Spinal cord tumors

What are spinal cord tumors?

The medical term ‘tumor’ refers to an increase in the volume of a tissue in the body. This can result from a variety of causes. However, the term is most commonly associated with a cancerous disease. More precisely, cancers are malignant tumors, which are clearly distinguished from benign tumors.

Spinal tumors are therefore space-occupying lesions within the spine, that can be differentiated into benign and malignant tumors. They can be primary tumors that originate in the spine, or secondary tumors that originate from different tissues that have spread toward the spine. The latter tumors are also referred to as metastases. 

Although benign tumors are significantly more common than malignant ones, the most frequent tumors in the spine are metastases. In such cases, the primary tumor, which the metastases have originated from, has to be determined and appropriately treated.

Depending on the character, location, and growth rate, spinal tumors should be treated promptly, as there is a risk of the tumors compressing the spinal cord and the emerging nerve roots. Important warning signs include sensory disturbances, muscle flaccidity, or complete paralysis. 

Which types of spinal tumors are there?

Primary spinal tumors are relatively rare. They arise from cells of the vertebral bodies and usually grow very slowly. Tumors can generally arise from various types of cells including bone, cartilage, blood vessels, connective tissue, and blood.

Benign spinal tumors

Benign tumors are clearly demarcated from surrounding tissue and grow very slowly. They also displace that surrounding tissue at very slow rates and do not metastasize. Benign spinal tumors include, among others:

• Osteoid osteomas
• Osteoblastomas
• Chondromas
• Hemangiomas
• Fibrous histiocytomas
• Aneurysmal bone cysts
• Eosinophilic granulomas

Malignant spinal tumors

Malignant tumors typically grow rapidly and can infiltrate surrounding tissues. This means that they displace and invade other tissues, compromising their normal function. Furthermore, tumor cells can spread through blood and lymphatic vessels to other areas of the body.

Malignant spinal tumors include, among others:

• Ewing sarcomas
• Osteosarcomas
• Chondrosarcomas

Spinal metastases

Spinal metastases are much more common compared to primary spinal tumors. Compared to most primary tumors, metastases are very invasive and destructive in nature. As a result, they can destroy vertebral bodies, leading to instabilities and deformities of the spine.

The most common cancers that metastasize into the spine are: breast cancer, prostate cancer, lung cancer, thyroid cancer, and kidney cancer. Multiple myeloma is the most common malignant disease that causes bone metastases. It is a type of non-Hodgkin lymphoma which is a malignancy of immune cells (B-lymphocytes).

What are the causes and risk factors for spinal tumors?

The causes of spinal tumors also differ between benign and malignant tumors. Often no specific cause can be identified for benign tumors and remains unknown.

Similarly, only in rare cases can the cause of malignant primary spinal tumors be determined. In some tumor cells, certain genetic abnormalities may be present. These can be both congenital or acquired over time. In general, malignant tumors arise due to genetic mutations in their cells, causing them to proliferate uncontrollably and independently of external signals. 

Spinal metastases originate from tumor cells from other tissues and spread to the spine via blood and lymphatic vessels. Although the exact causes of the cancers outside of the spine also often remain unknown, various risk factors have been identified that predispose cells to a malignant transformation.

An unhealthy lifestyle with little physical activity and an unbalanced diet belongs to these risk factors. Furthermore, stress may also contribute to the development of various illnesses. Smoking and excessive alcohol consumption remain known risk factors for many cancers.

However, it is important to note that while these risk factors increase the probability of diseases, they do not inevitably lead to malignant disease.

Symptoms and prevalence of spinal tumors

Primary spinal tumors can remain asymptomatic for a long period of time and are often discovered incidentally during imaging performed for other reasons. The most common and earliest symptom of spinal metastases is pain. The pain can occur in the affected segment of the spine as well as radiate to distal body regions that are supplied by the corresponding spinal nerves. It is caused by damage to the outer bone layer – the periosteum – which is much more sensitive compared to bone tissue. 

Furthermore, the infiltrated tumor cells cause inflammatory reactions that further intensify pain. Some metastases may also induce bone remodeling or resorption of the vertebral bodies, releasing calcium into the bloodstream. The elevated blood calcium levels can lead to kidney dysfunction or cardiac arrhythmias. 

Larger bony tumors affecting the spine may lead to instability. This can result in fractures even without adequate trauma or force. Therefore, in the presence of such pathological fractures, spinal tumors have to be ruled out.

Compression of the spinal cord may result in sensory deficits or paralysis. Similarly, bladder or bowel dysfunctions may also be caused by a spinal tumor. 

How are spinal tumors diagnosed? 

As most spinal tumors grow slowly and cause little to no symptoms, they are often discovered incidentally. For example, on X-ray, CT, or MRI imaging performed as part of a diagnostic workup for back pain. Then it must be determined whether the tumor is an incidental finding or responsible for the patient’s symptoms.

X-ray and CT imaging allow good visualization of bone structures. They are the best imaging modalities for diagnosing spinal tumors. MRI is best for evaluating surrounding soft tissues and is better suited for diagnosing cartilaginous or neural tumors.

If the imaging results suggest a malignant primary tumor, further diagnostics should be initiated to look for metastases in other tissues, such as the lungs. Conversely, when spinal metastases are found, the focus should be on identifying the primary tumor in other organs.

Treatment of spinal tumors and metastases

Radiation therapy

Radiation therapy is one of the three pillars of cancer treatment, alongside chemotherapy and surgery. This method uses ionizing radiation or particle radiation to destroy tumor cells by damaging their DNA. Radiation therapy can therefore reduce tumors in size as well as achieve complete tumor irradiation. 

Proton therapy

Proton therapy is a highly precise type of radiation therapy, which is a gentler alternative. Clinical studies have shown benefits for patients with chondromas and chondrosarcomas. 

Surgery

Surgical removal of the tumor is the third pillar of cancer treatment. It can also have a diagnostic value, as the excised tissue samples can be evaluated under a microscope. Well-demarcated spinal tumors can often be removed effectively.

Radiosurgery

Another treatment option for spinal tumors is CyberKnife radiotherapy. This method uses high-precision, high-dose radiation and often only requires a single session. The surrounding spinal tissue and spinal cord remain largely spared during the procedure. Strict criteria have to be met to be eligible for this treatment.

In general, the treatment depends on the specific type of tumor as well as individual patient circumstances. The decision about the treatment choice is made by the patient and physician together, following a thorough diagnostic work-up.

Rehabilitation and follow-up care after spinal tumor treatment

Depending on the treatment choice for the spinal tumor, specific follow-up regimens apply. As most spinal tumors are metastases, patients must attend regular follow-ups with their oncologists, following cancer treatment, to detect any recurrence. This is also referred to as a relapse of cancer. When certain cancers recur, the spine should be evaluated for possible metastases.

Rehabilitation may be beneficial in the event of vertebral fractures caused by spinal tumors. This includes various rehabilitative therapies to help patients return to their work and social lives.

Generally speaking, it is difficult to make any generalized statements regarding the follow-up care and rehabilitation. Not only do they depend on the specific type of tumor and chosen treatment, but also on individual patient circumstances.

Prognosis of spinal tumors

The prognosis of spinal tumors is highly individual and depends on:

• Time of initial diagnosis
• Type of tumor
• Extent of disease
• Age and overall health
• Response to treatment

What physicians and clinics specialize in the treatment of spinal tumors?

As the majority of spinal tumors are metastases of primary tumors from different organs, they are frequently diagnosed by specialists in gynecology or urology. This is particularly true for primary tumors of the breast, prostate, or kidney. In general, oncologists are responsible for the treatment of malignant diseases.

Spinal surgery is performed by specialized neurosurgeons. Radiation oncologists and radiotherapists manage any radiation therapy. Physicians from various specialties meet in so-called tumor boards to discuss each case and develop an individualized, interdisciplinary treatment plan.

We would like to help you find an expert for your condition. All listed physicians and clinics have been reviewed by our team based on their outstanding expertise in spinal tumors and look forward to your inquiry or treatment request.