The neck pain and numbness that plague office workers…it may be a tumor, not a disc

 Mr. Park, in his 50s, thought nothing of the neck pain and numbness that had continued for more than a year. He assumed it was muscle pain in the neck from long hours at the computer. When his symptoms recently worsened he visited a family medicine clinic, where he was advised to see a specialty hospital because a cervical disc herniation was suspected.  

He eventually went to a spine and joint hospital, and the results were unexpected. After detailed imaging, Park was diagnosed not with a disc herniation but with a spinal cord tumor. A tumor had formed inside the dura within the spinal canal and was compressing the spinal cord. Fortunately the tumor was at an early stage, and after having it removed surgically at the hospital, Park is now focusing on his recovery.

Spinal cord tumors are a relatively rare condition, occurring in about 2 to 4 people per 100,000 population each year. They usually appear in people in their 40s and 50s, and the exact cause has yet to be identified.  

Symptoms vary widely by subtype

Spinal cord tumors are divided into various types. By location they are classified as ▶extradural tumors ▶intradural extramedullary tumors ▶intramedullary tumors. Extradural tumors, which account for a large share of cases, are literally tumors that arise outside the dura. They are characterized by weakness and paralysis of the arms and legs developing over a few hours or days. Intradural extramedullary tumors develop between the inside of the dura and the outside of the spinal cord parenchyma, and cause asymmetric nerve root pain or sensory abnormalities. Intramedullary tumors, which arise within the spinal cord, cause abnormal sensation along with motor impairment, sensory impairment and urinary dysfunction.

Subtypes also differ by the type of cell involved. Extradural tumors are in most cases metastases from cancer elsewhere in the body. Among intradural extramedullary tumors, schwannomas arising from the nerve sheath surrounding peripheral nerves and meningiomas arising from the meninges surrounding the spinal cord together account for about 70% of all types. Intramedullary tumors, meanwhile, are classified as ependymomas, astrocytomas, hemangioblastomas and others.

For a primary spinal cord tumor, complete resection comes first

If left untreated, a spinal cord tumor aggravates nerve damage and worsens symptoms. It is therefore important to see a doctor for diagnosis and treatment as early as possible. At the hospital, the diagnosis is made through neurological examinations of sensation, muscle strength, balance, coordination, vision and hearing, together with imaging studies. If a metastatic tumor is suspected, a whole-body PET-CT scan is also performed.

Treatment differs according to the location and type of the tumor and the degree of nerve compression. For benign and primary spinal cord tumors, complete resection by surgery is the first consideration. Extradural spinal tumors can usually be removed by laminectomy. For intradural extramedullary tumors such as neurofibromas, however, complete removal requires cutting the nerve root.

In some cases only part of the tumor is removed, or radiation therapy is used. Metastatic tumors in particular are often distributed across several sites, making complete resection of every tumor difficult. In such cases the tumor lesions contributing to nerve compression are partially removed, and chemotherapy and radiation therapy are then considered together.

Yoon, Kangjun, President of St. Peter's Hospital, said, “Because spinal cord tumors arise where major nerves of the body run, the precision of the surgery has a great effect on the prognosis.” He added, “When choosing a hospital, it is important to look carefully at the spinal surgery experience and capability of the medical team, whether the latest equipment is available, and the systems in place for collaborative care and patient management.”