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#15-03 Mt. Elizabeth Medical Centre
3 Mt. Elizabeth, Singapore 228510

Spine Tumors

A Reason for Back Pain, Numbness and Weakness

Introduction

Spine Tumors refers to tumors that grow in or around the spinal cord and nerves and can cause severe disability and even paralysis if undetected and untreated by damaging the spinal nervous system. According to Dr. Prem Pillay, a Senior Neurosurgeon & Spine Specialist based in Singapore, the number of people affected by these tumors is increasing because of better detection and also our aging population. These tumors can also affect children.

There are two categories of spine tumors. There are those that are benign and often slow growing such as Meningiomas, Neurofibromas/Schwannomas and Hemangiomas/Cavernomas and AVMs. These are often seen in adults and children and can sometimes reach a large size by the time symptoms appear and are recognized. Dr. Prem Pillay advocates early detection in order to increase the chance of a smaller tumor size at diagnosis. This could make treatment more effective and safer.

The second category of tumors are those that are more malignant. They either start in the spinal cord or come from elsewhere to that location. Someone who has breast or lung cancer can have spread of this cancer to the spinal location. This may cause the spinal vertebrae to weaken and be associated with painful fractures (Pathological fractures). Tumors that start in the spinal cord are often Gliomas including astrocytomas. They can be low grade meaning slow growing but there are also malignant versions the most serious of which is called Glioblastoma.

Diagnosis

Spine tumors can present with back pain, neck pain, middle back pain and loss of strength or feeling in the arms or legs or sometimes both. Other symptoms include numbness/tinging in the body or limbs (arms, hands, legs and feet). Loss of coordination of movements, loss of sensation of feeling including pain, loss of distinguishing between hot and cold on the body are other symptoms to note. However, again Dr. Pillay observes that neck and back pain is often from slipped discs or spine degeneration rather than a spine tumor. Evaluation of the problem by a qualified medical specialist can help in arriving at a diagnosis usually aide by the appropriate use of tests including MRI and CT (Computed Tomography).

He has observed that some patients resort to traditional treatments and massage without relief and come to their doctors quite late for treatment. If massage therapy of any kind cannot solve your problem within three sessions or makes it worse after the first session you should seek advice from a proper / real Spine Specialist, states Dr. Prem Pillay.

In order to confirm the diagnosis, useful tests include MRI of the brain and the spine. The MRI does not use radiation but a magnetic field to arrive at images that can clearly show the nervous system of the spine and any tumors. The size and location of tumors can be precisely determined. Advanced tests such as a PET scan may be done if cancer is suspected that may have spread to the spine. A biopsy may be needed to know the tumor type particularly if cancer is suspected and involves the spinal bones. This can either be done as part of the operation for tumor removal or using a needle. The needle type biopsies are now often computer and image guided meaning that MRI or CT technology is used for navigation and precision.

Modern Treatments

In the past the treatment modalities for spinal tumors in adults and children was often limited to the use of surgery alone often with attempts at radical removal with large openings. Modern surgery includes the use of high end neuro microscopes, Computer Guidance linked to MRI and CT scans, and finer tools for tumor removal. New generation laser systems and even superior to laser technology is now available for spine tumor treatment and removal. Reconstruction of the spine with modern materials, such as titanium, ceramics/PEEK to replace the vertebrae and maintain the spine canal and nerve openings can be done. Parts of the tumor that are difficult or risky to remove can be treated later by other modalities such as Radiosurgery.

According to Dr. Prem Pillay, radiosurgery has become a major and useful tool in the treatment of spine tumors. Radiosurgery uses precision and guided energy beams that penetrate painlessly and invisibly to the tumor site without needing an open operation. In the past there was the Gamma knife (not possible to treat most of the spine) but now there are a wider range of radiosurgery platforms including Tomotherapy, LINAC (linear accelerator) systems with micro-multileaf collimators for high precision and the ability to treat the spine. There are tumors that can be treated with radiosurgery alone without open surgery as the first step.

Malignant tumors may need several modalities of treatment including surgery, radiation and chemotherapy. There are also a new generation of anti-tumor biologics which have less side effects than conventional chemotherapy and can be used for malignant tumors including malignant astrocytomas and gliomas.

Conclusion

Although spine tumors can be dangerous and devastating in adults and children, Dr. Prem Pillay believes that earlier diagnosis and the use of technologically advanced tools and further research including microsurgery, robotics and radiosurgery is playing a role in saving many people from pain and disability throughout the world including Singapore.

Further information is available at: spine-neuro.org or by email at: clinicsg@yahoo.com or contact us by phone on (+65) 6835 4325.