Spinal Cord Tumor: Symptoms, Surgery, Risks and Recovery

A spinal cord tumor is a growth inside the spinal canal that arises from the spinal cord itself, from the membranes around it or from the nerve roots. Typical symptoms are back or neck pain that is worse at night, numbness or tingling in the arms or legs, weakness, unsteady walking and changes in bladder control. Many spinal cord tumors are benign, and when they are removed before serious damage occurs, nerve function can usually be preserved.

Types of spinal cord tumors

Doctors describe these tumors by where they sit in the spinal canal, because location largely determines symptoms and surgery:

• Extradural tumors lie outside the protective membrane (dura), usually in the vertebral bone. In adults most are metastases. See our article on spinal tumor symptoms.
• Intradural extramedullary tumors lie inside the dura but outside the cord. The most common are meningiomas (from the membranes) and schwannomas or neurofibromas (from the nerve sheath). Most are benign.
• Intramedullary tumors grow within the spinal cord tissue. In adults the most common is ependymoma; in children astrocytoma is more frequent. Hemangioblastoma is a rarer type.

What causes spinal cord tumors?

In most patients no cause is found. Known risk factors include inherited conditions such as neurofibromatosis types 1 and 2 and von Hippel-Lindau disease, and previous radiation to the area. Lifestyle and diet have not been shown to cause spinal cord tumors.

Symptoms of a spinal cord tumor

Most spinal cord tumors grow slowly, so symptoms often develop over months or even years and are first blamed on a disc or muscle strain.

• Back or neck pain that is worse at night or lying down and responds poorly to painkillers
• Radiating pain into an arm, around the chest or down a leg
• Numbness, tingling or burning, often starting in the hands or feet and slowly moving upwards
• Weakness, heavy legs, tripping and difficulty with stairs
• Clumsy hands and trouble with fine tasks when the tumor is in the neck
• Reduced sense of temperature and poor balance, especially in the dark
• Bladder, bowel or sexual dysfunction in later stages

Spinal cord tumors rarely cause headache. In children, persistent back pain, a change in walking, painful scoliosis or regression in toilet training should prompt an assessment.

Diagnosis

The key test is an MRI of the spine with contrast. It shows where the tumor is, whether it lies inside or outside the cord, and whether there is swelling or a cyst around it. This information suggests the likely tumor type and allows the operation to be planned. There is no blood test that detects a spinal cord tumor; the exact diagnosis comes from examining the tissue removed at surgery.

Are spinal cord tumors benign or malignant?

Most meningiomas and schwannomas are benign. A large proportion of spinal ependymomas are low grade with a clear border. Astrocytomas tend to grow into the surrounding cord and are more challenging. However, "benign" does not mean harmless: the spinal canal is narrow, so even a benign tumor can cause permanent damage as it grows.

Spinal cord tumor surgery

For tumors that cause symptoms, the main treatment is safe removal with microsurgery. Very small tumors found by chance may be watched with MRI. Radiotherapy is added when a tumor cannot be fully removed or is high grade, and chemotherapy is used for selected tumor types. Read more on our spinal cord tumor treatment page.

How the operation is done

1. Planning: the level of the tumor and its relationship to the cord are mapped on MRI.
2. Neuromonitoring: the motor and sensory pathways of the spinal cord are monitored electrically throughout surgery, so that any threat to nerve function is noticed immediately.
3. Access: the back part of the vertebra is opened (laminectomy or laminoplasty) and the dura is opened.
4. Microsurgical removal: under the operating microscope, the tumor is separated from the cord and nerve roots and removed.
5. Closure: the dura is closed watertight; the spine is stabilised if needed.

How long does spinal cord tumor surgery take?

It depends on the type, size and position of the tumor. Removing a small tumor that sits outside the cord takes considerably less time than removing a large tumor from inside the cord. The expected duration for your operation is discussed beforehand; the priority is not speed but protecting nerve function.

Risks and side effects

As with any operation, infection, bleeding and leakage of cerebrospinal fluid can occur. The most important specific risk is temporary or permanent neurological change such as numbness or weakness. Temporary sensory changes are relatively common after surgery inside the cord and usually improve over weeks to months. Microsurgical technique and continuous neuromonitoring are used to keep these risks as low as possible.

Recovery after spinal cord tumor surgery

The strongest predictor of recovery is neurological function before surgery. Most patients who walk into the operation continue to walk afterwards, while those with significant weakness beforehand tend to recover more slowly and sometimes only partly. This is why treating a tumor before major damage develops matters so much.

• Patients are usually mobilised early after surgery.
• Physiotherapy and rehabilitation speed up recovery of strength and balance.
• Wound pain settles over the following weeks, and return to daily activities is planned individually according to the type of operation and the patient's job.

Can a spinal cord tumor come back?

The risk depends on the tumor type and on how completely it was removed. Recurrence is uncommon after complete removal of benign meningiomas and schwannomas, and more likely after partial removal or with higher-grade tumors. Follow-up MRI scans are therefore scheduled after surgery; if a tumor recurs, repeat surgery or radiotherapy can be considered.

When to seek urgent care

• weakness in the legs or arms that worsens over days,
• new inability to pass urine, or loss of bladder or bowel control,
• numbness in the groin or saddle area,
• sudden inability to walk.

Conclusion

Spinal cord tumors often progress quietly, and their first symptoms can resemble ordinary back or neck pain. Night pain, spreading numbness, clumsy hands and unsteady walking deserve a careful assessment. Prof. Dr. Ömür Günaldı is a neurosurgeon in Ataköy, Istanbul, who plans the diagnosis and microsurgical treatment of spinal cord tumors. This article is for general information; individual diagnosis and treatment require examination and imaging.