ConditionBrain & nerves
Spinal Cord Tumor
A spinal cord tumor is an abnormal growth within or next to the spinal cord or the nerve roots in the spinal canal. Many are benign, such as meningiomas and schwannomas, but even benign tumors can compress the cord. Cancer that has spread to the spinal bones from elsewhere is far more common than tumors starting in the cord itself. Typical symptoms are back or neck pain, often worse at night, followed by numbness, weakness, walking difficulty and bladder or bowel changes. Early diagnosis with MRI protects nerve function.
Also called: Spinal tumor, intraspinal tumor, tumor of the spinal cord, spinal column tumor
At a glance
- What it is
- A tumor in or around the spinal cord or spinal nerve roots.
- Most common
- Metastases from cancers elsewhere (breast, lung, prostate, kidney, myeloma) affecting the spine.
- Primary types
- Meningioma, schwannoma, ependymoma, astrocytoma, hemangioblastoma.
- Symptoms
- Back or neck pain (often at night), numbness, weakness, unsteady walking, bladder and bowel problems.
- Diagnosis
- MRI with contrast, then biopsy or surgery to confirm type.
- Treatment
- Surgery, radiation, steroids for swelling, chemotherapy or targeted therapy for some types.
When to get help
Call 911 or go to the ER
- New weakness in the legs or arms, difficulty walking, or loss of bladder or bowel control with back pain (possible spinal cord compression)
- Numbness in the groin, buttocks or inner thighs (possible cauda equina syndrome)
- In someone with cancer: new back pain with any nerve symptoms
See a doctor within a day or two
- In someone with known cancer: new or worsening back or neck pain, especially at night or when lying down
- Back pain with unexplained weight loss, fever or night sweats
- Progressive numbness, tingling or clumsiness in the hands or feet
Book a routine appointment
- Back or neck pain lasting more than 4 to 6 weeks that is worse at night or not related to movement
- Gradual unsteadiness, frequent tripping or stiffness in the legs
- Scoliosis that develops or worsens rapidly in a child
Types of spinal tumors
Tumors are grouped by location:
| Location | Examples | Notes |
|---|---|---|
| Extradural (outside the dura, usually in the spinal bones) | Metastases, myeloma, lymphoma, primary bone tumors | Most common. Metastatic cancer is the leading cause of spinal cord compression |
| Intradural-extramedullary (inside the dura, outside the cord) | Meningioma, schwannoma, neurofibroma | Usually benign, often curable with surgery |
| Intramedullary (inside the cord) | Ependymoma, astrocytoma, hemangioblastoma | Less common; ependymoma is most common in adults, astrocytoma in children |
Causes and risk factors
The cause of most primary spinal cord tumors is unknown. Risk factors include:
- Cancer elsewhere, especially breast, lung, prostate, kidney, thyroid and multiple myeloma, for metastases. See bone metastases
- Neurofibromatosis type 1 (neurofibromas) and type 2 (schwannomas, meningiomas, ependymomas)
- Von Hippel-Lindau disease (hemangioblastomas)
- Previous radiation to the spine
- Weakened immune system (lymphoma)
Symptoms
Symptoms develop as the tumor presses on the cord or nerve roots, usually gradually, but sometimes rapidly.
- Back or neck pain: often the first symptom, may be worse at night or lying down, and not relieved by rest
- Radiating pain along a nerve into the arm, chest or leg
- Numbness, tingling or reduced sensation to temperature
- Weakness in the legs or arms
- Difficulty walking, stiffness, falls
- Loss of bladder or bowel control, or difficulty passing urine
- Sexual dysfunction
- Scoliosis in children
- Muscle wasting or twitching
Some intramedullary tumors cause a fluid-filled cavity in the cord (syringomyelia).
Diagnosis
- Neurological examination: strength, sensation, reflexes, coordination and walking.
- MRI of the spine with contrast: the key test, showing the tumor's location and relation to the cord.
- CT scan: for bone involvement and surgical planning.
- Biopsy or surgical removal to identify the tumor type.
- Staging scans (CT chest, abdomen and pelvis, or PET) if metastatic cancer is suspected.
- Blood tests including protein studies for myeloma.
Treatment
Treatment depends on the type, location, size and the person's overall health.
Emergency treatment for spinal cord compression
- High-dose corticosteroids (such as dexamethasone) to reduce swelling
- Urgent surgery to decompress and stabilize the spine, and/or radiation therapy
- Treatment within hours to days gives the best chance of preserving walking ability
Surgery
- Complete removal is often possible and curative for meningiomas, schwannomas and many ependymomas
- Intraoperative nerve monitoring helps protect function
- Spinal stabilization with rods and screws if the spine is weakened
Radiation therapy
- Conventional or stereotactic radiation for metastases, residual tumor, or tumors that cannot be fully removed
- Often the main treatment for metastatic spinal tumors
Chemotherapy and targeted therapy
Used for lymphoma, myeloma, some astrocytomas and metastatic cancers, depending on the primary cancer.
Rehabilitation and supportive care
Physical and occupational therapy, pain control, bladder and bowel management, and psychological support.
Outlook
The outlook varies widely. Benign intradural tumors often have excellent outcomes after complete removal. Ependymomas also do well after full removal. High-grade astrocytomas and metastatic spinal tumors are harder to treat, and outcomes depend on the underlying cancer. Across all types, the most important factor for regaining function is how well a person can walk at the time of treatment, which is why early recognition matters.
Frequently asked questions
What are the first signs of a spinal cord tumor?
The first sign is often back or neck pain that is persistent, worse at night or when lying down, and not related to activity. Numbness, tingling, weakness, difficulty walking and bladder or bowel changes can follow as the tumor grows.
Are spinal cord tumors cancerous?
Many primary spinal cord tumors, such as meningiomas and schwannomas, are benign. However, even benign tumors can compress the cord. Tumors that spread to the spine from cancers elsewhere are more common and are malignant.
How is a spinal cord tumor diagnosed?
MRI of the spine with contrast is the main test. A neurological exam, CT scan and biopsy or surgery help confirm the type. Additional scans look for cancer elsewhere if metastatic disease is suspected.
How are spinal cord tumors treated?
Treatment may include surgery to remove the tumor, radiation therapy, steroids to reduce swelling, and chemotherapy or targeted therapy for some tumor types. Emergency treatment is needed if the tumor causes spinal cord compression.
Can you recover from a spinal cord tumor?
Many people recover well, especially after removal of benign tumors. Recovery of strength and sensation depends on how much the cord was compressed and for how long. Early treatment and rehabilitation give the best results.
Sources
This guide was written from current patient and clinical guidance, including:
- American Association of Neurological Surgeons: Spinal Tumors
- National Cancer Institute: Adult Central Nervous System Tumors Treatment (PDQ)
- NINDS: Brain and spinal tumors information
- American Cancer Society: Brain and Spinal Cord Tumors in Adults
- NICE: Metastatic spinal cord compression in adults (NG234)
- MedlinePlus: Spinal cord tumor