A spinal tumor is a noncancerous (benign) or cancerous (malignant) growth in or around the spinal cord.
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.
(See also Overview of Tumors of the Nervous System.)
Spinal tumors are much less common than brain tumors. Spinal tumors may be
Primary
Secondary
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) 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).
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.
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
Compression of the spinal cord by a tumor must be diagnosed and treated efficiently and quickly to prevent permanent damage.
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?
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, injuries, demyelination (damage to the tissues that cover nerves) and inflammation of the spinal cord, an inadequate blood supply to the spinal cord, or compression of the spinal cord by a pocket of pus (abscess) 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 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
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.
