Spinal tumors are an abnormal growth of tissue within or surrounding the spinal cord. The abnormal growth of the tissues is unchecked by the natural cellular mechanisms to halt the growth. Depending upon their cancerous (metastatic) potential, they may be benign (noncancerous), low-grade cancerous, or highly cancerous.

The spinal tumors may arise from the spinal column directly, which are known as primary spinal tumors. The tumors may also be implanted in the spinal column from another body part/organ known as secondary tumors or metastasis.

MRI of the lumbar spine in the axial section.

The spinal tumors are further classified depending upon their location in relation to the spinal cord. Intradural extramedullary tumors are contained within the spinal cord’s lining (dura mater) but outside the spinal cord tissue. Intradural intramedullary tumors are located inside the tissue of the spinal cord. Extramedullary tumors are situated outside the lining of the spinal cord and commonly arise from the vertebral bodies.

Intradural Extramedullary Tumors

The intradural extramedullary tumors represent the majority of the primary central nervous system spinal tumors. These tumors being outside the spinal cord tissue but inside their lining create a pressure effect on the cord. These are usually associated with back pain, which is more intense at night.

The tumors may also cause compression syndromes like cauda equina or central cord compression. There may be loss of bowel bladder function with weakness and numbness of the extremities. Patients may also complain of a radicular pattern of pain due to compression of specific nerve roots.

Schwannoma and Meningioma are common intradural extramedullary tumors. Schwannomas commonly affect middle-aged men/women and are mostly non cancerous. Schwannomas may be associated with a genetic disease known as Neurofibromatosis type 2.

Meningiomas occur more frequently in women and commonly affect the mid-back (thoracic spine). As with schwannomas, meningiomas are also commonly associated with neurofibromatosis type 2.

Intradural Intramedullary Tumors

The spinal tumors that arise within the spinal cord tissue often initially present with bowel/bladder dysfunction. These tumors often occur in children but may also affect adults. Patients often complain of weakness of the limbs associated with numbness in one or more regions along with bladder/bowel dysfunction.

Ependymomas and astrocytomas are intramedullary tumors arising from the spinal cord tissue. Astrocytomas commonly affect children and adults in their third decade. Ependymoma affects the spinal cord, often causing shape changes in the vertebral bodies.

Extradural Tumors

The extradural tumors are located outside the spinal cord’s lining and are commonly a result of advancing cancer in another part of the body. Cancer, in another part of the body, such as the prostate or breast, may spread to the spine when left unchecked. The tumor cells may reach the spine via blood or the CSF (cerebrospinal fluid) from their primary location. Rarely lymphomas may occur in the spine, usually affecting the cervical spine.

Diagnosis

The diagnosis of spinal tumors is made after thorough clinical examinations along with radiological tests and tissue biopsies. An X-ray is usually the first test done in case of a suspected spine tumor and is usually followed by an MRI that can clearly define the spine’s soft tissue structures. Multiple areas may be subjected to radiological tests to look for metastasis and to find the primary tumor in case of spine metastasis. Other radiological tests, such as bone scans, may be used.

Tissue biopsies are performed to diagnose correctly and may also be used to stage the tumor. The biopsied tissue may help the surgeon decide between the various treatment options that may be used for best results.

MRI of lumbar spine in sagittal section

Management

The treatment of spine tumors depends upon various factors such as the type of tumor, size, location, stage, age of the patient, etc. The treatment usually involves surgical resection of the tumor followed by chemotherapy or radiation therapy. With the advancement of spinal surgical techniques and early detection by imaging, most patients have an excellent prognosis with treatment.