Spinal Tumors

What are Spinal Tumors?

Spinal tumors are abnormal growths that develop in or near the spine, spinal cord, nerve roots, or spinal bones. They may be benign, meaning noncancerous, or malignant, meaning cancerous. Some spinal tumors begin in the spine or spinal cord, called primary spinal tumors, while others spread to the spine from cancer elsewhere in the body, called metastatic spinal tumors.

Spinal tumors may involve the vertebrae, epidural space, dura, nerve roots, or spinal cord. Tumors may be described as extradural, intradural extramedullary, or intramedullary, depending on their location. Examples may include metastatic tumors, meningiomas, schwannomas, neurofibromas, ependymomas, astrocytomas, chordomas, and other spinal lesions.

De Novo Brain & Spine evaluates adult patients with suspected or confirmed spinal tumors when symptoms or imaging suggest spinal cord compression, nerve root compression, spinal instability, vertebral fracture, back pain, neurological changes, or a tumor that may require neurosurgical review.

Common Signs and Symptoms

Spinal tumor symptoms depend on the tumor’s location, size, growth pattern, relationship to the spinal cord or nerve roots, and whether the tumor weakens the bones of the spine.

Common signs and symptoms may include:

• Neck pain, mid back pain, or low back pain
• Back pain that is persistent, worsening, or not clearly related to activity
• Pain that is worse at night or when lying down in some patients
• Pain that travels into the shoulder, arm, hand, buttock, leg, or foot
• Numbness or tingling in the arms, hands, legs, or feet
• Weakness in the arms, hands, legs, ankles, or feet
• Trouble walking, balance problems, or frequent falls
• Loss of coordination
• Reduced sensitivity to pain, temperature, or touch
• Muscle spasms or stiffness
• Symptoms of spinal cord compression, such as weakness, numbness, balance difficulty, or hand coordination problems
• Symptoms of nerve root compression, such as radiculopathy or sciatica
• Bowel or bladder changes in severe cases
• Pain or fracture symptoms when a tumor weakens a vertebra

Seek urgent medical evaluation for progressive weakness, worsening numbness, trouble walking, loss of coordination, bowel or bladder changes, severe pain at night, unexplained weight loss, fever, history of cancer, or rapidly worsening neurological symptoms. Seek emergency medical care or call 911 for sudden paralysis, loss of bowel or bladder control, severe spinal cord compression symptoms, or sudden neurological decline.

What Causes This Condition?

The cause of a spinal tumor depends on the tumor type. Some spinal tumors begin in the spine or spinal cord, while others spread to the spine from cancer elsewhere in the body.

Possible causes and related factors may include:

• Metastatic cancer, when cancer spreads to the spine from another part of the body
• Prior history of cancer, such as lung, breast, prostate, kidney, colon, melanoma, or other cancers
• Primary spinal tumors, which begin in the spinal bones, spinal cord, nerve sheath, meninges, or nearby tissues
• Benign nerve sheath tumors, such as schwannoma or neurofibroma
• Meningioma, which can occur in the covering around the spinal cord
• Intramedullary spinal cord tumors, such as ependymoma or astrocytoma
• Rare genetic conditions, such as neurofibromatosis or von Hippel-Lindau disease, in selected patients
• Prior radiation exposure in selected cases
• Tumor-related weakening of the vertebrae, which may lead to compression fracture or spinal instability

Many spinal tumors develop without a clearly known cause. A spinal tumor diagnosis does not usually mean that the patient did something to cause it. Treatment planning depends on the tumor type, location, symptoms, imaging findings, neurological examination, cancer history, pathology, and overall health.

How It Is Diagnosed?

Spinal tumors are diagnosed through medical history, physical examination, neurological examination, imaging, and sometimes tissue diagnosis. The evaluation helps determine the tumor’s location, whether the spinal cord or nerve roots are compressed, and whether the spine is stable.

Common diagnostic steps may include:

• Medical history and symptom review to understand pain location, symptom duration, cancer history, neurological symptoms, prior imaging, prior treatment, and red-flag symptoms
• Physical examination to evaluate spinal tenderness, posture, range of motion, gait, and painful movement
• Neurological examination to assess strength, sensation, reflexes, coordination, walking, balance, hand function, and signs of spinal cord or nerve root involvement
• MRI of the spine with and without contrast, often the main imaging study used to evaluate suspected spinal tumors
• MRI of additional spinal regions when symptoms or imaging suggest more than one level may be involved
• CT scan of the spine to evaluate bone involvement, fracture, spinal canal compromise, or surgical planning
• X-rays of the spine to evaluate alignment, vertebral collapse, fracture, deformity, or instability
• Standing spine X-rays in selected cases to evaluate spinal alignment or deformity
• CT myelogram in selected cases when MRI is not possible or when additional detail around the spinal cord and nerve roots is needed
• Body imaging, such as CT, PET/CT, or other oncology-directed studies, when metastatic cancer is suspected
• Blood tests in selected cases when infection, inflammation, multiple myeloma, or another medical condition is being considered
• Biopsy when tissue is needed to confirm tumor type, cancer origin, or treatment planning
• Pathology and molecular testing when appropriate to classify the tumor and guide oncology treatment

The goal of diagnosis is to identify the tumor type, determine whether it is benign or malignant, assess spinal cord or nerve compression, evaluate spinal stability, and guide the safest treatment plan.

Treatment Options

Spinal tumor treatment depends on the tumor type, location, size, symptoms, neurological examination, spinal stability, degree of spinal cord or nerve compression, cancer history, prior treatment, imaging findings, pathology, and overall health. Not every spinal tumor requires immediate surgery.

Treatment options may include:

• Observation with repeat imaging for selected small, stable, benign-appearing tumors that are not causing symptoms or compression
• Medication for symptom control, such as pain medication, anti-inflammatory medication, or nerve pain medication when medically appropriate
• Corticosteroids in selected cases when swelling or spinal cord compression requires urgent medical management
• Bracing in selected cases when vertebral weakening or fracture affects spinal support
• Radiation therapy for selected metastatic tumors, malignant tumors, residual tumor, recurrent tumor, or tumors that are not ideal surgical candidates
• Stereotactic body radiation therapy, also called SBRT, in selected spinal tumor cases when recommended by radiation oncology
• Chemotherapy, targeted therapy, immunotherapy, or other systemic therapy when recommended by oncology based on tumor type and cancer history
• Biopsy when tissue diagnosis is needed before treatment planning
• Spinal tumor removal when surgery is appropriate to remove tumor, obtain tissue diagnosis, relieve pressure, or reduce neurological risk
• Spinal decompression when tumor is compressing the spinal cord or nerve roots
• Spinal fusion or stabilization when tumor weakens the spine, causes instability, or requires reconstruction after tumor removal
• Corpectomy in selected cases when a vertebral body is involved and decompression or reconstruction is needed
• Treatment of vertebral compression fracture when tumor-related bone weakening causes collapse or pain
• Treatment for recurrent spinal tumors depending on tumor type, prior surgery, prior radiation, symptoms, and imaging findings
• Rehabilitation and supportive care to help with walking, strength, balance, pain control, bowel or bladder function, and daily activity when symptoms are present

Surgery is not appropriate for every spinal tumor. Neurosurgical treatment may be considered when a tumor causes spinal cord compression, nerve root compression, progressive weakness, spinal instability, vertebral collapse, diagnostic uncertainty, or symptoms that require structural treatment planning. Patients with spinal tumors may need spine and peripheral nerve surgery when a tumor affects spinal stability, compresses nerve structures, or requires surgical planning.