Spinal tumors are neoplasms located either in the spine or in the spinal cord. There are three main types of spinal tumors classified according to their localization: extradural and intradural (intradural-intramedullary and intradural-extramedullary). Extradural tumors are located outside the dura mater coating and are most often metastatic. Intradural tumors are located inside the dura mater and are subdivided into intramedullary and extramedullary tumors. Intradural-intramedullary tumors are located in the dura mater and parenchyma of the spinal cord.

On the other hand, intradural-extramedullary tumors are located in the dura mater but outside the parenchyma of the spinal cord. The most common symptom of spinal tumors is nocturnal back pain. Other common symptoms are muscle weakness, sensory loss and difficulty walking. Loss of control of the intestine and bladder can occur in the later stages of the disease.


Signs and symptoms

The symptoms of spinal tumors are often nonspecific, which leads to a delay in diagnosis. The compression of the spinal nerves and the weakening of the vertebral structure are the cause of the symptoms. Pain is the most common symptom during presentation. Other common symptoms of spinal cord compression are muscle weakness, sensory loss, numbness of the hands and legs, and rapid paralysis. Intestinal or bladder incontinence often occurs in the advanced stages of the disease. Children may have deformities of the spine, such as scoliosis. The diagnosis is difficult, mainly because the symptoms often mimic more common and benign degenerative diseases of the spine.

Compression of the spinal cord is frequently observed in patients with metastatic malignant tumors. Back pain is a primary symptom of spinal cord compression in patients with a known malignant tumor. Back pain can prompt a bone scan to confirm or rule out a metastasis of the spine. The rapid identification and intervention of metastatic compression of the spinal cord is necessary to preserve neurological function.



The cause of the majority of spinal tumors is currently unknown. Primary tumors of the spine are associated with a few genetic syndromes. Intramedullary hemangioblastomas can be observed in patients with von Hippel-Lindau disease. Spinal cord lymphomas are frequently observed in patients whose immune system is suppressed. Most extradural tumors are due to metastases, most often to breast, prostate, lung or kidney cancer.



Diagnosis – Medical examination

The diagnosis of spinal tumors is difficult because the symptoms can be nonspecific and often mimic more common and benign degenerative diseases of the spine. A complete medical examination is necessary to look for signs or symptoms that could indicate a more serious condition. This includes a comprehensive neurological examination focused on a motor or sensory disorder. Patients with a benign degenerative disease of the spine or a tumor of the spine often experience back pain. A patient with radiculopathy or myelopathy makes one suspect a more serious condition.



Imaging is often the next step when the diagnosis is unclear or when a serious condition requiring immediate intervention is suspected. Common types of medical imaging include X-rays, computed tomography (CT), magnetic resonance imaging (MRI), myelography and bone scintigraphy. MRI is the imaging of choice for spinal tumors. Myelography can be used as a substitute when the patient cannot undergo an MRI or it is not available. X-rays and computed tomography are more often used to visualize bone structures. However, they are less frequently used for spinal cord tumors, since they cannot reliably detect them. Bone scintigraphy can be used as an additional imaging modality for tumors involving the bone structures of the spine.



The treatment varies considerably depending on the type of spinal cord tumor, the objectives of the care and the prognosis. The main forms of treatment are surgical resection, radiation therapy and chemotherapy. Steroids (for example, corticosteroids) can be administered if there are signs of compression of the spinal cord. They do not affect the tumor mass but tend to reduce the inflammatory reaction that surrounds it and to decrease the overall volume of the mass encroaching on the spinal cord.



Surgery has several indications depending on the type of tumor, including complete resection, spinal decompression and stabilization. An attempt at total macroscopic resection for a possible cure is an option for patients with primary spinal cord tumors. Extramedullary tumors lend themselves better to resection than intramedullary tumors, and it is possible to operate on them by microendoscopic or purely endoscopic approaches. In patients with metastatic tumors, the treatment is palliative and aims to improve the patient’s quality of life. In these cases, the surgical indications are pain, stabilization and decompression of the spinal cord.



Non-surgical treatment

Observation, chemotherapy and radiotherapy are possible options in addition to surgery or for non-operable tumors. Since intradural-extramedullary tumors are often benign, observation with follow-up imaging is an option in cases where the lesions are small and the patient is asymptomatic. Radiotherapy and chemotherapy can be administered alone or in combination with surgery. The choice of chemotherapy or radiotherapy is a multidisciplinary process and depends on the histological grade, the type of tumor and the amount of surgical resection performed. In cases where radiotherapy is chosen, the rays are usually delivered to the involved segment of the spinal cord and to the uninvolved segment above and below the involved segment.

The combination of minimally invasive surgery and radiation therapy or chemotherapy is a new technique for treating spinal tumors. This treatment can be adapted to the particular tumor of the spine, whether it is metastatic or primary. Some suggest that direct decompressive surgery, combined with postoperative radiotherapy, gives better results than treatment with radiotherapy alone for patients suffering from spinal cord compression due to metastatic cancer.