Spinal Tumors



Spinal tumors may be referred to by the region of the spine in which they occur. These basic areas are cervical, thoracic, lumbar and sacrum. Additionally, they also are classified by their location in the spine into three major groups: intradural-extramedullary, intramedullary and extradural.


The most common of these types of tumors develop in the spinal cord's arachnoid membrane(meningiomas), in the nerve roots that extend out from the spinal cord (schwannomas and neurofibromas) or at the spinal cord base (filum terminale ependymomas). Although meningiomas are often benign, they can be difficult to remove and may recur. Nerve root tumors are also generally benign, although neurofibromas may become malignant over time. Ependymomas at the end of the spinal cord can be large, and the delicate nature of fine neural structures in that area may complicate treatment.


 These tumors grow inside the spinal cord, most frequently occurring in the cervical (neck) region. They typically derive from glial or ependymal cells that are found throughout the interstitium of the spinal cord. Astrocytomas and ependymomas are the two most common types. They are often benign, but can be difficult to remove. Intramedullarylipomas are rare congenital tumors most commonly located in the thoracic spinal cord.

Metastatic spinal tumors

The spinal column is the most common site for bone metastasis. Estimates indicate that at least 30 percent and as high as 70 percent of patients with cancer will experience spread of cancer to their spine.

Common primary cancers that spread to the spine are lung, breast and prostate. Lung cancer is the most common cancer to metastasize to the bone in men, and breast cancer is the most common in women. Other cancers that spread to the spine include multiple myeloma,lymphoma, melanoma  and  sarcoma, as well as cancers of the gastrointestinal tract, kidney and thyroid. Prompt diagnosis and identification of the primary malignancy is crucial to overall treatment. Numerous factors can affect outcome, including the nature of the primary cancer, the number of lesions, the presence of distant non-skeletal metastases and the presence and/or severity of spinal-cord compression.

Pediatric spinal tumors

Primary spinal tumors are rare in children and are challenging to treat. Incidence and outcome vary by subtype.Unlike adults, children have not achieved complete skeletal growth, which doctors must take into account when considering treatment. Other factors to consider are spinal stability, surgical versus nonsurgical interventions and preservation of neurological function.

Incidence and Prevalence

Intracranial (brain) tumors account for 85 to 90 percent of all primary central nervous system (CNS) tumors. Primary tumors arising from the spinal cord, spinal nerve roots and dura are rare compared to CNS tumors that arise in the brain. Overall prevalence is estimated at one spinal tumor for every four intracranial lesions. About 10,000 Americans develop primary or metastatic spinal cord tumors each year.

Intramedullary tumors are rare, accounting for only five to 10 percent of all spinal tumors. Benign tumors such as meningiomas and neurofibromas account for 55 to 65 percent of all primary spinal tumors. Meningiomas most frequently occur in women between the ages of 40 and 70. Metastatic spinal tumors are the most common type of malignant lesions of the spine, accounting for an estimated 70 percent of all spinal tumors.


The cause of most primary spinal tumors is unknown. Some of them may be attributed to exposure to cancer-causing agents. Spinal cord lymphomas, which are cancers that affectlymphocytes (a type of immune cell), are more common in people with compromised immune systems. There appears to be a higher incidence of spinal tumors in particular families, so there is most likely a genetic component.



Additional symptoms can include the following:

  • Difficulty walking, which may cause falls
  • Decreased sensitivity to pain, heat and cold
  • Loss of bowel or bladder function



  • X-ray: Application of radiation to produce a film or picture of a part of the body can show the structure of the vertebrae and the outline of the joints. X-rays of the spine are obtained to search for other potential causes of pain, i.e. tumors, infections, fractures, etc. X-rays are not very reliable in diagnosing tumors.
  • Computed tomography scan (CT or CAT scan): A diagnostic image created after a computer reads X-rays, a CT/CAT scan can show the shape and size of the spinal canal, its contents, and the structures around it. It also is very good at visualizing bony structures.

After radiological confirmation of the tumor, the only way to determine whether the tumor is benign or malignant is to examine a small tissue sample (extracted through a biopsy procedure) under a microscope. If the tumor is malignant, a biopsy also helps determine the cancer's type, which subsequently determines treatment options.

Staging classifies neoplasms (abnormal tissue) according to the extent of the tumor, assessing bony, soft tissue and spinal canal involvement. A doctor may order a whole body scan utilizing nuclear technology, as well as a CT scan of the lungs and abdomen for staging purposes. To confirm diagnosis, a doctor compares laboratory test results and findings from the aforementioned scans to the patient's symptoms.

Treatment Decisions

Treatment decision-making is often multidisciplinary, incorporating the expertise of spinal surgeons, medical oncologists, radiation oncologists, and other medical specialists. The selection of treatments including both surgical and non-surgical is therefore made keeping in mind the various aspects of the patient’s overall health and goals of care.

Nonsurgical treatment



Indications for surgery vary depending on the type of tumor. Primary spinal tumors may be removed through complete en bloc resection for a possible cure. In patients with metastatic tumors, treatment is primarily palliative, with the goal of restoring or preserving neurological function, stabilizing the spine and alleviating pain. Generally, surgery is only considered as an option for patients with metastases when they are expected to live 12 weeks or longer, and the tumor is resistant to radiation or chemotherapy. Indications for surgery include intractable pain, spinal-cord compression and the need for stabilization of impending pathological fractures.

For cases in which surgical resection is possible, preoperative embolization may be used to enable an easier resection. This procedure involves the insertion of a catheter or tube through an artery in the groin. The catheter is guided up through the blood vessels to the site of the tumor, where it delivers a glue-like liquid embolic agent that blocks the vessels that feed the tumor. When the blood vessels that feed the tumor are blocked off, bleeding can often be controlled better during surgery, helping to decrease surgical risks.

The posterior (back) approach allows for the identification of the dura and exposure of the nerve roots. Multiple levels can be decompressed, and multilevel segmental fixation can be performed. The anterior (front) approach is excellent for tumors in the front of the spine and effectively reconstructing defects caused by removal of the vertebral bodies. This approach also allows placement of short-segment fixation devices. Thoracic and lumbar spinal tumors that affect both the anterior and posterior vertebral columns can be a challenge to resect completely. Not infrequently, a posterior (back) approach followed by a separately staged anterior (front) approach has been utilized surgically to treat these complex lesions.


The typical hospital stay after surgery to remove a spinal tumor ranges from 2 to 14 days, depending on the patient's case. A required period of post-surgery physical rehabilitation may involve a stay in a rehabilitation hospital for a period of time.   In other cases, physical therapy may take place at an outpatient facility or at the patient's home. The total recovery time after surgery may be as short as three months or as long as one year, depending on the complexity of the surgery and the patient's overall health.


Outcome depends greatly on the age and overall health of the patient and on whether the spinal tumor is benign or malignant, primary or metastatic. In the case of primary tumors, the goal is to remove the tumor completely, leading optimally to the potential cure of the malignancy. In the case of metastatic tumors, the goal is almost always palliative, with treatment aimed at providing the patient with an improved quality of life and possibly prolonged life expectancy.


Information courtesy of the American Association of Neurological Surgeons


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