Back pain affects just about everyone from time to time. Often, the pain is caused by an injury or a muscle strain. Sometimes, back pain is due to arthritis or even a herniated disk.

In rare cases, however, back pain has a different cause: a spinal tumor. Tumors, both benign (noncancerous) and malignant (cancerous), can develop in or around the spinal cord or the spinal column. Spinal tumors often physically press against the spinal cord and nerves, leading to an array of symptoms, including back pain. The tumor’s compression of the spinal cord and nerves can also cause muscle weakness, numbness, and, in some cases, paralysis.

Spinal tumors can affect people of any age, though they are more common in adults than in children. Fortunately, spinal tumors are uncommon, accounting for only around 15% to 20% of central nervous system (CNS) tumors—that is, tumors of the brain and spinal cord. For every 100,000 people, it is estimated that between 0.5 to 2.5 individuals will develop a primary spinal tumor, and the lifetime risk of developing a malignant spinal tumor is less than 1%.

“The goal of spinal tumor treatment is to not only treat the tumor cells, with a goal of ridding the body of them; but also to restore neurologic function and alleviate pain,” says Yale Medicine neurosurgeon Patrick Doherty, MD.

Tumors form when abnormal cells divide and grow uncontrollably and, over time, develop into a mass of new tissue. They can develop in any part of the body, and they may be benign or malignant. Benign tumors remain localized to one part of the body; they cannot spread to other areas. Malignant tumors, however, can invade nearby tissues and spread to other parts of the body.

When tumors are located in the spine—either in or surrounding the spinal cord—they are called spinal tumors. They can push up against the spinal cord and the roots of the spinal nerves (a root is the initial part of the nerve that emerges from the spinal cord), affecting function.

The spinal cord and spinal nerves are responsible for a number of critical functions. They deliver information from the brain to the body’s muscles and organs, telling them how and when to move. They also carry sensory information—about touch, pain, pressure, and temperature—from the body to the brain.

When spinal tumors compress the spinal cord and/or nerve roots, it can cause problems with a person’s ability to move their arms and legs as well as other muscles; affect bladder control; and it can produce tingling sensations in the limbs. These tumors can also commonly cause debilitating pain.

Doctors divide the spine into four regions: cervical (neck), thoracic (middle back), lumbar (lower back), and sacral (base of the spine). Spinal tumors can develop in any of these regions.

In general, there are two broad categories of spinal tumors: primary and metastatic.

Primary spinal tumors are those that originate in or around the spinal cord. They may be benign or malignant.

Metastatic tumors, also known as secondary tumors, are formed from cancer cells that have spread (or metastasized) to the spine from a cancer in another part of the body. Metastatic tumors are cancerous, and the majority of spinal tumors are metastatic, meaning they originated from somewhere else in the body.

Doctors classify spinal tumors based on where they are located within the spine:

• Intramedullary tumors develop within the spinal cord. The most common types of intramedullary tumors are astrocytomas and gliomas.
• Intradural extramedullary tumors occur inside the dura mater (a membrane that surrounds the spinal cord), but outside the spinal cord. The majority of intradural extramedullary tumors are benign. Common types of intradural extramedullary tumors include meningiomas and nerve sheath tumors such as schwannomas and neurofibromas.
• Extradural tumors are positioned outside the dura mater. These tumors can destroy bone in the spinal column and may also compress the spinal cord and nerve roots. Extradural tumors are usually metastatic tumors that spread to the spine from cancer in another area of the body.

Researchers do not yet know what causes primary spinal tumors. It is known, however, that spinal tumors occur more frequently in people who have certain genetic conditions, including neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2), and von Hippel-Lindau (VHL) disease.

Most spinal tumors are metastatic tumors, meaning they originated from cancer elsewhere in the body. Several types of cancer are known to spread to the spine including lung, breast, and prostate cancers, as well as blood cancers such as lymphoma and myeloma.

Many of the symptoms caused by spinal tumors occur because the tumor exerts pressure on the spinal cord and nerves. Because tumors grow over time, they can exert more pressure on these structures, resulting in a progressive worsening of symptoms. Left untreated, spinal tumors can cause permanent damage to the spine, spinal cord, and nerve roots.

The symptoms caused by spinal cord tumors can vary greatly depending on the type of tumor, its location along the spine, and other factors. In general, though, symptoms may include:

• Back pain that worsens over time (pain is often worse when lying down and at night)
• Numbness, tinging, and/or loss of sensation in the arms and/or legs
• Progressively worsening weakness in the arms and/or legs (may make walking difficult, cause balance problems, and can ultimately lead to paralysis)
• Erectile dysfunction
• Loss of bowel and/or bladder control

Because the symptoms caused by spinal tumors are also associated with several other medical issues, your doctor will need to rule out these other conditions.

Diagnosis of spinal tumors typically begins with a medical history and physical exam. Your doctor will ask you about your symptoms, including when they began and if they have gotten worse over time. During the physical exam, he or she may examine your spine; check your muscle strength, reflexes, and balance; and look for other signs and symptoms of spinal tumors. Blood work may also be ordered to help determine the cause of symptoms.

To diagnose a spinal tumor, your doctor will need to order one or more imaging studies. These tests may include magnetic resonance imaging (MRI) studies, computed tomography (CT) scans, and X-rays of the spine.

If these imaging studies suggest that a tumor is present, a biopsy may be necessary. In this procedure, a doctor removes a small piece of tissue from the spinal tumor. The tissue sample can often be collected using a needle, but sometimes surgery is required. A pathologist will analyze the tissue sample in a laboratory to determine the type of tumor and whether it is cancerous or not.

If you are diagnosed with a malignant spinal tumor, your doctor may order additional imaging tests to see if cancer is present in other areas of the body.

Because spinal tumors may progress rapidly and can cause permanent damage to the spine, spinal cord, and nerves, treatment usually begins without delay after diagnosis.

Treatment for spinal tumors may include:

• Surgery. Some spinal tumors can be surgically removed. Depending on where the tumor is located, surgery may not be feasible as it would risk damaging important structures in the spine.
• Radiation therapy. This treatment uses radiation to kill tumor cells. It may be used after surgery to destroy any tumor cells that remain or on its own, to reduce the size of the tumor. Some spinal tumors are treated with a type of radiation therapy called stereotactic body radiation therapy (SBRT). SBRT precisely delivers high doses of radiation to the tumor. It typically requires fewer treatment sessions than conventional radiation therapy. Because it can cause growth and cognitive problems in children under 3 years of age, radiation therapy is not usually used to treat spinal and brain tumors for that age group.
• Chemotherapy. In this treatment, drugs—known as chemotherapy—are used to kill tumor cells. Chemotherapy may be used on its own to shrink tumors or in combination with surgery and/or radiation therapy.
• Targeted therapy. This treatment uses drugs that target specific components found in tumor cells but not healthy cells.

Corticosteroids such as dexamethasone may be given to reduce inflammation and swelling around tumors and thereby relieve pressure on the spinal cord and nerve roots.

In some cases, spinal tumors may not cause symptoms or may be accompanied by mild symptoms. In this scenario, a doctor may choose to monitor the tumor to see if it progresses over time. This may require a periodic MRI or other imaging test.

The outlook for people who have a spinal tumor depends on several factors, including their age and overall health, the location of the tumor, tumor type, severity of symptoms, and the timeliness of treatment. In most cases, outcomes are best when the tumor is treated early, before it has a chance to grow extensively and cause permanent damage. If a spinal tumor causes permanent damage to the spine, spinal cord, and nerves, it can result in persistent symptoms.

For metastatic spinal tumors, the prognosis depends, in part, on treatment of the primary tumor (the original tumor), including how well the cancer responds to therapies such as surgery, radiation, and chemotherapy.

“At Yale Medicine, we take a multidisciplinary and collaborative approach immediately after diagnosis,” says Dr. Doherty. “We rely on getting each patient the exact care that individual requires in a patient-centered manner, focused on treatment, convenience, and optimal care.”