Spinal Tumor

Types of spinal tumors

Spinal tumors are classified by location:

Vertebral hemangiomas are very common, harmless findings on scans and usually need no treatment.

Symptoms

• pain: back or neck pain that is persistent, progressive, worse at night or when lying down, and not relieved by rest; it may spread around the chest or down an arm or leg
• nerve symptoms: numbness, tingling, coldness or burning in the limbs or trunk
• weakness: in the legs or arms, difficulty walking, frequent falls
• bladder and bowel dysfunction: urgency, retention or incontinence
• sexual dysfunction
• scoliosis or spinal deformity
• fracture: sudden pain from a collapsed vertebra

Spinal cord compression

Metastatic spinal cord compression is an emergency in which a tumor squeezes the cord. Early signs include worsening back pain, then weakness, numbness, unsteadiness and bladder or bowel problems. Treatment within hours (high-dose steroids, surgery or radiotherapy) gives the best chance of preserving walking. People with cancer and new back pain should be assessed promptly.

Causes and risk factors

• metastatic cancer, especially breast, lung, prostate, kidney and thyroid, and myeloma
• genetic syndromes: neurofibromatosis types 1 and 2, von Hippel-Lindau disease
• previous radiation
• most primary spinal tumors have no known cause

Diagnosis

• neurological examination: strength, sensation, reflexes, gait
• MRI of the whole spine with contrast: the main test, showing location and cord compression
• CT: bone detail and surgical planning
• PET-CT or bone scan: to look for cancer elsewhere
• biopsy: to determine tumor type when it is not already known
• blood tests: including protein electrophoresis for myeloma

Treatment

Treatment depends on the type, location, spinal stability and overall health:

• Surgery: to remove benign tumors, decompress the cord, and stabilize the spine with rods and screws.
• Radiotherapy: conventional or stereotactic body radiotherapy (SBRT), the main treatment for many metastases.
• Chemotherapy, hormone therapy, targeted therapy or immunotherapy: depending on the cancer type.
• Corticosteroids: dexamethasone to reduce swelling around the cord.
• Vertebroplasty or kyphoplasty: cement injection for painful vertebral fractures.
• Observation: small, slow-growing benign tumors without symptoms.
• Rehabilitation and pain management.

Outlook

Outlook depends on the tumor type and whether the cord is affected. Many benign primary tumors are cured by surgery. For metastases, treatment aims to control pain, keep people walking and maintain quality of life. Neurological function at the time of treatment strongly predicts outcome.

Frequently asked questions

What are the first signs of a spinal tumor?

The most common first sign is back or neck pain that is persistent, gradually worsening, and often worse at night or when lying down. Numbness, tingling, weakness and bladder or bowel changes may follow as the tumor grows.

How is back pain from a spinal tumor different?

Tumor-related back pain tends to be constant, progressive, not relieved by rest, and worse at night. It may come with weight loss, a cancer history or neurological symptoms. Ordinary mechanical back pain usually improves with rest and changes in position.

Are spinal tumors cancerous?

Some are and some are not. In adults, most tumors in the spinal bones are cancers that have spread from elsewhere. Many tumors that start within the spinal canal, such as meningiomas and schwannomas, are benign.

Can spinal tumors be cured?

Many benign spinal tumors can be cured with surgery. Metastatic spinal tumors are usually controlled rather than cured, with radiotherapy, surgery and systemic treatments aimed at preserving function and relieving pain.