Spinal and spinal cord tumours

Spinal tumours are pathological lesions that develop in the spine and/or the spinal cord.

They may be benign or malignant and can occur at any level of the spinal column.

What are spinal tumours?

The spinal cord is a bundle of nerves extending from the brain down to the lumbar spine, responsible for transmitting nerve signals throughout the body. It is surrounded by the vertebrae, which are the bones of the spine, and protected by cerebrospinal fluid (CSF).

A spinal tumour is defined as an abnormal growth of cells in this region. Tumours are divided into:

Primary tumours, originating in the spine or spinal cord.
Secondary (metastatic) tumours, representing spread of cancer from another part of the body.

The cancers that most frequently metastasise to the spine are lung, breast, prostate and gastrointestinal cancers, as well as melanoma and lymphoma.

Categories by location

According to their position relative to the spinal cord and meninges, tumours are classified into three main categories.

Extradural tumours

These lie outside the dura mater, mainly within the vertebral bones. They are the commonest type and usually represent bony metastases.

Intradural–extramedullary tumours

These are located inside the dura but outside the spinal cord itself. Most are benign, typically meningiomas, schwannomas and neurofibromas.

Intramedullary tumours

These grow within the substance of the spinal cord. They are the rarest group, with typical examples being astrocytomas (more common in children) and ependymomas (more common in adults).

Symptoms

Symptoms depend on the size, type and exact location of the tumour. The most common symptom is spinal pain – in the neck, thoracic region or lower back – with features that distinguish it from simple mechanical back pain:

Pain due to a spinal tumour does not improve with rest and often worsens when lying down or at night, frequently waking the patient from sleep.

Beyond pain, the following may occur:

Weakness in the arms or legs.
Numbness and tingling (paraesthesiae).
Burning sensation in the limbs.
Gait disturbance.
Bladder or bowel dysfunction.
Sexual dysfunction.
A band‑like feeling of tightness around the trunk.
Vertebral fractures in malignant tumours.

Important: compression of the spinal cord by a metastatic tumour is a medical emergency and requires immediate management to avoid permanent neurological damage.

Diagnosis

The diagnostic process begins with a detailed history and clinical examination, followed by imaging investigations.

Magnetic resonance imaging (MRI)

MRI is the investigation of choice for spinal tumours. It accurately demonstrates the location, extent and nature of the lesion, and is often performed with contrast to enhance visualisation.

Bone scintigraphy / PET

These are used in malignant disease to assess the overall extent of involvement. They detect abnormalities in bone and help identify multiple sites of disease.

Computed tomography (CT)

CT is excellent for lesions affecting the vertebral bones. It provides detailed images from multiple angles and is used as a complementary test or when MRI is contraindicated.

Biopsy

When confirmation of the tumour type is required, a tissue sample is obtained either using a fine needle under CT guidance or surgically, for histological examination.

Management

Choice of treatment depends on tumour type and position, the extent of disease and the patient’s general condition.

The goal is always maximal removal or control of the tumour with minimal damage to the spinal cord and nerves.

Surgical removal

Surgery is the main treatment for most tumours. The aim is complete excision where feasible. For intradural and intramedullary tumours, minimally invasive microsurgical techniques with intraoperative neuro‑monitoring are used to protect neural structures.

Radiotherapy

Radiotherapy is offered for malignant tumours when surgical removal is not possible or as an adjunct after surgery. It may consist of one or multiple sessions.

Radiosurgery

Radiosurgery delivers high‑dose, targeted radiation (LINAC or Gamma Knife) without an incision. Treatment is completed in 1–5 sessions, usually without hospital admission, and the therapeutic effect develops gradually over several months.

Chemotherapy & medication

Chemotherapy is mainly used for metastatic tumours. Corticosteroids are employed to reduce oedema and relieve pressure on the spinal cord.

Spinal fusion / stabilisation

When the tumour itself or its surgical removal compromises spinal stability, metal constructs (pedicle screws, rods and cages) are implanted to prevent deformity and further neural injury.

Surveillance

In benign, slowly growing tumours that do not cause symptoms, patients may be managed conservatively with regular MRI scans and clinical review, without active treatment.

Management of metastatic spinal disease requires close collaboration between specialists – neurosurgeon, radiation oncologist, medical oncologist, pain specialist and physiotherapist.

Recovery and rehabilitation

The degree of recovery depends on the tumour type, the duration of spinal cord compression and the presence of neurological deficits. The spinal cord recovers slowly when it has been subjected to prolonged pressure.

Physiotherapy and occupational therapy play a central role in rehabilitation, helping to improve strength, coordination, balance and everyday function. Fatigue is a common symptom after severe illness or intensive treatment.

Short, regular rest periods, gradual return to everyday activities and avoidance of excessive exertion are recommended.