Complete Guide to Classification, Diagnosis, and Treatment

Spinal tumors are abnormal growths of cells that develop in the spine or spinal cord. Although the diagnosis can cause anxiety, it is essential to understand that many spinal tumors are treatable with excellent outcomes when they are diagnosed early and treated by an experienced specialist.

Dr. Ernesto Martínez de la Maza | Specialist in Intramedullary Tumors
Neurosurgery • Spine Surgery

A Message of Hope

If you or a loved one has received a diagnosis of a spinal tumor, I want you to know that there is hope and there is treatment. Advances in neurosurgery, microsurgical techniques, and neurophysiological monitoring have transformed the prognosis of many spinal tumors. My specialization in intramedullary tumors has allowed me to help numerous patients regain their neurological function and quality of life. You are not alone on this journey.

Classification by Anatomical Location

Spinal tumors are classified according to their location relative to the spinal cord and the membranes that protect it (the dura mater). This classification is essential because it determines the symptoms, treatment, and prognosis.

Intramedullary Tumors

Grow WITHIN the spinal cord

My Main Specialization

Main Types:

  • Ependymoma (60% of intramedullary tumors)
    Arises from cells lining the central canal of the spinal cord. Generally benign and with an excellent prognosis after complete resection.
  • Astrocytoma (30-35% of intramedullary tumors)
    Arises from astrocytes. They can be low-grade (better prognosis) or high-grade (more aggressive).
  • Hemangioblastoma (3-8% of intramedullary tumors)
    Benign vascular tumors. Surgical cure in >95% of cases. Associated with Von Hippel-Lindau syndrome.
  • Ganglioglioma (Rare in adults)
    Mixed neuronal-glial tumor, generally low-grade and with a good prognosis.
  • Intramedullary Lipoma (Very rare)
    Benign tumor of adipose tissue. Frequently congenital.
4-10% Of all CNS tumors
80-90% Are benign

Intradural Extramedullary Tumors

Inside the dura mater but OUTSIDE the spinal cord

Main Types:

  • Spinal Meningioma (25-46% of this category)
    Arise from the meninges. Benign in >95% of cases. More common in women (3:1) and in the thoracic region.
  • Schwannoma (Neurinoma) (29-40% of this category)
    Arise from the Schwann cells of nerve roots. Benign, encapsulated, with an excellent prognosis.
  • Neurofibroma (Less frequent)
    Similar to schwannomas but more associated with neurofibromatosis type 1. They can be multiple.
  • Filum Terminale Ependymoma (Rare)
    Ependymoma that grows in the filum terminale (the lower end of the spinal cord). Generally myxopapillary.
60-70% Of primary spinal tumors
>95% Are benign

Extradural Tumors

OUTSIDE the dura mater, in the epidural space

Main Types:

  • Epidural Metastases (95% of extradural tumors)
    Malignant tumors that have spread from other organs. Most common: breast, prostate, lung, kidney, thyroid.
  • Epidural Lymphoma (Less common)
    Can be primary or secondary. Responds well to radiation therapy and chemotherapy in combination with surgery.
  • Multiple Myeloma (Variable)
    Plasma cell cancer that frequently affects the spine. It can cause pathological fractures.
  • Epidural Sarcomas (Rare)
    Malignant soft-tissue tumors in the epidural space.
55-60% Of all spinal tumors
Majority Are metastases

Vertebral Tumors

In the vertebral BONE (body, arches, processes)

Main Types:

  • Vertebral Metastases (85-90% of vertebral tumors)
    Spread of cancer to the vertebral bone. They can cause pathological fractures and spinal cord compression.
  • Vertebral Hemangioma (10% of the general population)
    Benign vascular tumors of the vertebral body. Most are asymptomatic; they rarely cause compression.
  • Osteoblastoma (Rare, benign)
    Benign tumor but locally aggressive. More common in the posterior vertebral arches.
  • Osteoid Osteoma (Rare, benign)
    Small benign tumor that causes characteristic nighttime pain that improves with aspirin.
  • Chordoma (Rare, malignant)
    Low-grade malignant tumor that arises from notochord remnants. More common in the sacrum and clivus.
  • Chondrosarcoma (Rare, malignant)
    Malignant tumor of cartilage. More common in the cervical spine and ribs.
  • Osteosarcoma (Very rare)
    Aggressive malignant bone tumor. Rare in the spine except as a metastasis or after prior radiation therapy.
Variable Depending on tumor type
Majority Are metastases

Symptoms of Spinal Tumors

Symptoms vary depending on the location and size of the tumor, but there are common signs that should signal the need for an urgent neurosurgical evaluation.

Progressive Pain

Back or neck pain that progressively worsens, especially at night. It does not improve with rest and may wake the patient.

Muscle Weakness

Progressive loss of strength in the arms or legs. Difficulty walking, holding objects, or climbing stairs that worsens over time.

Loss of Sensation

Numbness or tingling that progresses. Loss of sensation to touch, temperature, or pain in a specific pattern of the body.

Balance Disturbance

Difficulty maintaining balance, frequent falls, a sense of instability when walking, or a "spastic gait."

Sphincter Dysfunction

Problems controlling the bladder or bowel. Urinary urgency, retention, or incontinence. AN EMERGENCY SYMPTOM.

Systemic Symptoms

Unexplained weight loss, persistent fever, extreme fatigue. More common in malignant tumors or metastases.

Detailed Comparison by Tumor Type

Characteristic Intramedullary Intradural Extramedullary Extradural Vertebral
Frequency 4-10% of CNS tumors 60-70% of primary spinal tumors 55-60% of all spinal tumors Variable depending on type
Typical Age 30-50 years (ependymomas)
20-40 years (astrocytomas)		 50-70 years (meningiomas)
30-60 years (schwannomas)		 40-70 years (metastases) Variable depending on primary type
Progression Slow (months to years) Very slow (years) Rapid to moderate (weeks to months) Variable
Initial Pain Diffuse, poorly localized, progressive Initially unilateral radicular Localized, nocturnal, severe Localized in the spine, mechanical
Motor Symptoms Progressive symmetric bilateral weakness Initially unilateral weakness, then bilateral Rapidly progressive bilateral weakness Variable depending on compression
Sensory Symptoms Sensory dissociation (loss of temperature/pain, preservation of touch) Radicular pattern that progresses to a spinal cord level Clear sensory level below the tumor Variable
Primary Treatment Open microsurgical surgery with myelotomy Open surgery with complete resection Decompressive surgery + radiation therapy/chemo Surgery + adjuvant therapy depending on type
Monitoring Required Advanced IONM (MEPs, SSEPs, EMG) essential IONM recommended, especially in the cervical region IONM useful but less critical Variable
Complete Resection 60-80% depending on type (ependymomas >90%) >95% (meningiomas and schwannomas) Goal: decompression, not cure Variable, sometimes requires vertebrectomy
Surgical Risk Higher: direct manipulation of the spinal cord Moderate: displacement of the spinal cord Moderate: urgent decompression Variable depending on extent
Overall Prognosis Good to excellent with early resection Excellent: >90% surgical cure Variable: depends on the primary tumor Variable depending on malignancy
Recurrence 10-20% (ependymomas <5% with complete resection) <5% with complete resection Depends on control of the primary tumor Variable

Complete Diagnostic Process

Accurate diagnosis of spinal tumors requires a systematic evaluation that combines clinical history, neurological examination, and advanced imaging studies.

1

Detailed Clinical History

Chronology of symptoms, characteristics of the pain, factors that improve or worsen it, history of prior cancer.

2

Complete Neurological Examination

Assessment of muscle strength, reflexes, sensation, gait, coordination, and sphincter function.

3

MRI with Contrast

The gold-standard study. It shows the exact location, size, relationship with the spinal cord, and contrast enhancement.

4

Complementary Studies

CT scan for bone evaluation, PET-CT if metastasis is suspected, myelogram in select cases, and studies of the primary tumor.

Treatment Approaches

Treatment depends on the specific type of tumor, its location, the patient's neurological status, and whether it is benign or malignant. Learn more about the spinal tumor surgery I perform.

Surgical Treatment

Goals of Surgery:
  • Complete resection of the tumor (if possible without causing a deficit)
  • Decompression of the spinal cord and nerve roots
  • Obtaining tissue for a definitive histopathological diagnosis
  • Preservation or restoration of neurological function
Specific Techniques:
  • Intramedullary Tumors: Wide laminectomy, dural opening, longitudinal myelotomy, microsurgical resection under advanced neurophysiological monitoring ( resection with intraoperative neuromonitoring)
  • Intradural Extramedullary: Laminectomy, dural opening, tumor resection while preserving functional nerve roots
  • Extradural: Urgent decompressive laminectomy, resection of the epidural tumor, stabilization if there is instability
  • Vertebral: Corpectomy/vertebrectomy, reconstruction with expandable cages, anterior and posterior instrumented fixation

Adjuvant Treatments

Radiation Therapy:
  • Stereotactic (SRS): For small tumors, metastases, residual schwannomas
  • 3D Conformal or IMRT: For tumors that cannot be completely resected
  • Palliative: For multiple metastases or patients who are not surgical candidates
Chemotherapy:
  • High-grade astrocytomas (glioblastomas)
  • Spinal lymphomas (highly chemosensitive)
  • Metastases from chemosensitive tumors
  • Medulloblastomas (rare in the spinal cord)
Targeted Therapies and Immunotherapy:
  • VEGF inhibitors for hemangioblastomas in Von Hippel-Lindau
  • BRAF/MEK inhibitors for astrocytomas with mutations
  • Immunotherapy for tumors with a high mutational burden. Learn more about the adjuvant treatments for spinal tumors

Why Intramedullary Tumors Require a Specialist

Intramedullary tumors represent the greatest technical challenge in spine neurosurgery. Unlike other spinal tumors that can be "separated" from the spinal cord, intramedullary tumors grow WITHIN the functional nerve tissue of the spinal cord, requiring an extremely precise microsurgical technique to distinguish and separate the tumor from the healthy nerve tissue that must be preserved.

My specialization in these tumors has allowed me to perform these complex surgeries with successful outcomes, preserving or improving neurological function in the vast majority of my patients. The key lies in the combination of experience, advanced technology, and a commitment to surgical excellence. If you wish, learn about Dr. Martínez de la Maza's training.

Microsurgical Technique

Use of a high-power microscope for extreme magnification and visualization of each nerve fascicle, allowing precise millimeter-level dissection between the tumor and the spinal cord.

Advanced Monitoring

Real-time motor and somatosensory evoked potentials that immediately alert us to any neurological compromise during surgery.

Specialized Experience

Years of specific training in intramedullary tumors, regularly performing these complex surgeries that many neurosurgeons only see occasionally.

Prognosis and Realistic Expectations

✓ Excellent Prognosis

These tumors have a high probability of surgical cure or long-term control:

  • Ependymomas:>90% tumor-free at 10 years with complete resection. Excellent prognosis.
  • Spinal meningiomas:>95% cure with complete resection. Recurrence <5%.
  • Schwannomas:>98% surgical cure. Rarely recurrent.
  • Hemangioblastomas:>95% cure with complete resection. Monitor for Von Hippel-Lindau.
  • Pilocytic astrocytomas (Grade I): Excellent prognosis with maximal safe resection.

Variable or Guarded Prognosis

These tumors require multimodal treatment and close follow-up:

  • Diffuse astrocytomas (Grade II-III): Guarded prognosis. They require surgery + radiation therapy. Close follow-up.
  • Intramedullary glioblastomas: Rare but aggressive. Poor prognosis despite aggressive treatment.
  • Spinal metastases: Depends entirely on the primary tumor and its extent. Goal: preserve neurological function and quality of life.
  • Chordomas: Low-grade tumors but locally aggressive. They require wide resection + radiation therapy. Frequent recurrence.
  • Chondrosarcomas: Similar to chordomas. Complete resection is difficult. Long-term follow-up is necessary.

Warning Signs: When to Seek Urgent Neurological Care

Progressive Weakness

Loss of strength in the arms or legs that worsens each day or week. Increasing difficulty walking, climbing stairs, or holding objects.

Severe Nighttime Pain

Back or neck pain that wakes you at night, does not improve with common pain relievers, and progressively worsens.

Loss of Sphincter Control

Difficulty controlling the bladder or bowel, urinary retention, urgency, or incontinence. A NEUROLOGICAL EMERGENCY.

Ascending Numbness

Loss of sensation that progresses from the feet upward, or a clear level below which there is no sensation.

History of Prior Cancer

Any new spine symptom in a patient with a history of cancer, even if it was "cured" years ago. Urgent evaluation.

Neurological Symptoms + Systemic Symptoms

A combination of back pain with fever, unexplained weight loss, night sweats, or extreme fatigue.

Keep reading

Related topics

See all spine conditions →

Frequently Asked Questions

  • What is a spinal tumor, and what are the most common symptoms?

    A spinal tumor is an abnormal growth of cells in the spinal cord or in the structures that surround it, such as the vertebrae. It is essential to understand that not all tumors are cancerous; many are benign.

    Symptoms can vary depending on the location and size of the tumor, but some of the most common include:

    • Persistent back pain: often described as pain that does not improve with rest and may even worsen at night.

    • Weakness or numbness: a sensation of weakness, tingling, or loss of feeling in the arms or legs.

    • Difficulty walking: balance or coordination problems that can lead to falls.

    • Changes in bladder or bowel function: difficulty controlling urination or bowel movements.

    If you experience any of these symptoms persistently, it is crucial to seek medical evaluation to obtain an accurate diagnosis.

  • Are all spinal tumors cancer?

    No, and this is one of the most important concerns we clarify for our patients. Spinal tumors fall into two broad groups:

    • Benign (non-cancerous): these tumors do not spread to other parts of the body. Although they are not malignant, they can cause problems by pressing on the spinal cord or the nerves.

    • Malignant (cancerous): these can arise in the spine itself (primary) or have spread from elsewhere in the body (metastatic). Metastatic tumors are more common than primary ones.

    An accurate diagnosis is essential to determine the nature of the tumor and the most appropriate treatment plan.

  • How is a spinal tumor diagnosed?

    Diagnosing a spinal tumor is a careful process that begins with a detailed clinical history and a complete neurological examination. To confirm the presence and characteristics of the tumor, advanced imaging studies are used. Magnetic resonance imaging (MRI) is the most important and precise tool, because it lets us see the spinal cord, the nerves, and the surrounding tissues in great detail to define the exact location and size of the tumor.

    In some cases, other studies may be ordered, such as a computed tomography (CT) scan or a biopsy, which involves taking a small tissue sample to analyze it and determine the exact type of tumor.

  • What is the treatment for a spinal tumor? Is surgery always needed?

    Treatment depends on multiple factors: the type of tumor (benign or malignant), its location, its size, and your overall health. Not every case requires immediate surgery. Treatment options may include:

    • Observation: for small, benign tumors that cause no symptoms, we may choose periodic follow-up with MRI scans.

    • Surgery: the most common treatment, especially for tumors that compress the spinal cord. The goal is to remove as much of the tumor as possible without damaging the nerve structures. Microsurgery and intraoperative neurophysiological monitoring are key technologies that increase the safety and precision of the procedure.

    • Radiation therapy: uses high-energy radiation to destroy tumor cells or stop their growth.

    • Chemotherapy: used for certain types of cancerous tumors, often in combination with other treatments.

    The treatment plan is always personalized and discussed with you in detail, seeking the best possible quality of life.

  • What are intramedullary tumors, and why do they require such specialized care?

    Intramedullary tumors are a specific type of spinal tumor that grows within the spinal cord itself. They are less common than other spinal tumors, but they represent a significant surgical challenge because of their delicate location.

    The spinal cord is the transmission center for every nerve signal from the brain to the rest of the body. For that reason, removing an intramedullary tumor demands very high precision and technical experience to preserve neurological function. Surgery for these tumors, such as ependymomas or astrocytomas, is performed under a microscope and with constant monitoring of nerve function to minimize risks and achieve the best possible outcomes for the patient. This is an area where the neurosurgeon’s experience is absolutely crucial.