Spinal Tumors: Information & Spinal Tumor Specialists

A spinal tumor is a benign or malignant tumor affecting the spine.

These tumors are classified, among other things, based on whether they

• inside the spinal meninges (intradural) or
• outside the subarachnoid space (extradural)

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Other important criteria for evaluating a spinal tumor include

• the location: cervical spine, thoracic spine, or lumbar spine, as well as
• the rate of growth: Benign tumors grow more slowly, while malignant tumors grow more rapidly.

Before a spinal tumor is removed, various examinations are performed:

• a physical and clinical-neurological examination, as well as
• X-rays of the spine.

This allows the doctor to assess the condition of the bones and the extent of any damage. The spinal tumor can damage the vertebrae.

Other important diagnostic methods prior to the removal of a spinal tumor include

• magnetic resonance imaging (MRI) of the spine and
• computed tomography (CT), as well as
• in some cases, angiography or
• nuclear medicine examination.

Before removing a spinal tumor, the doctor holds informative discussions with the patient © WavebreakMediaMicro | AdobeStock

Surgical treatment for a spinal tumor is generally performed using a strategy of function-preserving microsurgery. In the case of an intradural spinal tumor, this involves a small incision to preserve the stability of the spine as much as possible.

This surgery is typically performed under intraoperative electrophysiological monitoring. This means that the motor and sensory nerves of the spinal cord are continuously monitored during the procedure.

Surgical removal of the spinal tumor is performed using a surgical microscope. Depending on the type of lesion, the tumor is gradually reduced in size and dissected away from the healthy spinal cord.

The surgeon must take care to preserve blood vessels and thus maintain blood flow to the spinal cord. The goal is to prevent permanent paralysis and sensory disturbances.

Removal of Benign Spinal Tumors

The most common benign spinal tumors in the spinal canal are meningiomas. They usually have a distinct boundary layer separating them from the spinal cord. Therefore, they can generally be completely removed without causing neurological complications.

In such cases, the individual situation, as well as the size and location of the spinal tumor, are always important factors. The extent of spinal cord compression and the severity of pre-existing neurological deficits must also be taken into account.

The situation is similar with the removal of intraspinal neurinomas. These, too, are often very well demarcated from the spinal cord and the surrounding spinal nerves.

Due to their slow growth, neurinomas can occasionally alter the bony structures. In these cases, the stability of the spine is compromised.

More problematic are intradural spinal tumors such as low-grade gliomas or spinal ependymomas. They grow within the spinal cord itself and may infiltrate parts of the spinal cord.

The key factor here is

• the severity of the pre-existing damage and
• the neurological deficits

prior to surgery and the extent to which the healthy spinal cord has been infiltrated.

The earlier a spinal tumor is detected, the lower the risk and the less technically challenging its removal will be

• the earlier it is detected and
• the smaller it is.

However, even very long and extensive ependymomas can be removed with an acceptable risk of complications using appropriate microsurgical techniques.

Spinal hemangioblastomas represent a special type. These are highly vascularized spinal tumors with a rich blood supply.

The surgical strategy involves first bipolarly coagulating and transecting the feeding vessels. This allows for safe dissection and removal from the spinal cord.

This MRI image, taken with contrast, shows multiple hemangioblastomas in the cervical spinal cord of a patient with Hippel-Lindau disease. The largest tumor is located at the C2/C3 level and was removed via a right-sided hemilaminectomy.

Removal of Malignant Spinal Tumors

Malignant spinal tumors are removed using the same strategy and microsurgical techniques. Due to the infiltrative and pedunculated growth into the spinal cord, it may be necessary to leave residual tumor in the peripheral area. Otherwise, there is a risk of damage to spinal cord function, potentially resulting in severe neurological deficits.

In cases of spinal metastases, the extent to which the vertebral bodies are infiltrated is also of critical importance. This could compromise the stability of the spine.

In some cases, stabilization surgery may be necessary after removal of the spinal tumor. This involves the use of screws and rod systems or a titanium vertebral body replacement.

Occasionally, for spinal tumors with a rich blood supply, catheter angiography with embolization is also necessary. Close collaboration with interventional neuroradiologists is therefore urgently required.

Summary of the Surgical Treatment Strategy for a Spinal Tumor

The range of postoperative complications can be minimized through

• the use of microsurgical techniques and
• the increasing miniaturization of surgical approaches, such as in endoscopic spinal surgery,

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Infiltrative spinal tumors continue to pose the greatest challenge. Surgical removal of a spinal tumor always carries the risk of neurological deficits. This is particularly true when the spinal tumor invades functionally relevant areas of the spinal cord.

Generally, the risk of complications related to

• infection,
• a cerebrospinal fluid fistula, and
• postoperative hematomas, or
• secondary spinal instability.

Surgeons performing spinal surgery © Vadim | AdobeStock

Discharge from the hospital is possible after 4–6 days if only microsurgical removal of a spinal tumor was performed.

If stabilization surgery is also necessary, recovery generally takes a few days longer.

Occasionally, follow-up treatment is also performed. In the case of a malignant tumor, this is usually followed by

• radiation therapy and
• , if necessary, chemotherapy.

If the patient has good mobility, chemotherapy can usually be administered on an outpatient basis.

The range of complications and risks associated with the surgical removal of spinal tumors has been significantly reduced through the use of microsurgical and endoscopic surgical techniques under intraoperative electrophysiological monitoring.