Symptoms of Spinal Neoplasms
Spinal neoplasms characteristically present with progressive back or neck pain that worsens at night and improves when sitting up, often followed by neurological deficits if diagnosis is delayed. 1, 2
Pain Characteristics (Most Common Presenting Feature)
The hallmark symptom is new or rapidly increasing severe back or neck pain that differs from typical mechanical pain: 1, 2
- Night-time pain that worsens while lying down and improves when sitting up is the most characteristic red-flag symptom 2
- Persistent nighttime back pain that does not improve with rest or conservative therapy occurs in 25-30% of patients 2
- Pain located between or just below the shoulder blades is frequently reported 1, 2
- Radiating pain to the stomach, chest, arms, or legs may occur 1
- Rapid escalation of pain intensity over a short period suggests locally aggressive tumor 2
Critical pitfall: Pain is often the only symptom for months (average 3 months from onset to presentation), and its significance is frequently underappreciated until neurological deficits develop. 2, 3
Neurological Manifestations (Indicate Disease Progression)
These symptoms signal advanced involvement and potential spinal cord compression: 1, 2
- Decreased strength in the legs (and sometimes arms) 1, 2
- Difficulty controlling the legs or arms with markedly unsteady or wobbly gait 1, 2
- Numbness or tingling radiating down from chest, stomach, groin, and/or legs 1, 2
- Inability to walk and/or stand, or legs giving way 1, 2
- Weakness typically follows sensory symptoms in the natural progression 3
- Sphincter dysfunction represents late-stage involvement 3
The natural history is relentless progression to complete and irreversible paralysis unless timely treatment is undertaken. 3
Tumor-Location Specific Presentations
- Intramedullary tumors (ependymomas 30-35%, astrocytomas 45-60%) typically present with spinal cord compression symptoms including motor and sensory deficits 2
- Isolated neck pain without other neurological symptoms can occur, though this is rare 4
Systemic and Constitutional Signs (Less Common)
These are uncommon in primary spinal tumors but may indicate metastatic disease: 2
- Low-grade fever (especially when infection co-exists) 2
- Reduced range of motion of the spine 2
- Localized tenderness over the spine 2
- Irritability (particularly in children) 2
- Limping (in pediatric patients) 2
Critical Diagnostic Pitfalls to Avoid
- A normal plain radiograph does NOT exclude the presence of a spinal tumor 2
- Recent history of trauma should not be taken as evidence against tumor diagnosis 2
- Duration of pain in benign tumors can range from 1 to 6 years before diagnosis, making misdiagnosis common 5
- Patients whose symptoms progress or fail to respond over an appropriate period require further evaluation with MRI 5
Urgent Imaging Indications
Urgent MRI of the entire spine is mandatory for: 2, 6
- Any patient with persistent nighttime pain 2
- Palpable mass or swelling 2
- Progressive neurological deficits 2
- Signs of spinal cord compression (motor weakness, sensory loss) 2
MRI timeframes based on presentation: 6
- Back pain only: within 2 weeks
- Suspected epidural metastatic spinal cord compression (MESCC): within 12 hours
- Progressive radicular deficit <7 days: within 24 hours