Spine tumors account for approximately 6% to 10% of bone tumors in the body. Almost all types of bone tumors can be seen in the spine, such as osteosarcoma, osteoid osteoma, and aneurysmal bone cysts, while metastatic bone tumors account for more than half of spine tumors. What are the symptoms of spinal tumors?
Clinical appearance of spinal tumors
Due to the lack of characteristic clinical manifestations in the early stage of spinal tumor, it is difficult to be detected in the early stage, which is prone to misdiagnosis and leakage. Most patients with spinal tumors are often in the middle and late stages when they are diagnosed, which makes treatment difficult and affects the therapeutic effect. Early diagnosis and treatment of spinal tumors has a significant impact on the outcome and prognosis of patients.
Whether primary or metastatic spine tumors, the typical clinical manifestations are local pain, neurological dysfunction, local masses or spinal deformities. Asymptomatic spinal tumors are usually detected only during physical examination.
1.Pain
Pain is the most common and main symptom of spinal tumor patients. 80%-95% of primary spinal tumors have pain as the first and sometimes the only symptom at the time of diagnosis. The possible mechanisms of pain caused by spinal tumor include: infiltration and destruction of bone (especially expansion of periosteum), compression of bone lesion tissue, pathological fracture, instability of spinal vertebral joints, compression and erosion of spinal cord, nerve roots or plexus, etc.
Depending on the nature of the tumor and the site of occurrence, the time and nature of pain occurrence also differ. In terms of the time of pain onset, pain can occur months or years before the spinal tumor is confirmed, with benign spinal tumors generally having a longer duration of pain, which can be months or even years.
In contrast, malignant spinal tumors, such as osteogenic sarcoma, Ewing’s sarcoma or bone metastases, have a relatively short history of pain, but if the benign tumor forms compression on the spinal cord or nerve roots at an early stage, the pain occurs in a relatively short period of time.
Nocturnal pain is a characteristic manifestation of almost all spinal tumors and is equally common in patients with spinal tumors. The reasons for this are mainly due to.
(1) Patients usually adopt a recumbent position at night, where venous pressure is relatively high, and the peripheral nerves around the tumor are stimulated.
(2) At night, patients with spinal tumors have relatively higher mental attention and become more sensitive to pain.
(3) Some inflammatory mediators released by the tumor form stimulation to the nerves and so on. Patients coughing, sneezing, exertion or other actions that increase intra-abdominal pressure may induce pain aggravation.
2.Mass
Since most of the spinal bone tumors occur in the vertebral body, which is located deeper and difficult to be found on the body surface, it is not common to see patients with mass as the first manifestation, mainly in tumors of the cervical spine or posterior attachment structures of the spine. The masses of malignant tumors of the spine grow faster and often form pressure on the surrounding tissues, so they often have local pain and discomfort. Metastatic spinal tumors are often detected before the formation of larger masses due to the presence of the primary lesion and the fact that metastatic tumors are generally more malignant and grow more rapidly, which can easily induce spinal pain and neurological symptoms.
3.Deformity
Spinal deformity caused by spinal tumors is not uncommon. The main mechanisms include: destruction of vertebral body and/or accessories by tumors; spastic response of peri-spinal tissues and extrusion of surrounding structures by large size of tumors. For example, osteoid osteoma can often appear as a lateral convex deformity concave to the side of the lesion, and the apex of its lateral bending is mostly the site where the lesion is located.
4.Nerve dysfunction
Spinal nerve compression can be caused by direct invasion of the tumor itself, or secondary to deformation caused by the destruction of bony structures by the tumor. Since spinal tumor is mainly located in vertebral body, it often compresses cone bundle or anterior horn cells from the front, therefore, it is often manifested as motor function impairment first, and its clinical symptoms vary depending on the degree and location of spinal nerve compression, such as anterior horn syndrome, posterior horn syndrome and spinal cord hemisection syndrome.
5.Systemic symptoms of spinal tumor
The systemic symptoms of early spinal tumor patients are not obvious, and the appearance of systemic symptoms is usually the late manifestation of primary malignant tumor and metastatic tumor patients, and anemia, emaciation, hypothermia and weakness are the clinical manifestations of cachexia.