Benign Musculoskeletal Tumors

  • What are benign musculoskeletal tumors that can affect the spine?

    Benign musculoskeletal tumors that can affect the spine are abnormal growths or masses of cells in or surrounding the spinal cord. They are very rare in children.

    Although benign musculoskeletal tumors are not cancerous like malignant musculoskeletal tumors, they can still cause serious problems for children. Benign musculoskeletal tumors can grow — sometimes quickly — and damage a child’s spinal cord or other bones during crucial developmental years.

    At The Children's Hospital of Philadelphia, we have extensive experience diagnosing and treating children with a wide range of benign musculoskeletal tumors that can affect the spine, including:

  • Causes

    The causes of benign musculoskeletal are often unknown, but the growth may be linked to:

    • Environmental toxins, such as exposure to radiation or lead poisoning
    • Genetic abnormalities
    • Diet
    • Stress
    • Endocrine problems
    • Local trauma or injury
    • Inflammation or infection 
  • Primary vs. secondary spinal tumors

    Tumors that start in spinal tissue are called primary spinal tumors. Musculoskeletal tumors that spread to the spine from other places (e.g., lung) are called secondary spinal tumors.

    Either primary or secondary tumors can be benign or malignant (cancerous). Primary spinal tumors often progress slowly over months to years. Secondary spinal tumors often progress quickly.

  • Symptoms of benign musculoskeletal tumors

    Symptoms of benign musculoskeletal tumors depend on a variety of factors including the type of tumor, location of the tumor, and your child’s age and general health.

    Indications of a spinal cord tumor, however, may include:

    • Chronic neck or back pain. This is the most common symptom and the pain can be either very localized or radiating.
    • Pain, stiffness or tenderness at the site of the tumor.
    • Swelling or mass around the affected bone.
    • Fatigue, fever, weight loss and/or, anemia.
    • Spinal deformities such as scoliosis occur in up to one third of children with spinal cord tumors.
    • Specific neurological complaints. As the tumors expand and grow, they can create pressure within the spinal cord. These symptoms can be confused with “growing pains.” Specific symptoms can include:
      • Decreased motor skills, including difficulty walking
      • Loss of sensation or increased sensitivity to cold or hot
      • Muscle weakness or spasms
      • Numbness
      • Loss of bowel or bladder control 

    Tumors in the spinal cord may cause diffuse symptoms. Tumors outside the spinal cord may grow for a long time before becoming symptomatic. 

  • Testing and diagnosis

    Symptoms of a benign musculoskeletal tumor can be difficult to identify in children, so regular check-ups are extremely important. Your child's diagnostic evaluation begins with a thorough medical history and physical examination of your child.

    A detailed neurological assessment may also be performed. This involves a series of questions and tests to check the brain, spinal cord and nerve function.

    At The Children’s Hospital of Philadelphia, clinical experts use a variety of diagnostic tests to diagnose tumors, including: 

    • X-rays, which produce images of bones.
    • Magnetic resonance imaging (MRI), which uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.
    • Computed tomography (CT) scan, which uses a combination of X-rays and computer technology to produce cross-sectional images ("slices") of the body.
    • Angiography, a radiograph-type X-ray test which reveals the inside of blood vessels and organs.
    • Radioisotope bone scan, which can help locate areas of abnormal growth. 
    • Positron emission tomography (PET) scan, which uses radioactive sugar injected into a vein and a scanner to make detailed, computerized pictures of areas of the body.
    • Blood tests, which can help determine drug usage and effectiveness, biochemical diseases and organ function.
    • Biopsy, which is a surgical procedure to take a sample of the growth, may be necessary to confirm any findings.
    • EOS imaging, an imaging technology that creates 3-dimensional models from two planar images. Unlike a CT scan, EOS images are taken while the child is in an upright or standing position, enabling improved diagnosis due to weight-bearing positioning.  
  • Treatments

    At The Children’s Hospital of Philadelphia, we practice collaborative, family-centered care. A team of expert clinicians — including leading orthopedic physicians and surgeons, advanced practice providers, pediatric nurses, physical and occupational therapists, psychologists and other specialists — will partner with you in the care of your child. The team is led by orthopedic surgeon John P. Dormans, MD, FACS, chief of the Division of Orthopedics, who has led and participated in many studies in the area of pediatric spinal problems, including spinal tumors.

    In many cases, benign tumors need no treatment. Physicians may simply use “watchful waiting” to make sure the tumors do not cause pain or dysfunction. 

    However, treatment may be needed if symptoms are a problem. The goal of treatment — whether surgical or nonsurgical — of a spine tumor is to reduce or prevent nerve damage from pressure on the spinal cord. The faster symptoms develop; the sooner treatment is needed to prevent permanent injury.

    Treatment options for benign tumors affecting the spine include:

    • Medication (such as corticosteroids), which can reduce inflammation and swelling around the spinal cord.
    • Physical therapy, which can improve muscle strength and the ability to function independently.
    • Chemotherapy, which uses chemicals to shrink and treat the tumor.
    • Radiation therapy, which uses ionizing radiation to treat and shrink the tumor in a specific location on the body. This can be used alone or in conjunction with surgery.
    • Surgery, in which all, or part, of the tumor is surgically removed to relieve pressure on the spinal cord without damaging surrounding tissue and organs.

    Though surgery for a benign tumor is highly effective, we understand that any surgery can be a stressful experience for children and families. At CHOP, we offer a wealth of resources about how to prepare your child for surgery and what to expect during surgery.

    Additionally, we employ numerous best practices before, during and after surgery to decrease the risk of infection and increase positive outcomes. For more details about safety protocols at The Children's Hospital of Philadelphia, see safety in surgery.

  • Follow-up care

    Most children are able to go home shortly after surgery. They may require pain medications until the surgical site heals, but most are encouraged to resume their regular daily activities, like school, social events and play.

    Your child will see the orthopedic surgeon about one to two weeks after surgery, then again at three and six months post-surgery. Annual monitoring by trained clinicians is strongly encouraged to monitor for possible recurrence of the growth.

    Benign spinal tumors have the potential to reoccur, and some may become malignant months or years after successfully treated, so it is important for your child to see a physician regularly, especially if any symptoms reoccur.

    During follow-up visits, X-rays and other diagnostic testing may be done to monitor your child’s health.

    Follow-up care and ongoing support and services are available at our Main Campus and throughout our CHOP Care Network. Our team is committed to partnering with parents and referring physicians to provide the most current, comprehensive and specialized care possible for your child.

  • Outlook

    Outcomes for children treated for benign spinal tumors are typically good, but largely depend on the type of tumor, location and whether it reoccurs after treatment.

    Early diagnosis and treatment of spinal tumors can produce improved outcomes for pediatric patients and avoid some growth-related issues.

    With recent advances in treatment options, surgical instruments and surgical techniques, spinal cord tumors in children can be managed well and successfully treated.

Reviewed by John P. Dormans, MD, FACS on May 15, 2014