Spinal Tumor Symptoms: Night Pain, Warning Signs and When to Worry

The most common symptom of a spinal tumor is back or neck pain that is present at night or at rest, does not improve with lying down, and slowly gets worse over weeks. As the tumor grows and presses on nerves or the spinal cord, numbness, weakness, difficulty walking and changes in bladder or bowel control can follow. The vast majority of back pain is caused by muscles, joints or discs, but the pattern of the pain gives important clues, and recognising those clues leads to an earlier diagnosis.

What is a spinal tumor?

A spinal tumor is an abnormal growth in the bones of the spine (vertebrae) or in the structures inside the spinal canal. Doctors usually group them as follows:

• Metastatic tumors: cancer that has spread to the spine from another organ. In adults these are the most common tumors of the vertebrae. Breast, lung, prostate, kidney and thyroid cancers spread to the spine most often, and multiple myeloma frequently involves the vertebrae.
• Primary bone tumors: tumors that start in the spine itself. Benign examples include hemangioma, osteoid osteoma, osteoblastoma, giant cell tumor and aneurysmal bone cyst; malignant examples include chordoma, chondrosarcoma, Ewing sarcoma and osteosarcoma.
• Tumors inside the spinal canal: meningiomas, schwannomas and tumors of the spinal cord itself, such as ependymoma. These are covered in our article on spinal cord tumors.

Not every spinal tumor is cancer. Vertebral hemangiomas, for example, are very common, are usually found by chance on an MRI and most never need treatment.

Spinal tumor symptoms

1. Back pain with a different character

Pain is the first and often the only symptom. Features that make a tumor more likely than ordinary back strain include:

• pain that wakes you up at night or is worse when lying down,
• constant pain that does not settle with rest or a change of position,
• pain that keeps increasing over several weeks,
• tenderness when pressing on one particular vertebra,
• pain in the mid back or between the shoulder blades, where disc problems are less common than in the lower back.

When a tumor weakens a vertebra, sharp pain with standing, turning or walking can appear, which may mean the spine is becoming unstable.

2. Pain spreading into an arm, the chest wall or a leg

A tumor pressing on a nerve root causes pain that travels into the arm (neck tumors), around the chest like a band (mid-back tumors) or down the leg (lower back tumors), often with tingling or burning.

3. Weakness and difficulty walking

Pressure on the spinal cord can cause heavy legs, tripping, poor balance and difficulty with stairs. Tumors in the neck may first show up as clumsy hands, for example trouble with buttons or handwriting.

4. Bladder, bowel or sexual changes

New urinary retention or incontinence, loss of bowel control or numbness in the saddle area mean that the spinal cord or the lower nerve roots are under serious pressure. This is an emergency.

5. General symptoms

Unexplained weight loss, loss of appetite, night sweats and fatigue may accompany metastatic tumors. New back pain in anyone with a history of cancer should always be checked promptly.

Do spinal tumor symptoms come and go?

They can fluctuate, especially early on, which is one reason spinal tumors are sometimes diagnosed late. The overall trend, however, is usually progressive: the pain returns, lasts longer and new nerve symptoms gradually appear.

Can you feel a spinal tumor?

Most spinal tumors cannot be felt from the outside because they lie deep within or in front of the spinal canal. A lump you can feel on your back is far more often a harmless fatty or skin lesion, though any growing lump should be examined.

Spinal tumor or herniated disc?

Both can cause back pain that travels into a leg or arm, so they are easy to confuse. Points that favour a disc herniation are a clear trigger such as lifting, pain that changes with sitting and bending, and gradual improvement over weeks. Points that favour a tumor are night pain, pain at rest, steady worsening, symptoms on both sides, mid-back location and general symptoms such as weight loss. Only imaging can tell them apart with confidence. If you are being treated for a "disc" or a "pinched nerve" but the course does not fit, an MRI review by a spine surgeon is worthwhile. You can compare with our article on herniated disc symptoms.

Spinal tumors in children

Persistent back pain is less common in children than in adults and should be taken seriously, especially if it wakes the child at night. A painful or rapidly progressing scoliosis, a change in gait, frequent falls or a return to bed-wetting are further warning signs.

How is a spinal tumor diagnosed?

• MRI is the most useful test. It shows the tumor, its relationship to the spinal cord and nerves, and soft tissue extension. Contrast is added when needed.
• CT shows bone destruction and the strength of the vertebra, and helps plan surgery.
• PET-CT or bone scan looks for other sites of disease when metastasis is suspected.
• Biopsy, usually with a needle under imaging guidance, confirms the tumor type before treatment is planned.

Is there a blood test for a spinal tumor?

No single blood test can show or rule out a spinal tumor. Blood tests help in specific conditions such as multiple myeloma and in assessing general health, but the diagnosis relies on imaging and tissue examination.

Will a spinal tumor show on an X-ray?

Often not in the early stage. A considerable part of the vertebra must be affected before bone loss becomes visible on a plain X-ray, so a normal X-ray does not exclude a tumor.

How are spinal tumors treated?

Treatment is individual and is usually planned together by a neurosurgeon, an oncologist and a radiation oncologist:

• Observation with regular MRI for small benign tumors that cause no symptoms.
• Surgery to relieve pressure on the spinal cord and nerves, to stabilise a weakened spine with screws and rods, and in suitable tumors to remove the tumor completely. Nerve function is monitored throughout the operation.
• Radiotherapy, including high-precision stereotactic techniques that deliver a high dose to the tumor while sparing the spinal cord.
• Chemotherapy and targeted drugs according to tumor type.
• Vertebroplasty or kyphoplasty to support a fractured vertebra with bone cement and reduce pain.

More detail is available on our spinal tumor treatment page.

When to go to the emergency department

• rapidly increasing weakness in the arms or legs,
• new difficulty passing urine, or loss of bladder or bowel control,
• numbness around the groin, buttocks or inner thighs,
• sudden severe back pain in someone with a history of cancer.

Conclusion

Most back pain is harmless, but pain that is worse at night, does not ease with rest, keeps getting worse or comes with numbness or weakness should be investigated for a spinal tumor. Prof. Dr. Ömür Günaldı is a neurosurgeon in Ataköy, Istanbul, who diagnoses and surgically treats spinal and spinal cord tumors. This article is for general information only; a diagnosis and treatment plan can only be made after an examination and imaging.