Spinal Tumors

Hands holding a tablet that is displaying a spine X-ray image.

At the OHSU Spine Center, we provide complete care for people with spinal cord tumors. We work with you to create a treatment plan that is right for you. We offer:

  • Expertise in treating spine and spinal cord tumors.
  • A team approach, combining the expertise of many specialists. Our team meets regularly to discuss next steps in your care.
  • Patient-centered care, with experts who take time to get to know you and your loved ones. We work with you to plan treatment that meets your needs, wishes and values.

Our excellence

At OHSU, we know that each spine tumor is different, so we look at each case from multiple angles. We work together to treat the most challenging cases through our spine tumor program.

Our team of specialists meets monthly to examine cases together. These experts include neurosurgeons and orthopaedic surgeons who specialize in spine surgery, radiation oncologists, interventional radiologists, and medical oncologists.

OHSU is the only hospital in Oregon where experts work together in this way. Our approach makes sure that you:

  • Receive the best possible treatment, tailored to your condition.
  • Benefit from the knowledge of many spine and cancer experts.
  • Have access to the latest treatments, including clinical trials.
OHSU offers the most advance spinal tumor care in Oregon. Our spine tumor specialists meet twice a month, a meeting known as a “tumor board,” to discuss every patient and develop a personalized treatment plan.

Understanding spinal tumors

A medical diagram illustrating the anatomy of the human spinal cord.
Medical Illustration Copyright © 2020 Nucleus Medical Media. All rights reserved.

The spinal cord and brain make up the central nervous system, responsible for thinking, movement and sensation. A tumor happens when cells grow out of control, and form a mass on the spine or spinal cord. Tumors can form on any part of the spine, from the neck to the lower back.

Benign versus malignant: A spinal tumor can be benign (not cancer) or malignant (cancer). Both need treatment to avoid nerve damage.

Primary versus secondary or metastatic: A primary tumor starts on the spine. A secondary, or metastatic, tumor spreads to the spine from cancer that is somewhere else in the body. About 70% of all spinal tumors are metastatic. The rest are primary.

A metastatic spinal tumor is stage IV cancer. Many metastatic spinal tumors start with lung, prostate, breast or thyroid cancer. Other types of cancer can spread to the spine too.

There is no way to predict who will get a metastatic tumor and who will not. Your risk can vary based on the stage of the original cancer at diagnosis and the type of treatment you received.

It is important to find and treat metastatic tumors as early as possible. Go to all follow-up appointments after your cancer treatment and talk to your doctor about any symptoms.

Primary spinal tumors are rare, and doctors usually do not know what causes them. According to the American Association of Neurological Surgeons, about 10,000 Americans develop a spinal tumor each year. Only about 30% are primary tumors.

  • Meningiomas, tumors in the tissue covering the spinal cord, and benign tumors called schwannomas and neurofibromas are the most common primary spinal tumors.
  • Meningiomas most often occur in women ages 40 to 70.

The few risk factors linked to primary spinal tumors include:

  • Radiation exposure: Most often, a patient had radiation therapy for a different condition.
  • Family history: People with neurofibromatosis type 2 or Von Hippel-Lindau syndrome may have higher risk.
  • Age: Spinal tumors can affect anyone, but they are more common in young and middle-aged adults.

Survival rates vary widely depending on the tumor type, your age and whether the tumor is benign, malignant or metastatic. For example, more than 90% of patients ages 20 to 44 live at least five years after a meningioma diagnosis. The rate is 71% for patients ages 55 to 64.

Survival rates are averages, and can’t predict the outcome for any one person.

Symptoms of spinal tumors

Symptoms of both primary and metastatic spinal tumors are similar to those of many other conditions. Some people with spinal tumors have no symptoms at all.

A team that specializes in spinal tumors can make an accurate diagnosis. Symptoms differ from person to person but can include:

  • Neck pain
  • Worsening back pain, even with treatment
  • Muscle weakness or loss of feeling in the legs, arms or chest
  • Loss of bladder or bowel control
  • Paralysis
  • Scoliosis (curved spine)
  • Difficulty walking
  • Muscle contractions or twitches

Diagnosing spinal tumors

Most of our patients already have a diagnosis. Our team will do more tests, including surgery in some cases, to verify the diagnosis.

Tests may include:

  • Lumbar puncture: We use this test, also called a spinal tap, to look for cancer cells. If they are found, it means cancer spread from elsewhere in your body. To do the test, we numb your lower spine. We insert a needle between your spine bones and remove some of your cerebrospinal fluid. This is the clear liquid that cushions your brain and spinal cord.
  • Myelogram: This spinal X-ray uses a special injected dye to create detailed pictures of your spine bones and the spaces between them.
  • A spine CT or MRI: These tests create high-resolution images of your spinal cord so we can look for problems.
  • Needle biopsy: We use an operative microscope and advanced spinal cord monitoring to remove a small piece of tumor so we can analyze it. This helps us identify the tumor type and the best treatment plan.

Types of spinal tumors

There are three categories of primary spinal tumors: intramedullary, extramedullary and extradural.

These begin in the spine, usually in the neck. Types include:

  • Gliomas: These start in glial cells, which surround and support neurons. Neurons are the nerve cells that send signals throughout the body. Types of gliomas include:
    • Astrocytomas start in the cells that control movement, posture and balance.
    • Ependymomas develop in the cells that line the brain’s fluid-filled cavities and the center of the spinal cord.

These grow in the cells that surround the spinal cord or in the nerve roots that grow from the spinal cord. Types include:

  • Meningiomas: These begin in the meninges, tissues that cover the brain and spinal cord.
  • Nerve sheath tumors: These grow on nerves throughout the body. The nerve sheath is made up of myelin, which protects nerve fibers and helps them send signals. The cells that create myelin can grow rapidly and form a tumor. Common types are:
    • Schwannomas, which are usually benign. Types include vestibular schwannomas and acoustic neuromas, which form on the nerve that helps with hearing and balance.
    • Neurofibromas, associated with an inherited condition called neurofibromatosis type 1, or NF1.

Extradural spinal tumors grow inside the spinal column, often around the membrane that surrounds the spinal cord or on the backbone. Types include:

  • Sarcomas: A sarcoma is a tumor that starts in the cells of the bone or in the body’s soft tissues (like the fat, muscles, nerves, blood vessels or deep skin). 
  • Chordomas: A chordoma is a tumor that grows in the tissue inside of the spine. Chordomas grow very slowly. They can be anywhere on the spine, but the most common places for chordomas are:
    • Where the spine and the skull meet. This is called a clival tumor.
    • Near the tailbone. This is called a sacral tumor.

Staging

Staging primary spinal tumors

Primary spinal tumors usually don’t spread outside the central nervous system, so doctors don’t use the traditional cancer staging system to stage them. Other factors help guide treatment instead, such as: 

  • Age: Younger people often have better outcomes than older adults.
  • Impact: How much your daily functions are affected.
  • Tumor features: Your team considers the tumor type, location and size.
  • Genetic factors: The tumor’s genetic traits may offer treatment options.
  • Localization: Some tumors are in one site, while others have spread.

Staging metastatic spinal tumors

By definition, a metastatic spinal tumor is stage IV cancer. It is part of the original cancer, not a separate or new cancer diagnosis. For example, if you have breast cancer, a metastatic spinal tumor is stage IV breast cancer. If you have lung cancer, it is stage IV lung cancer.

Grading

Doctors grade spinal tumors on a scale of one to four. The lower the grade, the less aggressive the tumor and the easier it is to treat. Tumors graded I or II are often benign. Tumors graded III and IV are often malignant. Here’s how the World Health Organization defines grades:

  • Grade I: Slow-growing. Cells look almost normal. Associated with long-term survival. Rare in adults.
  • Grade II: Relatively slow-growing. Cells look slightly abnormal. Can spread to nearby normal tissue and recur, sometimes returning as a higher-grade tumor.
  • Grade III: Cells look abnormal and are reproducing. They can grow into nearby normal tissue and are prone to recurring, often as a grade IV tumor.
  • Grade IV: Cells look highly abnormal and rapidly reproduce. Tumors form new blood vessels to support growth. They have dead cells in their centers. They can easily invade nearby normal tissue.

Treatment of spinal tumors

If you have a spinal tumor, your care team may include specialists in the OHSU Knight Cancer Institute or OHSU’s Dotter Department of Interventional Radiology.

Your doctors will be experts in your diagnosis and the treatments or procedures you need. Your care team may include:

  • Interventional radiologists: Experts in using medical imaging technology to perform minimally-invasive procedures.  
  • Medial and neuro-oncologists: Experts in treating malignant or metastatic spinal tumors with chemotherapy and other medications.
  • Neuropathologists: Experts in diagnosing brain and spinal diseases.
  • Neuroradiologists: Experts in interpreting brain and spinal tumor imaging.
  • Neurosurgeons: Experts in diagnosing and treating complex brain and spinal conditions, including tumors, through surgery and other methods.
  • Orthopaedic surgeons: Experts in performing certain types of spine surgeries.
  • Radiation oncologists: Experts in treating malignant or metastatic tumors with high-energy beams that destroy cancer cells.

Radiation therapy

Radiation therapy is the main treatment for spinal tumors. We use one of the most advanced radiation therapy systems available. Targeted radiation therapy uses high doses of radiation to destroy the tumor. Our neuro-oncologists work closely with radiation oncologists to provide this advanced treatment.

Radiation sessions, also called fractions, usually happen once a day, Monday through Friday, for several weeks. Each session lasts about 30 minutes. We take care to target your tumor while protecting healthy tissue.

Types include:

  • Stereotactic radiosurgery delivers a precise dose to the tumor in a single session or a few sessions.
  • 3-D conformal radiation therapy (3D-CRT) uses several high-dose radiation beams, aimed from different directions and shaped to match the tumor.
  • Intensity-modulated radiation therapy (IMRT) is a type of 3D-CRT. We use a machine that changes your position during treatment. We can adjust beam strength while protecting healthy tissue.

Surgery

Surgery may be used to remove a tumor, relieve symptoms and improve your quality of life.

To help decide if surgery is the right treatment for you, the OHSU spinal surgery team will do a full evaluation. We consider:
 

  1. Your diagnosis. The size, location, type of tumor and whether it is primary or metastatic.
  2. Whether the tumor is pressing on the spinal cord or a nerve. This can cause weakness or numbness in the limbs, bowel or bladder changes and other neurological problems. Surgery may reduce or prevent these symptoms.
  3. Whether the tumor is damaging the bones. Some tumors can damage bones and make the spine unstable. This can lead to injury. Surgery may help repair or prevent the damage.
  4. Whether the tumor is causing pain. A lot of tumors cause pain, and sometimes the pain is debilitating. Surgery may help relieve the pain.

Our neurosurgeons, orthopaedic surgeons and interventional radiologists offer vast experience and the latest surgical techniques. Our surgeons are fellowship trained, meaning they completed advanced, hands-on work after their residency.

Spinal tumor surgeries include:

Full surgical resection. This is an open surgery with a longer incision, usually for patients with metastatic tumors.

Minimally-invasive surgery. These surgeries use smaller incisions and often have faster recovery times, less pain and fewer complications. Examples of minimally-invasive surgeries are:

  • Separation surgery: This is a treatment for metastatic spinal tumors. It involves removing parts of the tumor, or “separating” it, from the spinal cord or nerves.
  • Kyphoplasty: This is a treatment for metastatic or primary spinal tumors. Kyphoplasty can help repair bones that are damaged by spinal tumors. For this surgery, we place a balloon in the damaged area and inject it with a special cement.
  • Vertebroplasty: This is similar to kyphoplasty, but without a balloon.
  • Radiofrequency ablation: This is a treatment for metastatic spinal tumors. For an RF ablation, doctors use a special probe to damage or destroy a tumor with heat.
  • Microsurgery: This surgery uses a very small incision and a tool called a tubular retractor. This tool pulls the skin around the incision back so the surgeon can easily reach the tumor.
  • Hybrid surgery. Hybrid surgeries combine open and minimally-invasive techniques.

Preparing for surgery

Before you have spinal tumor surgery, you will meet at least once with your surgeon. Your surgeon will help you get ready for your surgery, and answer your questions about your surgery and recovery.

Depending on your diagnosis, you may also meet with cancer, radiation or other specialists. If you need other treatments along with your surgery, all of your doctors will work together to coordinate your care.

During surgery

Most spinal tumor surgeries take place under general anesthesia. Some procedures take several hours. Others are much shorter. Your surgeon will let you know how long they think your surgery or procedure will take, but it is always an estimate. It could be longer, or it could be shorter.

Surgery recovery

After spinal tumor surgery, most patients need to stay in the hospital. The length of your hospital stay depends on your condition and the type of surgery you have. Your surgeon, a physical therapist, and/or other specialists, will work with you to make sure your transition out of the hospital is safe.

You will meet with your surgeon for a follow-up appointment within two weeks of your surgery. At this appointment, we will make sure your wound is healing well. We will also talk about when you can return to your regular activities.

Depending on the type of job you do, the type of surgery you have and how your recovery is going, you may need to take several weeks off from work to recover from surgery.

Clinical trials

At OHSU, we offer access to a wide range of clinical trials. Find a clinical trial.

Additional services

As part of our partnership with the OHSU Knight Cancer Institute, our patients have access to a full range of support services, including:

Learn more

For patients

Referral: To become a patient, please ask your doctor for a referral.

Questions: For questions or follow-up appointments, call 503-418-9888.

Location

OHSU Spine Center, South Waterfront

Center for Health & Healing, Building 1, 12th floor
3303 S. Bond Ave.
Portland, Oregon 97239

Free parking for patients and visitors

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