What it is
Spinal tumors are a heterogeneous group of lesions that differ substantially based on where they arise and their tissue of origin. They are broadly categorized by location:
- Extradural (outside the dura — the membrane covering the spinal cord): most commonly metastatic cancer spreading to the vertebral body from a primary tumor elsewhere in the body (lung, breast, prostate, kidney, etc.). Also includes primary vertebral tumors.
- Intradural extramedullary (inside the dura but outside the spinal cord): includes meningiomas and nerve sheath tumors (schwannomas, neurofibromas). Most are benign and surgically resectable.
- Intramedullary (within the spinal cord itself): includes ependymomas, astrocytomas, and hemangioblastomas. Surgery is more complex and requires intraoperative monitoring.
Evaluation
The most important first step is characterization. MRI with and without gadolinium is the standard imaging. In many cases, the imaging appearance narrows the diagnosis substantially — but tissue biopsy is often needed before a treatment plan is finalized.
For suspected metastatic disease, systemic staging is critical before any local treatment decision.
Treatment
Treatment depends entirely on the diagnosis:
- Benign intradural tumors (meningioma, schwannoma) are often cured with surgical resection
- Metastatic epidural disease may be treated with surgical decompression and stabilization, stereotactic body radiation therapy (SBRT), or both, depending on the tumor's radiosensitivity and the urgency of spinal cord compression
- Intramedullary tumors are approached surgically with the goal of maximum safe resection, using intraoperative neuromonitoring
Multidisciplinary coordination between neurosurgery, radiation oncology, and medical oncology is essential for most spinal tumor cases.