Merck Manual

Please confirm that you are not located inside the Russian Federation

honeypot link

Spinal Tumors

By

Mark H. Bilsky

, MD, Weill Medical College of Cornell University

Reviewed/Revised May 2023 | Modified Oct 2023
VIEW PROFESSIONAL VERSION
Topic Resources
  • People may have weak muscles, lose sensation in particular areas of the body, or become unable to control bowel and bladder function.

  • Magnetic resonance imaging can usually detect spinal tumors.

  • Treatment may include corticosteroids, surgical removal, and radiation therapy.

Spinal tumors are much less common than brain tumors. Spinal tumors may be

  • Primary

  • Secondary

The Spine and Spinal Cord
VIDEO

Primary intradural spinal tumors may be cancerous or noncancerous. They are typically noncancerous. Intradural tumors include meningiomas, schwannomas and myxopapillary ependymomas.

Primary intradural spinal tumors may originate in the cells within or next to the spinal cord. Only about one third of primary spinal tumors originate in the cells within the spinal cord. These tumors can extend within the spinal cord, block the flow of cerebrospinal fluid (the fluid that surrounds the brain and spinal cord), and cause a fluid-filled cavity (syrinx Syrinx of the Spinal Cord or Brain Stem A syrinx is a fluid-filled cavity that develops in the spinal cord (called syringomyelia), in the brain stem (called syringobulbia), or in both. Syrinxes may be present at birth or develop later... read more ) to form. Astrocytomas and ependymomas are the most common spinal tumors. Most are not cancerous.

Most intradural spinal tumors originate in cells next to the spinal cord, such as those of the meninges—the layers of tissue that cover the spinal cord (see figure How the Spine Is Organized How the Spine Is Organized How the Spine Is Organized ).

Secondary spinal tumors, which are more common, are metastases of cancer originating in another part of the body and thus are always cancerous. These metastases typically spread to bones in the spine (vertebrae) and the space between the bone and the outer layer of tissue around the spinal cord (epidural space). Sometimes these tumors spread to the spinal cord. Metastases most commonly spread to the vertebrae from cancers that originate in other parts of the body. These cancers include

Metastases usually put pressure on (compress) the spinal cord or nerve roots from the outside the dura. Many of these tumors invade and destroy bone before they compress the spinal cord.

Most secondary spinal tumors that are located in the cells next to the spinal cord (rather than within it) are metastatic.

Table

Symptoms of Spinal Tumors

Symptoms are caused by pressure on the spinal cord and nerve roots. Pressure on the spinal cord may cause the following:

  • Back pain that progressively worsens, becomes worse at night, and may lessen when people awaken and move around

  • Decreased sensation, progressive weakness, or paralysis in areas controlled by the parts of the spinal cord below the part that is compressed

  • Erectile dysfunction

  • Loss of bladder and bowel control

Pressure on the spinal cord may also block the blood supply to the cord, resulting in death of tissue and swelling. The swelling may block more of the blood supply, leading to more tissue death in a vicious circle of damage. Symptoms due to pressure on the spinal cord can worsen quickly.

Pressure on spinal nerve roots can cause pain, numbness, tingling, and weakness in areas supplied by the compressed nerve root. Pain may radiate along the nerve whose root is compressed. If compression continues, the affected muscles may waste away. Walking may become difficult.

Diagnosis of Spinal Tumors

  • Magnetic resonance imaging or myelography with computed tomography

  • Sometimes a biopsy

Doctors consider the possibility of a spinal tumor in people who have certain patterns of weakness or nerve dysfunction (such as loss of sensation) or pain in certain locations in the back or neck, particularly if they have certain cancers in other parts of the body.

Because the spinal cord is organized in a specific way, doctors can locate the tumor by determining which parts of the body are not functioning normally.

Where Is the Spinal Cord Damaged?

Where Is the Spinal Cord Damaged?

When doctors suspect a spinal tumor, they must rule out other disorders that can affect the function of the spinal cord, such as a herniated disk Herniated Disk A herniated disk occurs when the tough covering of a disk in the spine tears or ruptures. The soft, jelly-like interior of the disk may then bulge out (herniate) through the covering. Aging... read more Herniated Disk , injuries Injuries of the Spinal Cord and Vertebrae A spinal cord injury is damage to the bundle of cells and nerves that carry incoming and outgoing messages between the brain and the rest of the body. Most spinal cord injuries result from motor... read more Injuries of the Spinal Cord and Vertebrae , demyelination Overview of Demyelinating Disorders Most nerve fibers inside and outside the brain are wrapped with many layers of tissue composed of a fat (lipoprotein) called myelin. These layers form the myelin sheath. Much like the insulation... read more (damage to the tissues that cover nerves) and inflammation of the spinal cord, an inadequate blood supply to the spinal cord Blockage of the Blood Supply to the Spinal Cord Blockage of an artery carrying blood to the spinal cord prevents the cord from getting blood and thus oxygen. As a result, tissues can die (called infarction). Causes include severe atherosclerosis... read more , or compression of the spinal cord by a pocket of pus (abscess Epidural Abscess in the Spine A spinal epidural abscess is an accumulation of pus in the space between the spine and outer layer (dura mater) of tissue covering the spinal cord (epidural space). These abscesses can put pressure... read more ) or blood clot.

Several procedures can help doctors diagnose a spinal tumor. Magnetic resonance imaging (MRI) is considered the best procedure for examining all the structures of the spinal cord and spine. When MRI is unavailable, myelography Myelography Diagnostic procedures may be needed to confirm a diagnosis suggested by the medical history and neurologic examination. Imaging tests commonly used to diagnose nervous system (neurologic) disorders... read more Myelography with computed tomography (CT) may be done instead.

X-rays of the spine are less useful because they show only changes in the bones. However, x-rays, which may be taken for other reasons, may detect destruction of the bone or distortion of the tissues around the spinal cord, especially if the tumor is metastatic.

A biopsy is sometimes needed to diagnose the precise type of tumor, especially primary spinal tumors. However, a biopsy is not needed for spinal tumors that result from metastases if cancer has been diagnosed elsewhere in the body. Often, a biopsy requires surgery, but sometimes it can be done using a needle with CT or MRI to guide doctors as they place the needle in the tumor.

Treatment of Spinal Tumors

  • Corticosteroids, given immediately

  • Surgery, radiation therapy, or both

  • Sometimes chemotherapy

If symptoms suggest that the tumor is compressing the spinal cord, corticosteroids (such as dexamethasone) are immediately given in high doses to reduce the swelling. Such tumors are treated as soon as possible, often surgically.

Many tumors of the spinal cord and spine can be removed surgically. In some cases, radiation therapy is given after surgery.

If tumors cannot be removed, radiation therapy is used, sometimes after surgery has been done to relieve the pressure on the spinal cord.

Other treatments, such as chemotherapy, may be used depending on the type of cancer.

Recovery generally depends on how quickly treatment begins and how much damage was done. Removal of meningiomas, neurofibromas, and some other primary spinal tumors may result in a cure. If a tumor has distinct borders and has not spread from elsewhere in the body, removing it causes symptoms to resolve in about half of people.

Drugs Mentioned In This Article

Generic Name Select Brand Names
AK-Dex, Baycadron, Dalalone, Dalalone D.P, Dalalone L.A, Decadron, Decadron-LA, Dexabliss, Dexacort PH Turbinaire, Dexacort Respihaler, DexPak Jr TaperPak, DexPak TaperPak, Dextenza, DEXYCU, DoubleDex, Dxevo, Hemady, HiDex, Maxidex, Ocu-Dex , Ozurdex, ReadySharp Dexamethasone, Simplist Dexamethasone, Solurex, TaperDex, ZCORT, Zema-Pak, ZoDex, ZonaCort 11 Day, ZonaCort 7 Day
NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
VIEW PROFESSIONAL VERSION
quiz link

Test your knowledge

Take a Quiz!
iOS ANDROID
iOS ANDROID
iOS ANDROID
TOP