About Benign Spinal Cord Tumours

Spinal cord tumours can be either benign or malignant. This website concentrates mainly on benign spinal cord tumours. Although benign tumours may not be particularly harmful in most parts of the body this differs where spinal tumours are concerned as damage to the spinal cord or nerves can cause many problems.

Symptoms

Initial symptoms can vary. They can include pain and sensory changes (eg numbness) and motor problems (eg muscle weakness and spasticity). The parts of the body which may be affected by these symptoms may vary according to the location of the tumour along the spinal canal.

Diagnosis

Several neurological tests will be performed. If necessary you will also have an MRI (magnetic resonance imaging) scan. This will show the spinal cord in detail.

Treatment

If a spinal cord tumour is diagnosed the most common form of treatment is for it to be removed by surgery. This will be carried out by a neurosurgeon. In some cases it isn’t possible to remove the whole tumour and the growth of the residual tumour is usually monitored by regular MRI scans. Sometimes surgery isn’t recommended because the damage it might do to the nervous system is considered too risky, and your consultant will discuss your options with you following your diagnosis.

Long term effects of benign spinal cord tumours

This can be very difficult to predict. Sometimes the nerves can recover to some extent but in other cases there may be some permanent nerve damage.

We would like to thank Professor Richard Hayward who has very kindly written the information below for us. He tells us about the different categories of spinal tumours and describes the types of tumours which can grow in each category. He also explains the difference between benign and malignant tumours.

SPINAL TUMOURS

By Richard Hayward

Professor, Paediatric Neurosurgery
Great Ormond Street Hospital
London

Emeritus Consultant Neurosurgeon,
The National Hospital for Neurology and Neurosurgery,
London.

General Comments

Spinal tumours are traditionally divided into three categories according to their relationship to the spinal cord, its surrounding membrane (the dura) and the bones (vertebrae) of the spine.

These categories are:
1. Intramedullary
2. Extra-medullary but intra-dural
3. Extra-dural

And a word about benign and malignant,

Benign tumours tend to be slowly growing, are often well-demarcated from the surrounding normal tissues (making them easier to remove completely) and do not spread (metastasize) around either spine (or brain) or the rest of the body.

Malignant (which usually means cancerous) tumours are usually rapidly growing and tend to have extensions into the adjacent normal tissues making them difficult to remove completely unless some of that normal surrounding tissue can be sacrificed without causing harm (not the case when it comes to the spinal cord or brain). They can also spread (often through the bloodstream) to other parts of the body.

Any tumour that has been completely removed surgically cannot (by definition) recur. But if fragments (even those too small for the surgeon to see) remain after the operation (which is more likely with malignant tumours but can happen also with a benign tumour) then further growth is likely.

Intramedullary tumours

These arise within the spinal cord itself and are rare. The two types most commonly seen are the astrocytoma and the ependymoma.

Astrocytoma
Spinal cord astrocytomas can affect children as well as adults. In adults they may occasionally be malignant but the majority in both adults and children are benign and slow growing. They tend to be partly cystic (fluid-filled) and partly solid. Some or all of the tumour tissue can usually be removed surgically (and cyst fluid drained). Radiotherapy, which can be effective in stopping further growth, is usually reserved for those tumours that have been incompletely removed and are/or are showing signs of continuing growth.

Ependymoma
Spinal cord ependymomas affect adults more than children. They tend to be benign tumours with a clear boundary between themselves and the surrounding spinal cord tissue that aids their surgical removal. Because they have a tendency to recur, post-operative radiotherapy is usually recommended and this is usually effective in preventing further tumour growth.

An important variant is the myxo-papillary ependymoma. This is more rapidly growing than the “classic” ependymoma desribed above. It usually arises from and spreads over the lowest part of the spinal cord (the conus medullaris). It is a soft, easily fragmented tumour that is difficult to remove completely. Fortunately it is extremely sensitive to radiotherapy which is usually curative.

Other even more rare intramedullary tumours include the Neurocytoma and the Ganglioglioma. Both are very benign and may show little growth over many years.

Extra-medullary but intra dural tumours

These arise within the space between the spinal cord and the dura. The two types most commonly seen in this location are the meningioma and the neurofibroma.

Meningioma
Meningiomas are slowly growing benign tumours that grow from the dura - that surrounds the brain and spinal cord and then cause pressure on those structures. They are very rare in childhood and mainly affect adults of middle age and older. In the spine they occur particularly in older women to cause slowly progressive difficulty with walking and bladder control. They show up well on spinal MRI scans. Most can be removed surgically and a complete removal should mean a cure. Post-operative treatment such as radiotherapy and/or chemotherapy is rarely needed.

Neurofibroma
Neurofibromas (also known as schwannomas) are predominantly benign tumours that arise from the outer coverings of the nerve roots as they emerge from the spinal cord. They grow slowly to produce (like meningiomas) slowly progressive difficulty with walking, reduced skin sensation (numbness) below their level and interference with bladder control. Irritation of the nerve from which they are growing can produce a band of pain that is felt along the skin that that nerve is going to (down an arm, or in a band around the trunk, or down one leg, for example).

Neurofibromas can sometimes be part of a more generalized tendency for the body to produce this type of tumour – a condition called neurofibromatosis that sometimes runs in families.

Extra-dural tumours

Extra-dural tumours are the most common spinal tumours and usually arise in the bone (vertebrae) themselves. Although some are primary (have started life there), the great majority are metastases (tumour spread) from a malignant tumour whose primary site is elsewhere.

Although this website deals predominantly with benign spinal tumours, some mention of the malignant types is made here.

Metastases
The most common primary (originating) sites for spinal metastatic disease include lung, breast, prostate and kidney. The affected vertebral bone is weakened and may collapse causing severe pain in the back. The collapsed bone and the tumour tissue itself then compresses the spinal cord to produce an often rapidly advancing leg weakness and bladder disturbance.

Treatment has two aims – control of the underlying primary malignant disease and control of the local (spinal) disease. The latter may require an urgent surgical decompression with or without an orthopaedic input (to strengthen the weakened spine) followed by local (often palliative) radiotherapy. The outlook for regain of useful leg function depends on the diagnosis being made before all use of the legs and bladder has been lost. The overall outlook (ie for life) depends on what if anything can be done to control the underlying primary malignant disease.

Primary bone tumours that can affect the spine include the highly malignant tumours osteogenic sarcoma and Ewing’s tumour. Their treatment usually involves a combination of surgery, radiotherapy and chemotherapy.

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SPINAL TUMOURS