Merck Manual

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Spinal Tumors


Mark H. Bilsky

, MD, Weill Medical College of Cornell University

Reviewed/Revised May 2023

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

Spinal tumors may also be

  • Primary: Originating in the spine)

  • Secondary: Originating elsewhere in the body

Intramedullary tumors

The most common intramedullary tumors are gliomas, particularly ependymomas and low-grade astrocytomas. Intramedullary tumors infiltrate the parenchyma and expand rather than displace the spinal cord. Intramedullary tumors may extend over multiple spinal cord segments and obstruct the flow of cerebrospinal fluid within the cord, resulting in a peritumoral 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 outside the spinal cord, rather than within its parenchyma

  • Extradural: Located outside the dura

Most intradural tumors are benign and are usually meningiomas, schwannomas, neurofibromas, or myxopapillary ependymomas. Myxopapillary ependymomas occur most often in the cauda equina (1 Reference Spinal 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... read more ).

Most extradural tumors are metastatic. They usually originate as carcinomas of the lungs, breasts, prostate, kidneys, or thyroid or are sarcomas or hematologic malignancies, such as multiple myeloma or lymphoma.

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


  • 1. Koeller KK, Shih RY: Intradural extramedullary spinal neoplasms: Radiologic-pathologic correlation. Radiographics 39 (2):468–490, 2019. doi: 10.1148/rg.2019180200

Symptoms and Signs of Spinal Tumors

Spine tumors manifest with three defined pain syndromes:

  • Biologic (so-called)

  • Mechanical

  • Radiculopathy (radicular)

Biologic pain is typically the earliest symptom of all spinal tumors. The pain usually occurs at night or early in the morning and resolves with activity. It is thought to be caused by inflammatory mediators secreted by the tumor, which are influenced by the diurnal variation in endogenous corticosteroids secreted by the adrenal glands or by administration of exogenous corticosteroids.

Mechanical pain is caused by a spinal fracture and is worsened by movement or activity.

Radiculopathy (radicular pain) results from nerve root compression and follows the distribution of a nerve root.

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

Neurologic deficits referable to the affected level of the spinal cord may 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.

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

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 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 (ie, biologic) 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

Diagnosis of spinal 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, compression fractures, destruction 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 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 10 mg IV, then 6 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 emergencies because deficits may quickly become irreversible.

Some well-localized primary spinal 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 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, schwannomas, 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 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
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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