pain and weakness of the whole body
• loss of reflexes
• indigestion due to impaired bowel function

In case of back pain, a professional examination is important.
This will reveal whether the problems in a certain area have a serious or less serious cause.

In diagnostics, medical history is important.

This is followed by a physical and neurological examination.
It is important to examine the spine, the posture and also the overall condition of the musculoskeletal system, even with regard to motor skills as well as the state of reflexes, muscle tension, muscle strength or sensory functions.

On this basis, it is not possible to clearly determine the cause.

Therefore, certain imaging techniques are used, such as:

• X-ray
• CT - computed tomography scan
• MRI - magnetic resonance imaging
• EEG - electroencephalogram

Collecting cerebrospinal fluid, blood for laboratory examination or biopsy is also used for differential diagnosis. An oncological disease may be mistaken for multiple sclerosis, spinal canal stenosis, disc herniation, abscess, or bone tuberculosis, for example.

The course of the disease depends on the type of disease. Pain is said to be one of the primary symptoms of spinal tumours.

The character and place of the pain depends on the location of the tumour. It can be local, or associated with radiating pain to other parts of the body or the limbs.

The pain is of a high intensity.

Pain is also associated with other problems, such as tingling, numbness, skin sensitivity. Therer are subsequent issues such as motor disorders, limb weakness, or impaired gait.

+ the rest of the symptoms is described under section with symptoms.

Problems occur below the level of the tumour. They can occur on one or both sides.

The severity of symptoms, whether benign or malignant, also depends on the rate of growth and how the surrounding tissue has been affected. The tumour may push against the spinal cord, nerves, blood vessels, other soft tissues or bone.

The severity is affected by several factors.
For example, the speed and extent of growth or the degree of restriction of cerebrospinal fluid and blood vessels.

In spinal metastases...

In this case, the pain may not be present until the first spinal problems occur. The primary problem may remain unobserved until then, as is the case with breast cancer, colon cancer or other cancers.

In this case, it is stated that there is a significantly abrupt onset. Spinal cord injury due to secondary tumour growth, or metastasis contribute to severity.

This condition mainly means there is absence of pain below the level of spinal cord injury, loss of sensitivity and motor skills in the area.

Paralysis may be mild or partial at first and then develops into the full form.
In about 5-10 percent of cases, the course of the disease is dramatic.