Neck pain is the most common presenting symptom of patients with a cervical spine tumor. Patients often have unrelenting pain, as well as night pain, that is not relieved by rest or traditional measures. Patients may have neck stiffness and decreased range-of-motion. Patients may have weakness or numbness if the tumor is advanced and causing neurologic compression or irritation. In addition, patients may have constitutional symptoms such as low-grade fever, night sweats, fatigue, malaise, and/or loss of appetite, among others.
Patients may demonstrate tenderness and spasm with decreased cervical range-of motion, but not routinely. The neurologic examination will generally be normal unless the spinal tumor is advanced and causing neurologic compression or irritation.
Plain x-rays of the cervical spine allow the clinician to assess the overall spinal alignment and bony integrity, and may demonstrate a bone-forming or bone-destroying neoplasm if the lesion is large enough. A magnetic resonance imaging test (MRI) with gadolinium is often recommended and required to accurate define the size and extent of the neoplasm, and whether it has spread into spinal canal. Spine tumors can be differentiated from pyogenic spine infections because neoplasms affect the vertebral body primarily and usually do not affect the disc, whereas pyogenic vertebral osteomyelitis preferentially destroys the endplate and intervertebral disc. A computed tomography (CT) scan may also be ordered as it allows clinicians to better visualize details of the bony anatomy better than an MRI test. A CT-myelogram (dye is injected within the thecal sac) may provide additional diagnostic information, especially when evaluating intradural neoplasms. A bone scan is a test frequently ordered when cancer is suspected, and can determine if there are other lesions in the bones throughout the entire body.
The treatment of a neoplasm of the cervical spine depends on a number of factors: the patient's age and associated medical conditions, the type, grade, and stage of the neoplasm, the severity of a patient's symptoms, and the severity of neurologic compression and bony destruction. In comparison to the thoracolumbar spine, metastatic tumors of the cervical spine are more likely to cause instability and/or neurologic compromise and are more often treated surgically. Benign primary bone tumors are often treated by surgical tumor resection; however, some benign tumors may be treated conservatively and observed if there is minimal pain and there is no evidence of spinal instability or neurologic compression. Malignant primary spine tumors are often treated by surgical resection and adjuvant chemotherapy and/or radiation. Surgical treatment often includes neurologic decompression, fusion, and instrumentation in addition to tumor resection. An anterior or posterior surgical approach, or at times a combined approach, may be utilized depending on where the tumor is located and where the neurologic compression is most prominent.