Spinal tumors are divided into extradural (located outside the spinal cord), intradural extramedullary (located inside the spinal cord but outside the spinal cord), and intramedullary (located inside the spinal cord).

 

They are revealed with different findings according to their location and age. The most common findings are neck, back or low back pain, bending of the spine, bone fractures, numbness and weakness in the hand or foot, and difficulties in urinating and defecating. Paradoxically, pain in spinal tumors is greater at rest and at night. Pain decreases with movement and throughout the day. This feature is attributed to the difficulty of returning dirty blood in the veins and the decrease in cerebrospinal fluid (CSF) vein absorption while lying down. Some spinal tumors (often ependymoma) can interfere with CSF circulation and cause hydrocephalus.

 

Bone Originated (Extradural) Spinal Tumors

Tumors that involve the vertebrae and are called extradural tumors are those associated with the bone. These tumors can be roughly listed as follows: Osteoma, Hemangioma, Osteoblastoma, Aneurysmal bone cyst, Osteosarcoma, Hemangioperistoma, Angiolipoma, Angiosarcoma, Giant cell tumor, Chondoma, Chondroma, Enchondroma, Osteochondroma, Plasmocytoma, Chondroblastoma, Multiple myeloma, Fibroma  Lipoma, Fibrosacoma, Angiolipoma.

 

Osteoid osteoma and osteoblastoma are pathologically the same character but different in size. Osteoid osteoma is smaller than 1.5 cm while osteoblastomas are larger than 1.5 cm. They are painful lesions and most often involve the leg bones. 10-41% spinal involvement is observed and is almost always seen in the posterior elements of the spine. It is more common in men in their 20s and 30s. Pain that increases at night and responds to aspirin is typical. Curettage or removal of the tumor can be performed for symptoms. In the tumor called osteochondroma  spine involvement is observed at a rate of 7%. They are benign lesions.

 

Aneurysmal bone cyst is a benign disease in which spinal involvement is rare. At the waist, the back elements are the more frequently involved area. It is more common in women aged 20-30 years. Pain, local swelling and nerve root involvement are the most common findings. Surgical removal is recommended for treatment.

 

Hemangiomas are the most common benign tumors of the vertebrae. It is most commonly seen in the back and women. Most of the time it does not cause complaints. It can cause local pain or, rarely, nerve and spinal cord compression. Surgical treatment or radiotherapy can be used to treat symptomatic cases.

 

Eosinophilic granuloma is a proliferative disease. If there is spinal involvement, it is most commonly observed in the neck vertebrae and the body of the spine. It progresses with pain and deterioration in the axis of the spine. The treatment is surgery.

 

Osteoclastoma is also called giant cell tumor and locally aggressive but benign tumors. Spinal involvement is observed only in 2-3% of cases. It is more common in women and can occur in any part of any spine at any age. Pain and muscle spasm are the most common findings. Surgical total removal should be the goal. 

 

Plasmocytoma can be solitary, extramedullary or multiple myeloma. Extramedullary type has a better prognosis than multiple myeloma and solitary myeloma. It is a malignant tumor. Involvement of the dorsal spine is common. It is more common in women aged 50 years. Pain is the most common symptom. Surgery and radiotherapy are used in treatment. Multiple myeloma is the most common malignant bone tumor.

 

Osteosarcoma is the most common malignant bone tumor after multiple myeloma.  Spine involvement has been reported in 1-3%. Involvement is more common in the anterior elements of the spine and in men. Pain and neurological deficit are the most common symptoms. Despite surgical treatment, radiation and drug therapy, the results may not be satisfactory.

 

Ewing's sarcoma is a malignant tumor with poor outcomes. It is common in the lower back and sacrum and constitutes 0.5% of primary malignant bone tumors. It is common in the 20s and pain is the most common symptom. Despite surgery, radiation and drug therapy, the results may not be satisfactory.

 

Chordoma most often occurs in the coccyx and where the head and neck meet. It constitutes 20% of the lesions in the skeleton. Although benign, it is an aggressive tumor.  It is common in men and in the 50s and 70s. Pain and impaired urinary and stool control are the most common symptoms. Despite surgical treatment and radiation therapy, 5-year survival was reported to be 66% in the best series.

 

Chondrosarcoma is a malignant primary bone tumor of cartilage origin. 10% originates from the spine. It is frequently observed in 40-year-olds and men. Pain and neurological deficit are the most common symptoms. 5-year life expectancy is below 50%.

 

Metastatic tumors (malignant tumors that spread to the bone)It accounts for approximately 90% of extradural tumors. These tumors can spread directly through the vein or through the foramen. Involvement of multiple non-adjacent vertebrae; It is seen in the spread of breast, prostate cancers and plasma cell cancers. The greatest barrier to keeping these tumors outside the spinal canal is the spinal cord. It is most commonly originated from breast, lung, lymph and prostate. In these, surgical treatment, radiation therapy, ablation or vertebroplasty (cement treatment) can be performed. Life expectancy mostly depends on the primary disease.

 

Intradural extramedullary tumors (located inside the spinal cord but outside the spinal cord)

They can be classified as follows according to their incidence: Nerve sheath tumors (schwannoma, neurofibroma) (40%), meningioma (40%), filum ependymoma (15%) and others (5%).

 

Neurofibromas usually arise from the nerve root ganglion and are shaped like a barbell. Most of it is outside the dura, and may even spread beyond the vertebral canal into the thoracic cavity or abdomen. They are generally benign lesions. They are surgically removed.

 

Meningiomas are a common type of intradural extramedullary tumors. It is most common in the back region. More common in women. They are benign and do not recur when completely removed.

 

Myxopapillary ependymoma is usually located at the level where the spinal cord ends and the nerves extend downward in the form of a fringe. In intradural tumors below the first vertebra of the waist, such tumors should be considered first. They are benign tumors. Cure can be achieved by surgical removal.

 

Epidermoid cysts develop from skin remnants during development in the womb. They are benign masses. If they can be removed completely, they will not recur.

 

Other intradural extramedullary tumors are lipomas, neuroenteric cysts, arachnoid cysts, paragangliomas, hemangioblastomas, sarcomas, metastases, and melanomas arising from the dura.
 

Intramedullary tumors (located inside the spinal cord)

Most common: Ependymoma (45%), astrocytoma (40%), hemangioblastoma (5%) and others (10%). Intramedullary rare tumors include oligodendroglioma, neurocytoma, and subependymoma.

 

Ependymoma is the most common intramedullary tumor. It is more common in women. It is most commonly located in the lower back, at the level where the spinal cord ends and the nerves extend downward in the form of a fringe. They present with pain and neurological symptoms. Spinal MRI is very useful in diagnosis. They are treated surgically. Radiation therapy can be tried in patients who cannot be completely removed.

 

Astrocytomas are another common tumor seen in the spinal cord. It is most commonly seen at the age of 40. It is most commonly located in the back and neck region. The tumor is often accompanied by a cystic structure. Surgical removal is quite difficult compared to ependymomas. In some patients, biopsy and radiation therapy can be applied.

 

Hemangioblastoma is a rarely seen tumor in the spinal cord. An important part of it is observed in the posterior cavity of the brain. It is treated surgically.