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Spinal Cord Tumors


Steven A. Goldman

, MD, PhD, Sana Biotechnology

Last review/revision Jan 2021 | Modified Sep 2022
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Spinal cord tumors may develop within the spinal cord parenchyma, directly destroying tissue, or outside the cord parenchyma, often compressing the cord or nerve roots. Symptoms can include progressive back pain and neurologic deficits referable to the spinal cord or spinal nerve roots. Diagnosis is by MRI. Treatment may include corticosteroids, surgical excision, and radiation therapy.

Spinal cord tumors may be intramedullary (within the cord parenchyma) or extramedullary (outside the parenchyma).

Intramedullary tumors

The most common intramedullary tumors are gliomas, particularly ependymomas and low-grade astrocytomas. Intramedullary tumors infiltrate the spinal cord, expand, and destroy the parenchyma. They may extend over multiple spinal cord segments and obstruct the flow of cerebrospinal fluid within the cord, resulting in a syrinx Syrinx of the Spinal Cord or Brain Stem A syrinx is a fluid-filled cavity within the spinal cord (syringomyelia) or brain stem (syringobulbia). Predisposing factors include craniocervical junction abnormalities, previous spinal cord... read more Syrinx of the Spinal Cord or Brain Stem .

Extramedullary tumors

Extramedullary tumors may be

  • Intradural: Located within the dura but on the surface of the spinal cord, rather than within its parenchyma

  • Extradural: Located outside the dura

Most intradural tumors are benign and are usually meningiomas or neurofibromas, which are the two most common primary spinal tumors.

Both intradural and extradural tumors exert their effects by compressing the spinal cord and its roots, rather than by invading the parenchymal. Most extradural tumors invade and destroy bone before compressing the cord.

Symptoms and Signs of Spinal Cord Tumors

Pain is an early symptom, especially for extradural tumors. It is progressive, unrelated to activity, and worsened by recumbency. Pain may occur in the back, radiate along the sensory distribution of a particular dermatome (radicular pain), or both.

Neurologic deficits referable to the affected level of the spinal cord eventually develop. Common examples are spastic weakness, incontinence, and dysfunction of some or all of the sensory tracts at a particular level of the spinal cord and below. Deficits are usually bilateral.

Intradural extramedullary tumors may be painful when the nerve roots are compressed but can also develop painlessly if the spinal cord is directly compressed without involving the root.

Some patients with intradural tumors—most often meningiomas and neurofibromas—present with sensory deficits of the distal lower extremities, segmental neurologic deficits, symptoms of spinal cord compression, or some combination.

Symptoms of spinal cord compression can worsen rapidly and result in paraplegia and loss of bowel and bladder control.

Symptoms of nerve root compression are also common; they include pain and paresthesias followed by sensory loss, muscular weakness, and, if compression is chronic, muscle wasting, which occurs along the distribution of the affected roots.

Diagnosis of Spinal Cord Tumors

  • MRI

Patients with segmental neurologic deficits or suspected spinal cord compression require emergency diagnosis and treatment.

The following symptoms and signs may suggest spinal tumors:

  • Progressive, unexplained, or nocturnal back or radicular pain

  • Segmental neurologic deficits

  • Unexplained neurologic deficits referable to the spinal cord or nerve roots

  • Unexplained back pain in patients with a history of cancer, particularly those with tumors of the lungs, breasts, prostate, kidneys, colon, or thyroid or with lymphoma

Diagnosis of spinal cord tumors is by MRI of the affected area of the spinal cord. CT with myelography is an alternative; it can help localize the tumor but provides less information than MRI.

Spinal x-rays, taken for other reasons, may show bone destruction, widening of the vertebral pedicles, or distortion of paraspinal tissues, especially if the tumor is metastatic.

Biopsy may be done to confirm the diagnosis.

Treatment of Spinal Cord Tumors

  • Corticosteroids to prevent spinal cord compression

  • Excision, radiation therapy, or both

If patients have neurologic deficits due to spinal cord compression Spinal Cord Compression Various lesions can compress the spinal cord, causing segmental sensory, motor, reflex, and sphincter deficits. Diagnosis is by MRI. Treatment is directed at relieving compression. (See also... read more Spinal Cord Compression , corticosteroids (eg, dexamethasone 100 mg IV, then 10 mg orally 4 times a day) are begun immediately to reduce spinal cord edema and preserve function. Tumors compressing the spinal cord are treated as soon as possible because deficits may quickly become irreversible.

Some well-localized primary spinal cord tumors can be excised surgically. Deficits resolve in about half of these patients. If tumors cannot be surgically excised, radiation therapy is used, with or without surgical decompression. Compressive metastatic extradural tumors are usually surgically excised from the vertebral body, then treated with radiation therapy. Noncompressive metastatic extradural tumors may be treated with radiation therapy alone but may require surgical excision if radiation therapy is ineffective. For metastatic prostate cancer to the spinal vertebrae, antiandrogenic chemotherapy may be used as an adjunct to focal radiation.

Key Points

  • Spinal cord tumors may be intramedullary (within the cord parenchyma) or extramedullary (outside the parenchyma).

  • Extramedullary tumors may be intradural or extradural.

  • Most intradural tumors are benign meningiomas and neurofibromas, which are the most common primary spinal tumors; most extradural tumors are metastatic.

  • Give corticosteroids to patients with neurologic deficits due to spinal cord compression.

  • Surgically excise spinal cord tumors and/or use radiation therapy.

Drugs Mentioned In This Article

Drug Name Select Trade
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
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