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Spinal Tumors: What to Know

They’re rare, but more treatment options are available when they’re identified early.

SOMEWHERE IN THE vicinity of 80% of Americans will suffer from acute back pain at least once in their lives, with most episodes resolving over time and very few turning into conditions that require reparative surgery. Though conditions like herniated discs, spinal instability and stenosis account for a large amount of back pain, there’s another much less common condition responsible for similar symptoms of acute and chronic back pain: spinal tumors. In the United States, only about 10,000 people a year will develop a tumor in the spine.

A spinal tumor creates a mass either inside or outside the spinal canal and is considered an abnormal growth. These tumor cells grow uncontrollably and can be either malignant (cancerous cells) or benign (non-cancerous cells). Even though some tumors do not contain cancer cells, they may still pose a threat, as serious problems can arise as the mass grows and presses on the spinal cord or surrounding nerves.[ 

Under the broad category of “spinal tumors,” there are different sub-types, dependent upon where on the spine the mass is growing.

  • Intramedullary spinal tumors occur inside the spinal cord.
  • Intradural extramedullary don’t enter the spinal cord but are spinal tumors within the spinal cord covering.
  • Extradural spinal tumors occur in the vertebral column involving cartilage and bone.

Treatment of a spinal tumor depends on where it starts. Those that originate in the spinal cord are called primary spinal tumors, and secondary tumors (or metastatic tumors) result from cancer that has spread to the spinal cord from another location in the body.

Here’s where things get tricky. There is not one specific symptom that distinguishes a spinal tumor from other conditions that can cause back pain. The most common early symptom of all types of spinal tumors, benign and malignant, is simply back pain. This type of back pain, however, is not explicitly attributed to injury, stress or physical activity. As the tumor grows, it begins to put pressure on the spinal cord, surrounding nerve roots, blood vessels and bones that cause many similar symptoms to a herniated disc or other spine issues. Some of these symptoms include: back pain that is worse at night and when lying down, pain that increases with activity, muscle weakness/numbness/tingling in the arms or legs, pain and difficulty when standing, difficulty with walking that sometimes leads to falls, decreased sensitivity to pain/heat/cold, loss of bladder or bowel control and erectile dysfunction in men.[ 

Having any of these symptoms doesn’t mean you have a spinal tumor, but because early diagnosis and treatment are critical, I recommend scheduling a doctor visit for any pain that is 1) progressive 2) not related to activity 3) worsens at night or 4) if you’ve developed any back pain and have a prior history of cancer. Changes in bowel or bladder function and progressive muscle weakness require immediate medical attention, and these shouldn’t wait for a regular doctor’s visit.

If a spinal tumor is suspected to be the cause of symptoms – or even to rule it out – an MRI or CT test may be indicated to show all of the parts of the spinal cord and spine and to pinpoint the location and size of the tumor. After confirmation of a tumor with these scans, the only definitive way to identify a benign or malignant tumor is through a biopsy to examine a small tissue sample. If the tumor happens to be cancerous, the biopsy will also help determine the type of cancer present, which in turn can illuminate the most appropriate treatment options.

Ideally, the goal of treatment is to remove the tumor altogether. However, sometimes complete removal can increase the risk of permanent damage to the spinal cord and spinal nerves, in turn, affecting some degree of bodily function. With spinal tumors, there is no “one size fits all” solution, and every patient requires an individualized plan based on his or her own needs. In developing a treatment plan, age, overall health and location/origin of the tumor are all taken into consideration. Generally, if small benign tumors are detected that are not yet causing bothersome symptoms, carefully monitoring them may be the best option with the least amount of risk involved. Surgery is recommended only when the benefits of removing the tumor outweigh the possible risk of spinal cord or other damage. If there are parts of the tumor remaining after surgery, radiation or chemotherapy can be used to eliminate them; these can also be used to attempt to shrink cancer tumors when an operation is deemed too risky.[ 

Though rare, spinal tumors can cause severe and permanent disability if not detected and treated promptly. My best advice for all back pain sufferers: Err on the side of caution and visit your spine specialist at the first sign of suspicious symptoms for the best chance at a successful treatment.

Neel Anand, M.D., Contributor

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