Are you experiencing spine pain from
spinal tumors, and want to know more about treatment
options? The specialists at United Spine & Joint are
prepared to help you.
Contact us to learn
more about what option is best for you, what your insurance
will cover and any additional surgery costs.
What are Spinal Tumors?
spinal tumor is a cancerous (malignant) or noncancerous
(benign) growth that develops within or near your spinal
cord or within the bones of your spine. Although back pain
is the most common indication of a
spinal tumor, most
back pain is associated with stress,
strain and aging not with a tumor.
In most areas of your body, noncancerous tumors aren't
particularly worrisome. That's not necessarily the case with
your spinal cord, where a spinal tumor or a growth of any
kind can impinge on your nerves, leading to pain,
neurological problems and sometimes paralysis.
spinal tumor, whether cancerous or not, can threaten
life and cause permanent disability. Yet advances in spinal
tumor treatment offer more options than ever before.
Symptoms of Spinal Tumors
Depending on the location and type of tumor, various
signs and symptoms can develop, especially as a tumor grows
and impinges on your spinal cord or on the nerve roots,
blood vessels or bones of your spine. Signs and symptoms may
Back pain, often radiating to other parts of your
body and worse at night
- Loss of sensation or muscle weakness, especially in
- Difficulty walking, sometimes leading to falls
- 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 your body, depending on which nerves
Scoliosis or other spinal deformity resulting from a
large, but noncancerous tumor
Back pain, especially in the middle or lower back, is
the most frequent symptom of both noncancerous and cancerous
spinal tumors. The pain may be worse at night or on
awakening. It also may spread beyond your spine to your
feet or arms and may become more severe over time in
spite of treatment.
Spinal tumors progress at different rates. In general,
cancerous tumors grow more quickly, whereas noncancerous
tumors may develop very slowly, sometimes existing for years
or even decades before causing problems.
When to Consult a Professional
Most back pain is not the result of a spinal tumor. But
because early diagnosis and treatment are important for many
back problems, see your doctor about your back pain if:
- It's persistent
- It's not activity related
- It gets worse at night
- It isn't relieved by over-the-counter analgesics
Seek immediate medical attention if you experience:
- Progressive muscle weakness or numbness in your legs
- Changes in bowel or bladder function
Causes of Spinal Tumors
Although scientists are learning more about the genetic
and environmental factors involved in the development of
many kinds of tumors, spinal tumors are still a relatively
unknown quantity. Spinal tumor cells often contain a number
of abnormal genes, but in many cases, researchers don't know
what causes these genetic alterations. They do know that in
some cases, spinal cord tumors run in families and are
associated with familial cancer syndromes such as:
Neurofibromatosis 2. In this hereditary
disorder, noncancerous tumors develop on or near the
nerves related to hearing, leading to progressive
hearing loss in one or both ears. Some people with
neurofibromatosis 2 also develop tumors in the arachnoid
layer of the spinal cord or in the supporting glial
- Von Hippel-Lindau disease. This
rare, multisystem disorder is associated with
noncancerous blood vessel tumors (hemangioblastomas) in
the brain, retina and spinal cord and with other types
of tumors in the kidneys or adrenal glands.
It's also known that spinal cord lymphomas cancers that
affect lymphocytes, a type of immune cell are more common
in people whose immune systems are compromised by
medications or disease.
Overview of the spine
Your spine provides structural support for your body while
at the same time allowing flexible movement. It comprises a
complex network of bones, muscles, cartilage, ligaments,
joints and nerves. Of these, the vertebrae and spinal
cord are the most important for an understanding of spinal
- Vertebrae. Your spine is made up of
24 small bones (vertebrae), stacked on top of one
another, that enclose and protect the spinal cord and
its nerve roots. The sacrum, containing five fused
vertebrae, sits below the lower back. The last three
tiny vertebrae, also fused together, are called the
- Spinal cord. Your spinal cord is a
double-layered, long column of nerve fibers that carries
messages to and from your brain. The inner layer of your
spine contains nerve cells, blood vessels and glial
cells, which are cells that support the brain. The outer
layer contains nerve fibers (axons) that relay sensory
information and conduct motor impulses. Wrapped around
the entire spinal cord are three protective membranes (meninges).
The inner membrane is called the pia mater, the middle
is called the arachnoid, and the tough, outer membrane,
to which the spinal nerves attach, is called the dura
Types of Spinal Tumors
Spinal tumors are classified according to their location in
- Extradural (vertebral) tumors. Most
tumors that affect the vertebrae have spread (metastasized)
to the spine from another site in the body often the
breast, lung or kidney. Although the original
(primary) cancer is usually diagnosed before back
back pain may be the first symptom of disease in
people with metastatic spinal tumors.
Cancerous tumors that begin in the bones of the spine
are far less common. Among these are
osteosarcomas (osteogenic sarcomas), the most common
type of bone cancer in children, and
Ewing's sarcoma, a particularly aggressive tumor
that affects young adults.
Multiple myeloma is a cancerous disease of the bone
marrow the spongy inner part of the bone that makes
blood cells most commonly seen in older adults.
Noncancerous tumors, such as osteoid osteomas,
hemangiomas, also can develop in the bones of the
spine where they may cause long-standing pain, spinal
and neurological problems.
- Intradural-extramedullary tumors.
These tumors develop in the spinal cord's arachnoid
membrane (meningiomas), in the nerve roots that extend
out from the spinal cord (schwannomas and
neurofibromas) or at the spinal cord base (filum
terminale ependymomas). Meningiomas occur most often in
middle-aged women. Although almost always noncancerous,
meningiomas can be difficult to remove and may sometimes
recur. Nerve root tumors also are generally
noncancerous, although neurofibromas can become
cancerous over time. Ependymomas at the end of the
spinal cord are often large, and their treatment may be
complicated by the extensive system of nerves in that
- Intramedullary tumors. These tumors
begin in the supporting cells within the spinal cord.
Most are either astrocytomas, which mainly affect
children and adolescents, or ependymomas the most
common type of
spinal cord tumor in adults. Intramedullary tumors
can be either noncancerous or cancerous and, depending
on their location, may cause numbness, loss of feeling,
or changes in bowel and bladder function. In rare cases,
tumors from other parts of the body can
metastasize to the spinal cord itself.
Complications of Spinal Tumors
Both noncancerous and cancerous spinal tumors can
spinal nerves, leading to a loss of movement or
sensation below the level of the tumor and sometimes to
changes in bowel and bladder function. Nerve damage is often
permanent, and disabilities are likely to continue even
after the tumor is removed. Depending on its location, a
tumor that impinges on the spinal cord itself may be
Prepare for Your Evaluation
If you have symptoms that are common to spinal tumors
persistent, unexplained back pain, weakness or numbness
in your legs, or changes in your bowel or bladder function
call your doctor promptly. After your doctor sees you, he or
she may refer to you a doctor who is specially trained to
diagnose and treat cancer (oncologist) or brain and spinal
cord conditions (neurologist).
Here's some information to help you get ready for your
appointment, and what to expect from the doctor.
What you can do
- Write down any symptoms you've been
experiencing, and for how long.
- List your key medical information,
including other conditions with which you've been
diagnosed and the names of any prescription and
over-the-counter medications you're taking.
- Note any family history of brain or spinal
tumors, especially in a first-degree relative,
such as a parent or sibling.
- Take a family member or friend along, if
possible. Sometimes it can be difficult to soak
up all the information provided to you during an
appointment. Someone who accompanies you may remember
something that you missed or forgot.
- Write down questions to ask your
Questions to ask your doctor at your initial appointment
- What may be causing my symptoms or condition?
- Are there any other possible causes?
- What kinds of tests do I need?
- What do you recommend for next steps in determining
my diagnosis and treatment?
- Should I see a specialist?
Questions to consider if your doctor refers you to an
oncologist or neurologist include:
- Do I have a
- What type of tumor do I have?
- Is the tumor noncancerous or cancerous?
- If the tumor is cancerous, how aggressive is it?
- What are the goals of treatment in my case?
- Am I a candidate for surgery? What are the risks?
- Am I a candidate for
radiation? What are the risks?
- What treatment approach do you recommend?
- If the first treatment isn't successful, what will
we try next?
- What is the outlook for my condition?
- Do I need a second opinion?
In addition to the questions that you've prepared to ask
your doctor, don't hesitate to ask questions during your
appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions.
Thinking about your answers ahead of time will help you make
the most of your appointment. A doctor who sees you for a
possible spinal tumor may ask:
- What are your symptoms?
- When did you first notice these symptoms?
- Have your symptoms gotten worse over time?
- If you have pain, where does the pain seem to start?
- Does the pain spread to other parts of your body?
- Have you experienced any weakness or numbness in
- Have you had any difficulty walking?
- Have you had any problems with your bladder or bowel
- Have you been diagnosed with any other medical
- Are you currently taking any over-the-counter or
- Do you have any family history of noncancerous or
cancerous spinal tumors?
Diagnosing Spinal Tumors
Spinal tumors sometimes may be overlooked because
they're rare and because their symptoms resemble those of
more common conditions. For that reason, it's especially
important that your doctor know your complete medical
history and perform both physical and neurological exams. If
your doctor suspects a spinal tumor, one or more of the
following tests can help confirm the diagnosis and pinpoint
the tumor's location:
Spinal magnetic resonance imaging (MRI).
radiation, MRI uses a powerful magnet and radio
waves to produce cross-sectional images of your spine.
MRI accurately shows the spinal cord and nerves and
yields better pictures of bone tumors than computerized
tomography (CT) scans do. A contrast agent that makes
certain tissues and structures light up may be injected
into a vein in your hand or forearm during the test. In
addition, some medical centers use high-field-strength
scanners to find small tumors that might otherwise be
missed. You may feel claustrophobic inside the scanner
or find the loud thumping sound it makes disturbing. But
you're usually given earplugs to help with the noise,
and some scanners are equipped with televisions or
headphones. If you're very anxious, your doctor may
prescribe a mild sedative.
- Computerized tomography (CT). This
test uses a narrow beam of radiation to produce
detailed, cross-sectional images of your spine.
Sometimes it may be combined with an injected contrast
dye to make abnormal changes in the spinal canal or
spinal cord easier to see. Although not invasive, this
test exposes you to more radiation than a regular X-ray
- Myelogram. In this test, a contrast
dye is injected into your spinal column. The dye then
circulates around your spinal cord and spinal nerves,
which appear white on an X-ray or CT scan. Because the
test poses more risks than does an MRI or conventional
CT, a myelogram is usually not the first choice for
diagnosis, but it may be used to help identify
Biopsy. The only way to determine whether a
tumor is noncancerous or cancerous is to examine a small
tissue sample (biopsy) under a microscope. If the tumor
is cancerous, biopsy also helps determine the cancer's
grade information that helps determine treatment
options. Grade 1 cancers are generally the least
aggressive and grade 4 cancers, the most aggressive. How
the sample is obtained depends on your overall health
and the location of the tumor. Your doctor may use a
fine needle to withdraw a small bit of tissue, or the
sample may be obtained during an operation.
Treatment for Spinal Tumors
Ideally, the goal in treating a spinal tumor is to
eliminate the tumor completely, but this aim is complicated
by the risk of permanent damage to the surrounding nerves.
Doctors also must take into account your age, overall
health, the type of tumor and whether it is primary or has
spread to your spine.
Treatment options for most spinal tumors include:
- Monitoring. Sometimes spinal tumors
are discovered before they cause symptoms often when
you're being evaluated for another condition. If small
tumors are noncancerous and aren't growing or pressing
on surrounding tissues, watching them carefully may be
the only treatment that you need. This is especially
true in older adults for whom surgery or
radiation therapy may pose special risks. If you
decide not to treat a spinal tumor, your doctor will
recommend periodic scans to monitor the tumor's growth.
- Surgery. This is often the first
step in treating tumors that can be removed with an
acceptable risk of nerve damage. Newer techniques and
instruments allow neurosurgeons to reach tumors that
were once inaccessible. The high-powered microscopes
used in microsurgery make it easier to distinguish
tumors from healthy tissue. Doctors also can test
different nerves during surgery with electrodes, thus
minimizing nerve damage. In some instances, they may use
sound waves to break up tumors and remove the remaining
Even with advances in treatment, not all tumors can be
removed completely. Surgical removal is the best option
for many intramedullary and intradural-extramedullary
tumors, yet large ependymomas at the end of the spine
may be impossible to extricate from the many nerves in
this area. Although noncancerous tumors in the vertebrae
can usually be completely removed,
metastatic tumors are less likely to be operable.
When a tumor has spread to the spine, radiation alone
is usually the treatment of choice. However, research
has found that surgery combined with radiation may be
more effective at preventing loss of nerve function in
people who are healthy enough to tolerate an operation
and who have tumors that have spread from an unknown
location, have some evidence of nerve injury, have
tumors resistant to radiation or have recurrent tumors
that were previously irradiated. Recovery from spinal
surgery may take weeks or months, depending on the
procedure, and you may experience a temporary loss of
sensation or other complications, including bleeding and
damage to nerve tissue.
- Standard radiation therapy. This
may be used following an operation to eliminate the
remnants of tumors that can't be completely removed or
to treat inoperable tumors. It's also often the first
line therapy for metastatic tumors. Radiation may also
be used to relieve pain or when surgery poses too great
Medications can help some of the side effects of
radiation, such as nausea and vomiting. And depending on
the type of tumor, your doctor may be able to modify
your therapy to help prevent damage to surrounding
tissue and improve the treatment's effectiveness.
Modifications may range from simply changing the dosage
of radiation you receive to using sophisticated
techniques that offer better protection to healthy
tissue, such as 3-D conformal radiation therapy.
- Stereotactic radiosurgery (SRS).
This newer method, capable of delivering a high dose of
radiation, is being studied for the treatment of
spinal tumors. In SRS, doctors use computers to
focus radiation beams on tumors with pinpoint accuracy,
and from multiple angles. This approach has been proved
effective in the treatment of brain tumors. Research is
under way to determine the best technique, radiation
dose and schedule for SRS in the treatment of spinal
- Chemotherapy. A standard treatment
for many types of cancer,
chemotherapy hasn't proved beneficial for most
spinal tumors. However, there may be exceptions. Your
doctor can determine whether chemotherapy might be
beneficial for you, either alone or in combination with
- Other drugs. Because surgery and
radiation therapy as well as tumors themselves can
cause inflammation inside the spinal cord, doctors
corticosteroids to reduce the swelling, either
following surgery or during radiation treatments.
Although corticosteroids reduce inflammation, they are
usually used for short periods only to avoid such
serious side effects as
osteoporosis, high blood pressure,
diabetes and an increased susceptibility to