What is a Spinal Neoplasm?
A spinal neoplasm is any abnormal growth or tumor that develops within or around the spine, encompassing the spinal cord, surrounding membranes, nerve roots, or vertebral bones—these can be either benign or malignant, and are classified by their anatomical location relative to the dura and spinal cord. 1, 2
Anatomical Classification
Spinal neoplasms are categorized based on their location relative to the dura mater and spinal cord 2, 3:
Intramedullary tumors: Arise within the spinal cord parenchyma itself, accounting for 35-40% of intraspinal tumors 1, 3
- Most common types are astrocytomas (45-60%) and ependymomas (30-35%) 1
Intradural-extramedullary tumors: Located inside the dura but outside the spinal cord 2, 3
- Meningiomas are the most common primary neoplasms in this location 3
Extradural tumors: Located outside the dura, most commonly in the vertebral bodies 2, 3
- This is the most common location overall, typically representing metastatic disease 2
Primary vs. Metastatic Disease
Primary Spinal Neoplasms
Primary tumors originate from the spine itself and are relatively rare 1, 2:
Benign primary tumors of the spinal column include 1, 4:
- Osteochondroma
- Osteoblastoma
- Osteoid osteoma
- Giant cell tumor
- Aneurysmal bone cyst
Malignant primary tumors comprise only 20% of primary spinal column tumors and include 1, 2, 4:
- Chordoma
- Chondrosarcoma
- Ewing sarcoma
- Osteosarcoma
- Leukemia
- Lymphoma
Metastatic Spinal Neoplasms
Metastatic disease represents the most common malignant spine tumor overall 2, 5:
- Spinal metastases occur in approximately 70% of cancer patients at autopsy 6, 7
- More than 50% originate from breast, lung, or prostate carcinomas 6, 7
- Renal cell carcinoma is also a common primary source 8, 7
The spine's predilection for metastatic involvement relates to its rich vascular supply through Batson's venous plexus, which allows hematogenous spread of tumor cells 6.
Clinical Presentation
Key Warning Signs
Persistent nighttime back pain refractory to conservative management and rest is the hallmark symptom, present in 25-30% of children with spinal neoplasm 1:
- More specific symptoms including motor or gait disturbance and neurologic deficits usually present later 1
- Locally aggressive tumors may present with rapid increase in pain intensity over a short interval 1
Complications
Spinal neoplasms can cause devastating complications 6, 7:
- Pathological fractures
- Spinal cord compression (metastatic epidural spinal cord compression is a neurologic emergency) 3
- Neurological deficits
- Severe pain profoundly impacting quality of life
Diagnostic Imperative
Imaging is imperative when suspecting spinal neoplasms, because delay in imaging can result in catastrophic consequences 1. MRI of the entire spine with contrast (T1 and T2 sequences) is the gold standard for diagnosis 6.
Common Pitfalls
The rarity of primary spinal tumors makes their management more complex and less well-established compared to metastatic disease 1. In children, it is imperative to exclude serious diagnoses like neoplasm when evaluating back pain, as benign causes (muscle strain, spondylolysis) are more common but missing a tumor can have catastrophic consequences 1.