What is a spinal tumor?
A spinal tumor is an abnormal mass of tissue within or surrounding the spinal cord and/or spinal column. These cells grow and multiply uncontrollably, seemingly unchecked by the mechanisms that control normal cells. Spinal tumors can be benign (noncancerous) or malignant (cancerous). Primary tumors originate in the spine or spinal cord, and metastatic or secondary tumors result from cancer spreading from another site to the spine.
At Northwell Health, we take the most advanced approach to treating malignant and benign spinal tumors. Our team of specialists has decades of training and experience, applying the latest technology and research-backed therapies to treat spinal tumors. From diagnosis through treatment and follow-up, you are in the capable hands of some of the region's top tumor experts every step of the way.
Our physicians regularly participate in multidisciplinary conferences where spinal tumor experts across multiple departments and disciplines (including medical oncology, surgical oncology and radiation oncology) share ideas and best practices for delivering the best possible collaborative patient care.
Types of spinal tumors
There are many different types of spine tumors, which are diagnosed and treated by their location and the type of cells they contain.
- Intramedullary—Tumors that grow inside the spinal cord, most frequently occurring in the cervical (neck) region. They typically derive from glial or ependymal cells that are found throughout the interstitium of the spinal cord. Astrocytomas and ependymomas are the two most common types.
- Extramedullary—Tumors that grow outside the spinal cord, that typically attributed to metastatic cancer or schwannomas derived from the cells covering the nerve roots. Types of these tumors include meningiomas, schwannomas and myxopapillary ependymoma.
Non-mechanical back pain, especially in the middle or lower back, is the most frequent symptom of both benign and malignant spinal tumors. Depending on the location and type of tumor, other signs and symptoms can develop, especially as a malignant tumor grows and compresses on the spinal cord, the nerve roots, blood vessels or bones of the spine.
Additional symptoms can include the following:
- Loss of sensation or muscle weakness in the legs, arms or chest
- Difficulty walking
- Decreased sensitivity to pain, heat and cold
- Loss of bowel or bladder function
- Paralysis that may occur in varying degrees and in different parts of the body
- Scoliosis or other spinal deformity
The cause of most primary spinal tumors is unknown. Some of them may be attributed to exposure to cancer-causing agents. Spinal cord lymphomas, which are cancers that affect lymphocytes (a type of immune cell), are more common in people with compromised immune systems. In a small number of cases, primary tumors may result from presence of these two genetic diseases:
- Neurofibromatosis 2—A hereditary disorder, where benign tumors may develop in the arachnoid layer of the spinal cord or in the supporting glial cells.
- Von Hippel-Lindau disease—This rare, multi-system disorder is associated with benign blood vessel tumors (hemangioblastomas) in the brain, retina and spinal cord, and with other types of tumors in the kidneys or adrenal glands.
How is it diagnosed?
The first step in diagnosing a spinal tumor is usually a thorough examination, during which your doctor will also review personal and family medical history. If a tumor is suspected, you will likely need additional tests. Doctors use a variety of imaging tests and other diagnostic methods to deliver an accurate tumor diagnosis, including:
- Bone scan—After a dye is injected and absorbed by bone tissue, X-rays are taken to detect tumors and bone abnormalities.
- CT or CAT scan (computerized axial tomography)—This procedure uses a combination of X-rays and computer technology to produce detailed 3D images. This test is normally used to detect and monitor tumors and can be used to guide treatment procedures.
- MRI scan (magnetic resonance imaging)—A powerful magnet, radio waves, and computer imaging combine to create highly detailed pictures of areas to show if and where the cancer has spread.
- MR SPECT (magnetic resonance spectroscopy or MRS)—This specialized spine scan can diagnose whether an unexpected finding on MRI is a tumor or not.
- Neurological exam—The physician tests reflexes, muscle strength, eye and mouth movement, coordination and alertness.
- Biopsy—For some patients, a surgical procedure called a biopsy (much smaller than a complete tumor removal) may be preferred to a larger operation as a way to diagnose what kind of tumor is present.
- Spinal tap—The physician uses a thin needle to remove fluid from the lower spine. The fluid is then checked by a pathologist for cancer cells or other problematic signs.
Treatment decision-making is multidisciplinary, incorporating the expertise of spinal surgeons, medical oncologists, radiation oncologists and other medical specialists. The selection of treatments, including both surgical and nonsurgical, is therefore made with the various aspects of the patient’s overall health and goals of care in mind.
Nonsurgical treatment options include observation, chemotherapy and radiation therapy. Tumors that are asymptomatic or mildly symptomatic and do not appear to be changing or progressing may be observed and monitored with regular MRIs. Some tumors respond well to chemotherapy and others to radiation therapy, such as stereotactic radiosurgery.
Whether a minimally invasive procedure or traditional "open" surgery is used depends on symptoms, MRI findings and the location of the tumor.
The most common surgical procedures are:
- Minimally invasive discectomy/fusion
- A combination of minimally invasive surgery and radiation or chemotherapy