Spinal Tumor Types & Treatments Explained

There are more than 20 types of spinal tumors. The spinal column consists of vertebrae, a series of stacked bones, and at the center of that column is the spinal canal. Housed within the spinal canal is the spinal cord, which is a narrow tube of nerve tissue that sends messages between the body and the brain—this occurs via nerves and nerve roots that branch off from the spinal cord. The spinal cord and the brain, together, make up the body’s central nervous system. These tumors can originate in different anatomical compartments and may have vastly different clinical behavior and treatment approaches.

While primary spinal cord tumors are often benign, both benign and malignant tumors can cause significant symptoms due to compression of neural structures. Regardless of tumor type, mass effect from spinal tumors can result in neurological deficits including sensory loss, motor weakness, and sphincter dysfunction.

Doctors determine these kinds of tumors based on their location within the spinal cord. Tumors that grow in the nerve tissue within the spinal cord are called intramedullary tumors. Tumors that develop within the spinal canal, but outside of the spinal cord tissue, are called intradural–extramedullary tumors. Tumors located outside the dura are classified as extradural tumors.

Spinal Tumor Types: Intramedullary Spinal Tumors

Intramedullary tumors arise within the spinal cord parenchyma and most commonly affect the cervical and upper thoracic spine. They often originate from glial or ependymal cells—a type of glial cell—that are found throughout the interstitium of the spinal cord. Approximately 5 percent of spinal tumors originate in this location. The most common types of spinal tumors that occur in the neck area include:

• Ependymoma: This is the most common type of spinal cord tumor. Myxopapillary ependymomas are most frequently found in the filum terminale, while classic ependymomas are more commonly located in the cervical region.
• Astrocytoma: Astrocytomas are more common in the thoracic region followed by the cervical. Astrocytomas in children often have a more infiltrative pattern and can be difficult to resect completely.
• Hemangioblastoma: This spinal tumor type contains several blood vessels and can arise in any area of the spinal cord. These are typically benign and can be associated with von Hippel-Lindau disease.
• Lipoma: This spinal tumor type is rare and begins in fat tissue, usually in the middle of the back, where it may press against the spinal cord. This is a congenital condition, meaning it’s present at birth. Intramedullary lipomas are rare congenital tumors most commonly located in the cervicothoracic spinal cord. These may be associated with spinal dysraphism.

How to Treat Intramedullary Spinal Tumors

There are three ways intramedullary spinal tumors are treated: through surgery, radiation therapy and chemotherapy. Since intramedullary spinal cord tumors are slow growing and locally contained, surgical resection, when feasible, is the preferred treatment for most symptomatic intramedullary tumors, particularly ependymomas. 

Although radiation is an option for treating intramedullary spinal tumors, the benefits of radiation therapy are hard to prove given the slow-growing nature of these types of tumors. Because of this, the efficacy of radiation treatment as a primary therapy for these types of tumors is still unknown. Lastly, chemotherapy is rarely used and typically reserved for high-grade astrocytomas or recurrent cases.

Spinal Tumor Types: Intradural-Extramedullary Spinal Tumors

Intradural-Extramedullary tumors arise within the dural sac but outside the spinal cord, and account for approximately 40% of all primary spinal tumors. Although intradural-extramedullary tumors don’t originate in the spinal cord itself, these types of tumors may affect spinal cord function by causing spinal cord compression and additional problems. Most of these spinal tumor types develop in the spinal cord’s arachnoid membrane in the nerve roots that extend out from the spinal cord, or at the spinal cord base. The most common types of extramedullary tumors that affect the spinal cord include:

• Meningioma: This spinal tumor type begins in the thin membranes that cover the spinal cord. It usually appears in the upper portion of the back and is most common in women. Although meningiomas are often benign, they can be difficult to remove and may recur. These tumors are typically slow-growing and can be managed effectively with surgical resection.
• Neurofibroma: This spinal tumor type originates in the protective covering of the spinal cord and nerves. It often occurs in people with neurofibromatosis, a condition that causes nerve tumors throughout the central nervous system and skin. Plexiform neurofibromas in NF1 have higher malignant potential.
• Schwannoma: This spinal tumor type is composed of Schwann cells, which produce the material that insulates nerves. It is usually located within the dura, on the outside of the spinal cord. Schwannomas are typically well-encapsulated and amenable to surgical excision.
• Myxopapillary Ependymoma: Typically found in the conus medullaris and filum terminale, and considered a subtype of ependymoma.

How to treat Intradural-Extramedullary Spinal Tumors

Intradural-extramedullary spinal tumors are treated through surgery. This treatment option is ideal since it removes the tumor completely and is often a successful treatment route, even for those who are older and/or have additional health problems. Surgery for these tumors is often minimally invasive. Depending on tumor location and size, microsurgical resection is often feasible with low morbidity. Although the goal is to remove the tumor completely through surgery, it’s sometimes not always possible. However, the goal with surgery is to restore patients to a healthier, more active lifestyle that’s free from spinal cord compression symptoms.

Spinal Tumor Types: Extradural Spinal Tumors

Although initially extradural, advanced tumors can cause spinal cord compression. They are often located in the epidural space, which is the area surrounding the outer membrane that protects the spinal cord. These types of spinal tumors typically occur due to metastatic cancer or less commonly schwannomas derived from the cells covering the nerve roots. Occasionally, an extradural tumor extends through the intervertebral foramina, lying partially within and partially outside of the spinal canal. This is known as a dumbbell-shaped tumor.

How to Treat Extradural Spinal Tumors

Extradural spinal tumors are treated surgically and are removed completely. From there, the spine is stabilized through vertebral fusion using bone graft, pins or cages. This reduces any type of deformity that is left after the tumor excision. Postoperative radiation or chemotherapy may be required in metastatic cases depending on tumor type and systemic disease status.

Diagnosing Spinal Cord Tumors in New Jersey

For more than 25 years, the experienced physician team at New Jersey Brain and Spine has delivered highly-skilled and compassionate care to more than 40,000 patients with complex brain, spine and neurological conditions. Please contact us today to decide if we are the right option for your care and treatment. Consider adding a sentence about MRI as the gold standard for spinal tumor diagnosis.

We also offer an expert second opinion service should you wish to discuss your treatment options. For more information, or to request a second opinion, reach out to us immediately by calling 201-342-2550 or emailing us at secondopinion@NJBrainSpine.com.