Spinal tumors are abnormal tissue growths within the spinal canal or vertebral bones. They may be benign or malignant, and can originate within the spine (primary) or spread from other parts of the body (metastatic). These tumors can produce symptoms like pain, neurological deficits, and impaired spinal function.
Tumor Location Types
Extradural (most common, often metastatic)
Intradural‑extramedullary (e.g. meningiomas, schwannomas)
Intramedullary (e.g. ependymomas, astrocytomas)
Imaging & Biopsy
MRI and CT are essential for assessing location, size, neurological compression, spinal stability .
Biopsy is critical to determine histology, grade, and guide treatment strategies—percutaneous biopsy is highly accurate and carries lower complication risk compared to open biopsy .
Steroid Therapy
Acute spinal cord compression from tumors is an oncologic emergency. Steroids are administered to reduce spinal cord swelling and prevent irreversible deficits.
Radiotherapy & SRS
For radiosensitive metastatic or primary lesions, conventional radiotherapy or stereotactic radiosurgery (e.g. Gamma Knife, CyberKnife, proton therapy) offers excellent local control, particularly when surgery isn’t feasible .
Chemotherapy / Targeted Therapy
Used in specific malignancies such as Ewing’s sarcoma or chordoma; denosumab is effective for unresectable giant cell tumors.
Minimally Invasive Ablation
Targeted radiofrequency ablation (t‑RFA), cryoablation, or vertebral augmentation offer palliative pain relief for metastatic vertebral lesions with minimal surgical burden.
Rehabilitation & Support
Physical and occupational therapy help manage neurological symptoms and preserve mobility. Palliative care is essential in advanced disease to support quality of life and manage pain.
When Surgery Is Recommended
Indicated for severe pain, neurological deficits from spinal cord or nerve root compression, or instability. Also essential for local control of primary osteogenic or sarcoma tumors.
Types of Surgical Resection
Benign lesions (e.g., schwannomas, meningiomas): often amenable to gross total or marginal excision, with low recurrence rates (≈7 % for meningiomas if completely resected) .
Malignant primary tumors: wide or en bloc resection (e.g., total en bloc spondylectomy) offers highest rates of local control and long-term disease-free survival.
Sacrificing adjacent structures (e.g., thoracic nerve roots) may be necessary to achieve margin clearance while preserving overall neurological function.
Surgical Approach Planning
Approach (posterior, anterior, combined) depends on tumor extent; complex tumors may require multidisciplinary surgical collaboration.
Minimally Invasive Options
Certain intradural and extradural tumors can be excised using micro-endoscopic or endoscopic techniques, reducing tissue trauma and improving recovery.
A. Personalized Evaluation
Combines high-resolution imaging, precise biopsy, spinal instability scoring (e.g. SINS, ESCC), neurologic examination, and tumor staging.
B. Strategic Treatment Planning
Benign, asymptomatic lesions → observation with serial imaging.
Symptomatic benign tumors → aim for gross total or marginal excision.
Primary malignant tumors or metastases with symptoms → combine surgery, radiotherapy, and chemotherapy as indicated.
Multimodal team approach involving neurosurgery, oncology, radiology, physiatry, and palliative care.
C. Surgical Precision & Minimally Invasive Techniques
Employing micro-decompression, intralesional or en bloc resections when feasible, with advanced navigation to minimize neurological damage.
D. Rehabilitation & Long-Term Support
Structured rehabilitation for mobility, pain control, reintegration into daily activity, education for patients/caregivers, and regular surveillance for recurrence or progression .
