Spinal tumor is the tumor developed in the bone tissue, ligament and surrounding soft tissues. Myeloma develops in the spinal cord or in the dura. To provide clearer information, the term “spinal tumor” containing the both tumor types will be used. Spinal tumors have an important plane in neurosurgery practice due to severe disability/death rate and obtaining positive results in case of early diagnosis and suitable treatment methods. Success rate of the treatment has increased thanks to diagnosis opportunities in line with technological development and development of surgical techniques (in particular microsurgery).

About 10% to 25% of central nervous system tumors are spinal tumors. Classifying spinal tumors according to their locations provides convenience in the diagnosis and treatment. Therefore, the relation of the tumors with dura should be taken into account in the classification. According to this, spinal tumors are classified as extradural (out of dura), intradural extramedullary (in the dura but out of spinal cord) and intramedullary (in the spinal cord). The most common symptoms of spinal tumors is the pain in the related area of the spine and radiating upwards or downwards. The pain arises especially at night and may increase with physical activity. In the event that the tumor is caused directly by the spinal cord or the tumor caused by the spine compresses the spinal cord, spinal compression findings may be observed. These vary depending on the location of the compression. Findings such as numbness in arms, legs and chest, power loss in hand, arm and legs and difficulty in walking may be observed. Diagnosis of the spinal tumors starts with medical history and physical examination. The patient may have previous or current cancer history. If your physician suspects of tumor, he may request some imaging examinations such as x-ray, tomography and MRI. Sometimes, scintigraphy or PET/CT may be requested to determined whether there is involvement in other areas of the body. If the tumor is determined with imaging methods, the second step is to carry out biopsy to determine type and source of the tumor. This procedure is generally carried out under local anesthesia with needle or trocar biopsy by spinal surgeons or interventional radiology specialists. In that case, open biopsy may be preferred. If source and type of the tumor can be revealed with biopsy, it will help to determine the next treatment. Surgical treatment of spinal tumors is to remove the tumor in part or in whole. This decision should be taken by the physician. While making the decision, the surgeon takes type of the tumor, metastasis, malignancy-benignity, sensitivity to chemo-radiotherapy, neurological risk rate and expected life time into account. By evaluating these criteria, risk-benefit rate and other possible treatment options shall be provided to the patient. By evaluating the destruction of the tumor itself or surgery in the spine and developed abnormal mobility, it may be required to fix the spine with metal implants (instrumentation/plaque/screw application). These interventions can be carried out in the front or back of the spine, or sometimes at both sides. In some benign tumors, just the part containing tumor is scraped and removed and remaining cavity is filled with bones or bone cement. In malignant tumors, the tissue with tumor is dissected as a wide part, and metallic fixation-instrumentation is applied to the spine. In addition, metal cage filled with bone is placed into the front of the removed spine. In metastatic tumors, the vertebra with tumor can be filled with bone cement or it can be removed and instrumentation-cage procedure can be applied.

After the surgery, hospitalization may take 3 to 10 days and it may be required to apply physical medicine and rehabilitation for a while. Period of hospitalization may vary depending on the requirement and period of physical therapy, and opportunity of applying the therapy at home. For some tumors, chemotherapy or radiotherapy may be applied after surgery. Application of these treatments may affect total recovery period. Non-surgical treatment methods include observation chemotherapy and radiation. Benign tumors which do not have significant symptoms and aggressive metastasis can be followed with imaging methods (generally MRI) taken often. In addition malignant primary spinal tumors or their metastasis can be sensitive to chemotherapy or radiotherapy. In this type of tumors, chemotherapy or radiotherapy may be primary treatment methods. When malignant tumors caused by the spine itself are detected, generally surgical treatment is preferred. The aim is to distract malignant tumors from the area. If primary malignant or metastatic tumors cause progressive neurological loss or loss of fecal-urinary control in short time, surgical treatment may be required. Surgical treatment may be required to fix the damaged vertebra in patients having a tumor destructing the spine strength and, accordingly, abnormal spine movement. Another condition requiring surgery is the sensitivity of the tumor to chemotherapy or radiotherapy and that the tumor does not respond to these treatments. Surgical treatment of spinal tumors is to remove the tumor in part or in whole. This decision should be taken by the physician. While making the decision, the surgeon takes type of the tumor, metastasis, malignancy-benignity, sensitivity to chemo-radiotherapy, neurological risk rate and expected life time into account. By evaluating these criteria, risk-benefit rate and other possible treatment options shall be provided to the you. By evaluating the destruction of the tumor itself or surgery in the spine and developed abnormal mobility, it may be required to fix the spine with metal implants (instrumentation). These interventions can be carried out in the front or back of the spine, or sometimes at both sides. In some benign tumors, just the part containing tumor is scraped and removed and remaining cavity is filled with bones or cement. In malignant tumors, the tissue with tumor is dissected as a wide part, and metallic fixation-instrumentation is applied to the spine. In addition, metal cage filled with bone is placed into the front of the removed spine. In metastatic tumors, the vertebra with tumor can be filled with cement or it can be removed and instrumentation-cage procedure can be applied.