Diagnosing Spinal Cord Tumors
The spinal cord is a column of nerves encased in the middle of the spine; the spinal cord and brain make up the central nervous system. The spinal cord carries signals between your brain and your body that allow you to move and to feel hot and cold temperatures, vibrations, and pain. It also regulates processes such as blood pressure, digestion, and heart rate.
Spinal cord tumors, which are growths that begin in and around the spinal cord, are relatively rare. Most grow slowly and are unlikely to spread, or metastasize, to other parts of the body. But even benign, or noncancerous, spinal cord tumors can interfere with nerve function, especially if they compress or invade nerve tissue within the spinal cord or the nerve roots that branch off it.
Signs and Symptoms
Back or neck pain is usually the first symptom of a spinal cord tumor. Some people experience sharp pain only when they walk. This can occur when a soft tumor replaces solid bone in the spine, which can make the spine unstable.
Others experience severe back pain at night or when they wake up, and their pain decreases after they move around. This may indicate that the tumor has spread, causing inflammation in and around the spine.
Depending on the location and size of a spinal cord tumor, symptoms may also include numbness and tingling in the arms and legs, muscle weakness, balance and coordination problems, and a loss of bladder or bowel control. Some people become less sensitive to pain and temperature.
In children, spinal cord tumors can lead to scoliosis, an abnormal curvature of the spine, or other spine conditions. Without treatment, these tumors can cause permanent disability and, in some instances, paralysis.
Most spinal cord tumors arise in adults, but some, such as astrocytomas, are more common in children. The cause of a spinal cord tumor is usually unknown, although some inherited conditions, such as neurofibromatosis or von Hippel–Lindau disease, may cause benign tumors to grow throughout the central nervous system.
At NYU Langone, doctors assess your symptoms, take a comprehensive medical history, and perform a variety of diagnostic tests to identify spinal cord tumors.
During a neurological exam, the doctor asks you to describe symptoms such as pain, numbness, tingling, and weakness and when they began. The doctor may also check your reflexes, muscle strength, vision, coordination, and balance. In addition, the doctor may insert a gloved finger into the anus to examine rectal muscle tone, which can be weakened by a tumor that affects muscles and coordination.
An MRI scan is the most reliable method of diagnosing spinal cord tumors, although additional tests are needed to confirm the type of tumor. MRI is also useful in identifying spinal cord compression, which occurs when a tumor presses against the nerves within the spinal cord.
This imaging test uses a magnetic field, radio waves, and a computer to produce detailed, three-dimensional pictures of the spinal cord and other soft tissues in and around the spine, including nerve roots and growths.
Before the procedure starts, your doctor may give you a contrast agent through an injection into a vein to enhance these images.
Magnetic Resonance Spectroscopy Scan
A magnetic resonance spectroscopy (MRS) scan resembles an MRI scan, except it measures the chemical changes in the spinal cord that may indicate the presence of a tumor. MRS scanning creates a detailed image that can help the doctor determine the type of tumor, based on its chemical components.
Magnetic Resonance Perfusion Scan
Sometimes the doctor may use a test known as a magnetic resonance perfusion, or MR perfusion, scan to determine if a tumor is growing slowly or quickly. In this procedure, the doctor injects a contrast dye into a vein. Then he or she performs an MRI scan.
Unlike a conventional MRI scan, which looks for the presence of a tumor, an MR perfusion scan can detect how much blood has entered the spine and tumor. This indicates how the tumor is growing, which can help to determine the best location to perform a biopsy.
Myelography is an imaging technique used to look for spinal cord compression or inflammation when an MRI scan can’t be performed—for instance, if you have a pacemaker or if you recently had MR perfusion using a metallic contrast material.
In myelography, a radiologist first injects a local anesthetic in the back before injecting a contrast dye into the spinal fluid cavity to enhance the image. The radiologist then takes a CT scan, which uses X-rays to make a detailed picture of bony structures in the area where the tumor is located.
The image reveals the outline of the tumor and can help in planning treatments such as surgery or radiation therapy.
Doctors may perform spinal angiography to examine the blood vessels leading to and from a spinal cord tumor, such as a hemangioblastoma. Information about the size and number of blood vessels involved is helpful in preventing excessive blood loss during surgery.
During this test, performed using anesthesia, the doctor inserts a thin, flexible tube, called a catheter, into an artery in the leg. A contrast dye is delivered through the catheter, and a technician takes pictures of the blood flow with a three-dimensional fluoroscope, which is similar to an X-ray.
After determining the diagnosis using the results of these tests, our doctors work to eliminate as much of the tumor as possible and offer treatments to relieve symptoms such as pain, weakness, numbness, and impaired bladder or bowel control.
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