Symptoms of Spine Tumors
The most common and critical symptom of spinal tumors is persistent nighttime back pain that is refractory to conservative management and rest, occurring in 25% to 30% of patients with spinal neoplasms. 1
Primary Pain Characteristics
Night pain is a red flag symptom requiring urgent investigation. 1 The pain pattern in spinal tumors has distinctive features:
- Persistent pain during recumbent position (lying down during sleep) that improves when sitting up 1, 2
- New and/or increasing severe back or neck pain 1
- Pain between or just below the shoulder blades 1
- Locally aggressive tumors present with rapid increase in pain intensity over a short time interval 1
Neurological Symptoms (Late Presentation)
More specific neurological symptoms typically present later in the disease course and indicate progression. 1 These include:
- Motor or gait disturbance 1
- Decreased strength in the legs (and sometimes arms) 1
- Difficulty controlling the legs or arms 1
- Very wobbly or unsteady gait 1
- Numbness or tingling radiating from chest, stomach, groin, and/or legs 1
- Inability to walk and/or stand, or legs giving way 1
Radicular and Referred Pain
Radiating pain patterns can help localize tumor involvement: 1
- Radiating pain in the stomach, chest, arms, or legs 1
- Neurological signs inconsistent with the level of degenerative disease should raise suspicion 2
Systemic and Constitutional Symptoms
Systemic symptoms are unusual in primary spinal tumors but may indicate metastatic disease. 1 In pediatric populations specifically:
- Low-grade fever (more common with infection but can occur) 1
- Decreased range of motion 1
- Irritability (in children) 1
- Localized tenderness 1
- Limping 1
Critical Pitfalls to Avoid
A common diagnostic pitfall is attributing symptoms to coexisting degenerative spine disease, which can significantly delay tumor diagnosis. 2 Key warning signs include:
- Persistent pain after disc surgery without long-lasting relief 2
- Back pain in the recumbent position (a frequent and distinctive symptom) 2
- A "normal" x-ray does not exclude spinal tumors 1
- Recent history of injury does not exclude spinal tumors 1
Presentation by Tumor Location
Tumor symptoms vary by anatomical location: 3, 4
- Extradural lesions (most common, typically metastatic): Present primarily with pain and mechanical instability 3, 4
- Intradural-extramedullary tumors: Present with radicular pain and progressive neurological deficits 3
- Intramedullary tumors (astrocytomas 45-60%, ependymomas 30-35%): Present with spinal cord compression symptoms 1, 3
Urgent Evaluation Indicators
Imaging is imperative when suspecting spinal tumors because delay can result in catastrophic consequences. 1 Urgent MRI is required for:
- Any persistent nighttime pain 1
- Any mass or swelling 1
- Progressive neurological deficits 5
- Spinal cord compression symptoms 1, 5
The average duration of symptoms before presentation is 3 months, but many patients present later, emphasizing the importance of maintaining high clinical suspicion. 1