The term tumor refers to the presence of an abnormal mass of cells that form a pathological tissue within healthy tissue. When this neoformation grows in the context of the vertebral column, we speak of a spinal tumor.
The causes of spinal tumor
The tumors of the back can arise from lesions that develop in the vertebral column, from areas adjacent to the column itself or from localizations, by blood or lymphatic route, of malignant lesions born at a distance. Neoplasms of the spine are distinguished into primary and secondary tumors.
Primary tumors originate from the cells that make up the skeleton of the column itself (for example from cartilages or bone) while secondary or metastatic tumors originate from tissues of other organs (prostate, breast, kidney, lungs, lymphatic system, etc.) and grow in the spinal column.
The primary tumors of the spine are then distinguished as benign and malignant on the basis of their intrinsic characteristics of aggressiveness towards neighboring tissues or based on their ability to metastasize at a distance. By contrast, secondary tumors of the spine are by definition malignant and represent the tumor lesion most frequently observed by orthopedists.
Vertebral tumors can remain asymptomatic for a long time leading to an inevitable diagnostic and therapeutic delay.
When the symptoms manifest, they are usually the result of an expansion of the tumor mass beyond the bony limits with vertebral destruction and consequent vertebral instability, compression or invasion of the marrow and of the spinal roots.
The symptoms caused by a neoplasm of the vertebral column are many – one can find non-specific symptoms such as weight loss, generalized malaise, and fever, but more frequently the patient complains of pain localized at the site of the tumor.
The neoplastic pain is typically continuous, often occurs at night and responds little to common anti-inflammatory drugs and painkillers.
The computerized tomography (CT) is the best tool for the study of bone tissue and allows optimal visualization of the skeletal lesion. In the case of the tumor, this appears as an osteolytic lesion, which, in other words, affects and destroys the bone tissue.
In recent years a particularly effective method has been introduced in the diagnosis of tumors, positron emission tomography (PET), which identifies metabolically very active areas of the body, as in the case of neoplasms.
The final assessment is, however, the histological examination, performed after bone or soft tissue biopsy. The result allows distinguishing with absolute certainty the benign formations from the malignant ones, the primary tumor from the secondary ones
The treatment for spinal tumor
The tumors of the vertebral column are treated differently, depending on the type of tumor (primary or secondary), of its aggressiveness (benign or malignant) and of the histotype and, therefore, of its greater or lesser sensitivity to chemotherapy and to radiotherapy.
In principle, the concept holds that the tumor mass must be removed entirely. If this possibility is not feasible, instead of a therapeutic intervention, only palliative therapy can be planned.
Another fundamental aspect of the choice of the treatment of vertebral neoplasms is the presence of a pathological fracture with consequent vertebral instability. This condition, in addition to being very painful, is also dangerous as it increases the risk of compression and neurological damage. Therefore, faced with a fracture of this type, it is necessary to protect the patient with a suitable rigid or semi-rigid corset and, in some cases, it is necessary to opt for a vertebral stabilization surgical operation in order to to avoid the risk of neurological compression.
Surgery, therefore, plays a crucial role in the treatment of tumors of the spine. It aims fundamentally at restoring stability and removing the tumor mass. This last option, however, may, for purely anatomical reasons, be challenging because it is necessary to protect and preserve fundamental neighboring structures including spinal cord, nerve roots, large arterial and venous vessels.
There are several top orthopedic hospitals in India that carry out spinal tumor surgery. The most well known among these are Christian Medical College at Vellore and Fortis Memorial Research Institute at Gurgaon. Operation on the spine by best surgeons may cost about INR 4 lakhs, or USD 5,500 and chemotherapy may require an additional INR 6 lakhs or USD 8,300 for 3 cycles.
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