Thursday, August 13, 2020

Brain & Spine Disorders

Benign Tumors of the Spine

Doctors use the term benign to indicate that a particular tumor or a cancer is usually easy to control and that the patient is unlikely to die from this type of cancer. This is different from malignant cancers, which are more likely to spread, more difficult to control, and can be much more deadly.  The most common benign tumors of the spine are: 

Osteoid OsteomasOsteoid Osteomas
Osteoid osteomas are a benign (meaning relatively well-behaved and easy to treat) type of a cancer that has a unique tendency to affect the posterior part of the vertebra during adolescence. It accounts for about 10% of all bone tumors involving the spine. It typically presents as unrelenting pain, clearly worse at night, which is exceedingly sensitive to aspirin or Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) like Ibuprofen. It may be difficult to see on a plain x-rays, but a bone scan is highly diagnostic. Treatment options include prolonged management with NSAIDs until the lesion eventually "burns out," surgical excision, and a new treatment method using radio-frequency ablation. With surgery or ablation, pain relief is rapid and recurrence is rare.

Osteoblastomas are bigger versions of osteoid osteomas, and by definition, are greater than 2.0 cm in diameter. They also have the tendency to affect the posterior part of the spine and present with pain. They tend to be more aggressive and usually require surgical resection. Recurrence rates are higher than those seen with osteoid osteomas, meaning that they can come back in the same place about 10% of the time.

 Aneurysmal Bone CystsAneurysmal Bone Cysts
Aneurysmal bone cysts are uncommon benign tumors that may affect the posterior elements of the spine or the vertebral body itself. These tumors tend to affect older adolescents, presenting with pain and in some cases, neurological symptoms. The cause is poorly understood. The recommended treatment is excision and curettage of the lesion and decompression of the spinal elements when needed.

 Giant Cell TumorsGiant Cell Tumors
Giant cell tumors are poorly understood. They tend to affect the vertebral body (front of the spine), and despite being technically "benign," they can be very aggressive and sometimes spread elsewhere. The most common age is between 20-40 years old, but this is variable. Treatment is generally surgical, with en-bloc (complete) resection as the preferred choice. There are some instances where radiation and pre-operative immobilization of the tumor will improve the surgical risk and outcome. These tumors require careful pre-operative planning and a team approach before the initial surgical procedure.

Eosinophilic Granuloma
An eosinophilic granuloma is a benign lesion of bone that will present with pain and the characteristic radiographic finding of "vertebra plana," a collapse or flattening of the vertebral body. These tumors may occur by themselves, or as part of a syndrome involving multiple bones and other organs. Treatment decisions are highly individualized with no clear consensus on the "best" method of treatment. Many of these tumors can be managed without surgery, or in certain cases, low dose radiation.

Enchondromas are benign tumors made of cartilage. They have the potential to enlarge to the point of impinging on the spinal canal or neural elements. When symptomatic, the recommended treatment is surgical excision. There is a rare incidence of these tumors changing to a low-grade malignant cartilage tumor known as a chondrosarcoma. This is fortunately quite rare, but a rapid increase in size may warrant biopsy of the lesion.

A hemangioma is a benign tumor that can involve the body of the vertebra. This tumor is often found in the lower thoracic or upper lumbar spine, usually involving only a single vertebra. Interestingly, not all hemangiomas produce symptoms such as pain. Hemangiomas typically occur during mid-life, affecting females more often than males.

The most common symptom associated with a hemangioma is pain. This is typically the result of a large hemangioma involving the entire vertebral body. Hemangiomas may be discovered as part of an evaluation for back pain. They have a very characteristic appearance on regular x-rays, referred to as " honeycombing." There may also be a varying degree of collapse and loss of vertebral height with extensive involvement. When the collapse is severe, impingement on the spinal cord or neural elements will produce severe pain and loss of function in the legs, bowel or bladder.

There are a number of treatment options for vertebral hemangioma, ranging from observation to radiation to surgical resection. Treatment decisions are based upon the severity of symptoms or neurologic compromise. The management of a vertebral hemangioma must take into account the generous blood supply of the lesion, and requires careful planning by the surgeon involved in your care before surgical treatment is recommended.

With all benign spinal tumors, complete resection is the goal.  Dr. Aryan, in conjunction with Dr. Christopher Ames at UC San Francisco, has helped develop new surgical techniques to completely remove tumors that were once thought to be inoperable.

Tumors of the Spine

Spine Disorders

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