OVERVIEW

What are spinal tumors?

Spinal tumors refer to tumors that grow in the spinal region. Due to their anatomical proximity to nerves and the spinal cord, they pose significant risks. Their deep location and complex anatomy make them difficult to remove, distinguishing them from bone tumors in the limbs.

Are all spinal tumors metastatic?

Most are.

Metastatic spinal tumors account for the majority of spinal tumors. Autopsies of patients who died from cancer reveal that one-third already had spinal metastases. However, some spinal tumors are primary.

What are the common types of benign spinal tumors?

Benign spinal tumors make up 20–40% of all spinal tumors. Common types include osteoid osteoma, osteoblastoma, osteochondroma, aneurysmal bone cyst, hemangioma, eosinophilic granuloma, giant cell tumor, and fibrous dysplasia. These benign bone tumors often occur in young people, and treatment varies by tumor type, including conservative observation, radiation therapy, or surgery.

What are the common types of malignant spinal tumors?

Primary malignant spinal tumors mainly affect adolescents and include osteosarcoma, chondrosarcoma, Ewing's sarcoma, chordoma, and multiple myeloma.

SYMPTOMS

What are the symptoms of spinal tumors?

• Pain: Usually the earliest symptom of spinal tumors. Neck pain occurs if the tumor is in the cervical spine, back pain if in the thoracic spine, and lower back pain if in the lumbar spine. It is often accompanied by limited spinal mobility.

• Neurological symptoms: If nerves are affected, symptoms may include a sensation of tightness around the chest or back (like being bound by a rope or band), as well as pain, numbness, or weakness in the arms or legs. Severe cases may lead to paralysis.

• Deformity: Larger tumors may cause visible swelling or bulging at the back of the spine. Destruction of vertebral bodies can lead to hunchback or spinal curvature deformities.

CAUSES

What are the common sources of spinal metastases?

The common sources of spinal metastases are breast cancer, lung cancer, prostate cancer, gastrointestinal cancer, and thyroid cancer. Therefore, patients with these tumors need to be especially vigilant.
More than half of spinal metastases in women originate from breast cancer. These individuals should pay particular attention and seek medical attention promptly if symptoms such as pain occur.
ECT can be performed to check for metastases, but it should not be done too frequently. It is recommended when symptoms are present or when there is substantial evidence suggesting spinal metastases.

DIAGNOSIS

How to Detect Spinal Tumors Early? What Are the Early Symptoms?

First, the earliest sign of a spinal tumor may be pain. If you experience persistent neck pain, chest pain, or back pain, you should consult a doctor and undergo examinations.
Second, for young people or children, primary spinal tumors (originating in the spine itself rather than spreading from elsewhere) are usually considered. MRI and CT scans are needed to determine the tumor's location, nature, and its relationship with nerves and blood vessels.
For older adults, metastatic tumors are the main concern. In addition to MRI and CT scans, PET-CT (positron emission tomography-computed tomography) and tumor marker tests may be required to identify the primary source of the metastasis.

What Tests Should Patients with Spinal Tumors Undergo?

Conventional X-rays, CT scans, and MRI are essential, as they each have unique advantages in detecting tumors. X-rays provide a general overview and help locate the affected area. CT scans offer detailed views of bone destruction, while MRI reveals the tumor's relationship with surrounding blood vessels and nerves, as well as spinal cord compression.
In addition, an ECT (whole-body bone scan) should be performed to check for tumors in other vertebrae or bones.
For metastatic bone tumors, PET-CT is also necessary to identify the primary tumor site. This is crucial—for example, some patients may first discover a spinal metastasis without realizing it originated from prostate cancer.

TREATMENT

Which department should I visit for spinal tumors?

Spinal tumors are highly specialized and are generally treated in the orthopedic department or neurosurgery department.

What are the main treatment methods for spinal tumors?

The main treatment methods currently include surgical resection, chemotherapy, radiotherapy, targeted drug therapy, and endocrine therapy.
If surgical resection is possible, it is the preferred option, followed by adjuvant radiotherapy and chemotherapy.
If the tumor is difficult to completely remove or is multifocal, other methods are chosen. Some tumors are sensitive to radiotherapy, while others respond better to endocrine therapy.

Under what circumstances is surgery considered for metastatic spinal tumors?

Whether and how to perform surgery for spinal tumors requires thorough professional evaluation. Generally, surgery is considered in the following three situations:

• The tumor can be completely removed: For example, certain benign tumors or malignant tumors confined to the spine without invading surrounding soft tissues may be completely resected after medical evaluation.

• Nerves or the spinal cord are compressed: Some rapidly growing metastatic or malignant tumors may compress surrounding nerves or the spinal cord, causing sensory abnormalities or motor dysfunction. Even if the tumor cannot be completely removed, surgery should still be attempted to relieve compression and protect or restore nerve function.

• The patient experiences unbearable pain that is difficult to control with medication: If complete tumor removal is not feasible, partial resection may still be performed to reduce tumor burden, alleviate pain, and improve quality of life.

Is surgery necessary for benign spinal tumors?

The following benign tumors should be surgically removed:

• Benign tumors compressing the spinal cord or nerve roots, causing neurological dysfunction that does not respond to medication;
• Benign tumors that continue to grow and compress adjacent organs or tissues;
• Benign tumors with potential for metastasis or malignant transformation, such as giant cell tumors.

Can metastatic spinal tumors be treated surgically?

Previously, spinal metastasis was considered a late-stage condition where surgery was deemed unnecessary. However, current thinking suggests that surgery can be performed if it relieves pain and preserves neurological function, especially for tumors with relatively low malignancy and longer average survival, such as thyroid, breast, and prostate cancers. Surgery may be considered for metastatic spinal tumors meeting the following criteria:

• The metastasis involves only one vertebra without bone destruction, allowing complete resection;
• The tumor compresses the spinal cord, causing progressive neurological decline;
• The pain is intractable and unresponsive to medication, radiotherapy, or chemotherapy, or recurs after treatment;
• The patient is in good overall health, can tolerate surgery, and has an expected survival of over six months.

Can surgery restore function if a spinal tumor has caused paralysis?

This depends on whether the spinal cord is completely necrotic:

• If the tumor compresses the spinal cord or nerves, causing degeneration (similar to injury but not complete death), surgical removal may partially or fully restore neurological function.

• If the spinal cord or nerve cells are completely necrotic, surgery cannot restore mobility.

Assessing nerve degeneration versus necrosis depends on the degree and duration of compression. Currently, no definitive test exists, though electromyography may provide clues. An orthopedic doctor must evaluate the patient’s condition.

Why is bone grafting needed for spinal tumor surgery?

Since the tumor invades the bone, the affected bone must be removed and replaced with bone from another area—essentially "robbing Peter to pay Paul." Non-weight-bearing bones like the iliac crest are typically used, minimizing impact on daily life.

When is radiotherapy suitable for spinal tumors?

Most metastatic spinal tumors are sensitive to radiotherapy, especially those originating from the lung, kidney, prostate, or breast.
Among primary spinal tumors, hemangiomas, myelomas, and eosinophilic granulomas are more responsive. Notably, giant cell tumors may undergo malignant transformation after radiotherapy, so it is generally not recommended.
Radiotherapy can also be used pre- or post-surgery. Preoperative radiotherapy reduces tumor vascularity, kills tumor cells, and shrinks soft tissue masses. Postoperative radiotherapy ensures more thorough tumor cell eradication.

How long after radiotherapy can spinal tumor surgery be performed? How long after surgery can radiotherapy begin?

Early post-radiotherapy tissue edema or necrosis may affect surgery and wound healing. Thus, surgery is typically considered at least two weeks after radiotherapy.
Postoperative radiotherapy is best initiated 3–4 weeks after surgery, allowing wound healing and patient recovery. Earlier radiotherapy may impair wound healing and bone graft fusion.

What is spinal tumor particle implantation surgery?

Particle implantation is a form of localized internal radiotherapy, primarily for advanced inoperable cases. It kills local tumor cells, partially relieving compression and pain.
Under CT guidance and local anesthesia, radioactive particles are delivered via needle to the affected vertebra to kill nearby tumor cells.
Advantages include minimal trauma, precision, and outpatient feasibility.
Disadvantages include incomplete treatment, potentially requiring multiple implants.

How long is spinal tumor particle implantation effective? Does it pose radiation risks to family members?

Common particles (e.g., iodine-131 or strontium) are less than 1 mm in size, with a radiation range of 5–10 mm, posing no risk to others. Effectiveness lasts 3–6 months before radioactivity diminishes harmlessly.

Which spinal metastatic tumors are more sensitive to chemotherapy?

Myelomas, lymphomas, osteosarcomas, and metastases from breast or lung cancer are chemotherapy-sensitive.
Systemic chemotherapy delivers drugs (e.g., cyclophosphamide, fluorouracil, gemcitabine, oxaliplatin) intravenously to kill tumor cells but also damages healthy cells, causing side effects like vomiting, hair loss, and bone marrow suppression.

What is palliative treatment for spinal tumors?

Palliative treatment is used when complete surgical removal is impossible. Surgery aims to reduce tumor burden, relieve pain, and improve quality of life.

What is vertebroplasty (PVP or PKP) for spinal tumors?

Vertebroplasty is a palliative treatment for metastatic spinal tumors. Bone cement (a liquid material that hardens like concrete) is injected into the tumor-damaged vertebra to restore stability and relieve pain.
It is contraindicated if the posterior vertebral wall is compromised, as cement leakage could compress the spinal cord.

Do vertebral hemangiomas require treatment?

Hemangiomas occur in 10% of spines, often incidentally found on MRI with no symptoms.
Rare cases causing fractures or pain require radiotherapy or vertebroplasty.
Asymptomatic cases need only periodic monitoring (every 1–2 years). Treatment is reserved for symptom onset.

Can spinal tumors recur after surgery?

All malignant tumors may recur due to:

• Tumor location and treatment limitations (e.g., proximity to nerves or vessels hindering complete resection);
• Aggressive pathology (e.g., giant cell tumors, chordomas);
• Incomplete surgical removal.

Most benign tumors rarely recur if properly treated.

What conservative treatments are available for spinal tumors?

The overall goals are prolonging life, alleviating pain, and improving quality of life. Tailored options include chemotherapy, radiotherapy, endocrine therapy (for breast/prostate cancer), and physical therapy, chosen based on tumor type.

Can elderly spinal tumor patients with comorbidities undergo surgery?

Patients with hypertension, diabetes, or chronic bronchitis can often safely undergo surgery if preoperatively optimized.

Severe conditions (e.g., immunodeficiency, coagulation disorders, cardiopulmonary or renal dysfunction) generally contraindicate surgery due to high risk. If surgery is strongly desired, medical stabilization is required first.

Spinal surgery is major, and factors like age and comorbidities increase risk, particularly for the elderly, children, or frail individuals.

What is the life expectancy for spinal tumor patients?

This depends on tumor type. Benign tumors, once removed, do not affect lifespan. Malignant tumors vary by aggressiveness: thyroid or breast metastases may allow 3–10 years, whereas lung, liver, or kidney metastases often permit only 6 months to 2 years.

DIET & LIFESTYLE

What are the dietary precautions for patients after spinal tumor surgery?

There are no specific dietary restrictions for patients recovering from spinal surgery, but it is recommended to consume high-protein and nutritious foods such as eggs and milk. At the same time, vegetables and fruits should also be included to provide essential vitamins and boost the body's immunity. It is important to note that patients should not eat immediately after surgery. They should wait at least 6 hours after leaving the operating room before consuming food, as they may not be fully awake, and eating too soon can lead to aspiration and pneumonia. Even after 6 hours, soft and liquid foods should be prioritized, gradually transitioning to a regular diet.

Do the screws placed in the spine during spinal tumor surgery need to be removed?

The internal fixation materials currently used are mostly made of titanium alloy, which does not cause foreign body reactions. Under normal circumstances, they do not need to be removed. However, if breakage occurs, removal may be necessary.

PREVENTION

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