Overview
Spinal tumors are abnormal growths originating within or adjacent to the spinal column. They may be primary — arising de novo from spinal structures — or metastatic, representing hematogenous spread from systemic malignancies. The spine is the third most common site of metastatic disease overall, after the lung and liver, underscoring the frequency with which neurosurgeons encounter oncologic spinal pathology. Spinal cord and nerve root tumors (intradural tumors) present distinct diagnostic and technical challenges requiring subspecialty expertise.
Classification
By location:
- Extradural (epidural): Outside the dural sac; most commonly metastatic disease or primary vertebral tumors (e.g., chordoma, osteosarcoma, multiple myeloma)
- Intradural extramedullary: Within the dura but outside the cord; includes meningiomas and nerve sheath tumors (schwannomas, neurofibromas) — most are benign and surgically curable
- Intramedullary: Within the spinal cord substance itself; includes ependymomas, astrocytomas, and hemangioblastomas
Symptoms
- Progressive back or neck pain — often worse at night, unrelated to activity, not relieved by rest
- Radiculopathy from nerve root compression
- Myelopathy: spastic gait, hand dysfunction, hyperreflexia, Babinski sign
- Neurological deficits: weakness, numbness, loss of proprioception
- Bowel and bladder dysfunction in advanced cases
- Vertebral instability and pathologic fracture in metastatic disease
- Constitutional symptoms (weight loss, fatigue, night sweats) suggesting systemic malignancy
Diagnosis
MRI with gadolinium contrast is the gold standard for characterizing spinal tumors, providing tissue detail, extent of neural compression, and vascular characteristics. CT myelography supplements MRI for bony involvement. CT of the chest, abdomen, and pelvis, PET scan, and bone scintigraphy evaluate metastatic extent. CT-guided or open biopsy establishes histopathological diagnosis when tissue is required before treatment.
Treatment
Management depends on tumor type, extent, spinal stability, neurological status, and patient performance status. A multidisciplinary approach — integrating neurosurgery, medical oncology, radiation oncology, and interventional radiology — is essential.
- Surgical decompression: Relieves neural compression and restores neurological function; may be the definitive treatment for benign intradural tumors or a component of multimodal care for malignant disease
- Stabilization and reconstruction: Vertebral body replacement, anterior column support, and posterior instrumentation restore mechanical stability after tumor resection
- Stereotactic radiosurgery (SRS): High-dose focused radiation for radioresistant or residual tumors; often combined with surgery in a separation surgery paradigm
- Conventional radiation: Palliative irradiation for radiosensitive tumors (lymphoma, multiple myeloma)
- Systemic therapy: Chemotherapy, immunotherapy, and targeted agents directed at the primary malignancy
Separation Surgery
For metastatic epidural cord compression, Dr. Kwan performs separation surgery — a decompressive procedure designed to create circumferential space around the spinal cord, enabling safe delivery of high-dose SRS. This combined approach has transformed the management of spinal metastases, achieving durable local control with minimal morbidity.
Consult Dr. Kevin Kwan
Dr. Kwan has specialized training in the neurosurgical management of spinal tumors, including complex intradural and intramedullary cases. His approach integrates oncologic principles with spine biomechanics to achieve optimal neurological and functional outcomes.