Spinal Tumor Overview

About Spinal Tumors

A spinal tumor is an abnormal mass of tissue within or surrounding the spinal cord and spinal column, in which cells grow and multiply uncontrollably. Spinal tumors are classified by grade, origin and location. Spinal tumors are graded as benign (non-cancerous) or malignant (cancerous). Primary spinal tumors originate in the spine or spinal cord and secondary or metastatic spinal tumors are the result of cancer which has spread from another site in the body to the spine. Spinal tumors may also be referred to by the area of the spine in which they occur. These basic areas are cervical (neck area), thoracic (mid-back), lumbar (lower back) and sacrum (bone at the end of the spine). Additionally, spinal tumors are also classified by their location in the spine – anterior (front) and posterior (back).

Spinal Tumors by Grade

Benign Spinal Tumors

  • Aneurysmal Bone Cyst (ABC): These benign cysts of the bone are filled with fluid and appear to expand the bone. ABCs can occur in any bone, but when they appear in the spine they occur most often in the posterior areas. Most are discovered when patients are in their teens or twenties.
  • Hemangiomas, Aggressive: A variant of benign hemangiomas, aggressive hemangiomas can increase in size and extend outside the bone into the soft tissue. These may require treatment in some instances.
  • Hemangiomas, Benign: Hemangiomas are non-cancerous (benign) tumors made of abnormal blood vessels. They are common and can occur anywhere in the body. Most hemangiomas of bone are in the spine and are found more often with advancing age. Spinal hemangiomas usually appear in the middle of your back (thoracic area) or your lower back (lumbar area). Most are incidentally found and do not need intervention.
  • Giant Cell Tumor (GCT) of bone: Giant cell tumors are benign but locally aggressive tumors that can appear in any bone. When in the spine, this aggressive tumor is most often found in the sacrum, a bone at the base of the spine. These tumors require treatment, including minimally invasive surgery, or medical therapies, depending on patient’s condition and preferences.
  • Osteoid Osteoma: A benign bone tumor which can develop in any bone of the body. Osteoid osteomas characteristically cause night pain which is relieved by non-steroidal anti-inflammatory medications. Though osteoid osteomas can cause pain and discomfort, they do not spread throughout the body. These tumors tend to be small—less than 1.5 centimeters in size and they do not grow. It is the most common cause of painful scoliosis. Treatment focuses on removing or destroying the tumor in a minimally invasive way.
  • Osteoblastoma: A benign bone tumor that is structurally related to an osteoid osteoma. Osteoblastoma differs from osteoid osteoma in its ability to grow larger than 2.0 centimeters in diameter and it can have a more aggressive behavior. Treatment focuses on removing or destroying the tumor in a minimally invasive way.

Malignant Spinal Tumors

  • Ewing Sarcoma: Ewing sarcoma is a cancerous tumor that grows in the bones or in the soft tissue around bones of the legs, pelvis, ribs, arms or spine. Ewing sarcoma presents in young adults and is often painful. The treatment is centered around chemotherapy followed by surgery or radiation, followed by more chemotherapy.
  • Malignant Peripheral Nerve Sheath Tumor (MPNST): Malignant peripheral nerve sheath tumors (MPNST) are sarcomas which originate from nerves, and nerve roots or from cells associated with the nerve sheath, such as Schwann cells, perineural cells, or fibroblasts. Because MPNSTs can arise from multiple cell types, the overall appearance can vary greatly from one case to the next. This tumor is seen more commonly in patients who have a condition called neurofibromatosis type I. Treatment often includes pre-operative radiation followed by surgery to remove the tumor completely.
  • Osteosarcoma: Osteosarcoma is the most common sarcoma of bone. There are two common age groups in which osteosarcomas present, one is in children and young adults and a second peak is seen in the elderly. This often presents as a painful lesion and requires a thorough evaluation. This is often treated with chemotherapy followed by surgery to remove the tumor entirely, followed by more chemotherapy.

Spinal Tumors by Origin and Location

Metastatic Spinal Tumors

Metastatic tumors are also called secondary tumors because they originate from another site such as the breast, lung, or colon. This is the most common type of tumor to occur in the spine. Any tumor that has the potential to metastasize can go to the spine but the most common solid tumors are breast, lung, prostate, and renal (kidney) cell. Hematologic (non-solid) cancers such as multiple myeloma and lymphoma also occur in the spine often. Metastatic tumors to the spine can cause severe pain, fractures, and neurologic problems such as weakness as well as paralysis, loss of sensation, and bowel bladder difficulties.

Primary Spinal Tumors

Primary spinal tumors are much less common, comprising less than 10 percent of all spinal tumors. Primary spinal tumors occur from the bone or soft tissue structures of the spine including cartilage or cells that give rise to the discs of the spine. Primary spinal tumors include chordoma, chondrosarcoma, osteosarcoma, giant cell tumor, or aggressive hemangioma.

Spinal Cord Tumors

Spinal cord tumors are tumors that arise from the spinal cord and/or nerve structures. They occur in the intradural space (within the spinal canal) and may be inside or outside of the spinal cord. Spinal cord tumors rarely metastasize outside of the spinal canal but can spread within the spinal canal. Spinal cord tumors include the following:

  • Astrocytomas: Astrocytomas are tumors that arise from the glial cells (support cells) of the spinal cord. They occur as either low-grade (slow growing) or high-grade (more aggressive and rapidly growing) astrocytomas. Complete resection (removal) is recommended but not possible in all cases, especially for high-grade tumors. Chemotherapy and radiation treatments are also available for difficult to remove tumors.
  • Ependymoma: Ependymomas are tumors that arise from the ependymal cells of the spinal cord. Contrast MRI scans typically reveal a sausage-like tumor. Complete surgical removal is recommended to minimize recurrence. Myxopapillary ependymomas are a subtype of ependymomas that occur at the conus (or distal end) of the spinal cord.
  • Schwannomas: Schwannomas are benign tumors arising from the Schwann cells of nerve rootlets. These are most commonly benign and grow very slowly. They can cause nerve and spinal cord compression. Surgical removal is recommended if they are symptomatic. These tumors are typically able to be removed completely and have a very low recurrence rate.
  • Meningiomas: Meningiomas are tumors of the protective layer around the spinal cord called the dura. These are typically benign, slow growing lesions but can become more aggressive. These tumors grow outside the spinal cord but can cause significant compression of the cord or nerve structures. Complete removal may require removal of the dura which then requires patch reconstruction of the dura to prevent leakage of spinal fluid (fluid surrounding the spinal cord). Total resection is recommended but not always possible. In these cases chemotherapy and radiation treatments may also recommended.
  • Neurofibromas: Neurofibromas are typically slow-growing, benign tumors arising from nerve rootlets and nerve cells. They can become malignant in rare cases. Neurofibromas as well as meningiomas and schwannomas may all be associated with genetic mutations such as a genetic condition called neurofibromatosis.

Symptoms and Diagnosis of Spinal Tumors

Symptoms for all types of spinal tumors are similar and include:

  • Pain that does not diminish with rest, pain that may be worse at night than during the day, or unprovoked, deep aching pain.
  • Muscle weakness (myopathy) or numbness in the arms or legs.
  • Numbness, tingling, or general loss of sensation.
  • Difficulty with urination (incontinence).
  • Change in bowel habits (retention).

Diagnosis for all spinal tumors depends on imaging studies including MRI, CAT scan, and X-rays, as well as the patient’s medical history.

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