Spinal Tumours (Benign and Malignant)
A spinal tumour is an abnormal growth of cells within or adjacent to the spinal column. Spinal tumours can be benign (non-cancerous) or malignant
What are Spinal Tumours?
A spinal tumour is an abnormal growth of cells within or adjacent to the spinal column. Spinal tumours can be benign (non-cancerous) or malignant (cancerous), and can originate from the spine itself (primary tumours) or spread to the spine from a cancer elsewhere in the body (metastatic tumours). Depending on their location and size, spinal tumours can compress the spinal cord, nerve roots, or blood vessels, causing pain, neurological dysfunction, and, if untreated, permanent disability.
Spinal tumours are classified anatomically by their location relative to the spinal cord and its coverings:
- Extradural (epidural) tumours — outside the dural sac; the most common type, most often representing metastatic disease or primary bone tumours
- Intradural extramedullary tumours — inside the dural sac but outside the spinal cord itself; typically benign (meningioma, schwannoma, neurofibroma)
- Intramedullary tumours — within the substance of the spinal cord; less common, often astrocytomas or ependymomas
At One Brain and Spine, our Melbourne neurosurgeons provide expert assessment and surgical management of all types of spinal tumours, working collaboratively with oncologists, radiation oncologists, and the broader multidisciplinary team to optimise outcomes for each patient.
Types and Causes of Spinal Tumours
Metastatic Spinal Tumours (Most Common)
Metastatic tumours are by far the most common spinal tumours in adults. They occur when cancer cells from a primary tumour elsewhere in the body — most commonly breast, lung, prostate, kidney, thyroid, or multiple myeloma — spread to the vertebrae via the bloodstream. Spinal metastases typically affect the vertebral body and can cause vertebral collapse, spinal cord or nerve root compression, and severe pain.
Benign Intradural Tumours
- Meningioma — a benign tumour arising from the meninges (spinal cord coverings); most common in the thoracic spine in middle-aged women; slow-growing but can cause significant spinal cord compression
- Schwannoma — a benign tumour arising from the nerve sheath; commonly presents as a dumbbell-shaped tumour extending through the neural foramen; usually curable with surgical excision
- Neurofibroma — similar to schwannoma, associated with neurofibromatosis type 1 (NF1) in some patients
Intramedullary Tumours
- Ependymoma — the most common intramedullary tumour in adults; arises from the ependymal cells lining the central canal; often well-circumscribed and potentially curable with surgery
- Astrocytoma — arises from astrocytes within the spinal cord; often infiltrative and presents a surgical challenge
- Haemangioblastoma — a vascular tumour, associated with von Hippel-Lindau (VHL) disease in some cases
Primary Bone Tumours of the Spine
These include both benign lesions (osteoid osteoma, osteoblastoma, giant cell tumour, aneurysmal bone cyst) and malignant lesions (chordoma, osteosarcoma, Ewing sarcoma) — all of which are rare but require specialist neurosurgical management.
Symptoms of Spinal Tumours
The symptoms of a spinal tumour depend on its type, location, and rate of growth. Common presentations include:
Back or Neck Pain
Progressive, persistent pain that is often worse at night or at rest (unlike mechanical back pain which improves with rest) is a characteristic feature of spinal tumour. Pain may be localised to the affected spinal level or may radiate in the distribution of compressed nerve roots.
Neurological Symptoms
As a tumour grows and compresses neural structures, progressive neurological symptoms develop — including arm or leg weakness, numbness and tingling, unsteady gait, and bladder or bowel dysfunction. These symptoms demand urgent investigation.
Symptoms Requiring Urgent Assessment
Seek urgent neurosurgical assessment if back or neck pain is accompanied by any of the following:
- Progressive weakness in the arms or legs
- Gait disturbance or falling
- Bladder or bowel dysfunction
- Known cancer diagnosis with new or worsening back pain
- Unexplained weight loss, night sweats, or fever with back pain
How are Spinal Tumours Diagnosed?
- MRI with gadolinium contrast — the definitive investigation for spinal tumours; demonstrates tumour location, extent, relationship to neural structures, and enhancement characteristics
- CT scan — provides excellent bony detail; used for surgical planning and to assess vertebral destruction
- CT-guided biopsy — tissue diagnosis of vertebral lesions when the primary tumour is unknown or when histology will change management
- Full-body imaging — CT chest/abdomen/pelvis, PET scan, or bone scan to stage disease and identify the primary tumour in metastatic cases
- Blood tests — including tumour markers and haematological investigations
Treatments
Non-Surgical Treatment Options
Treatment of spinal tumours depends on the tumour type, extent, neurological status, and overall patient health. A multidisciplinary approach is essential:
- Radiotherapy — a primary treatment modality for many metastatic spinal tumours and some primary tumours; can relieve pain and slow tumour progression; stereotactic radiosurgery (SRS) allows precise high-dose radiation delivery to spinal lesions
- Systemic therapy — chemotherapy, targeted therapy, immunotherapy, or hormonal therapy, depending on tumour type
- Corticosteroids — dexamethasone reduces tumour-related spinal cord oedema and can provide rapid, temporary neurological improvement
- Bisphosphonates and denosumab — for metastatic bone disease to reduce pain and skeletal complications
When is Surgery Required?
Surgical intervention for spinal tumours is indicated when:
- Spinal cord or nerve root compression is causing neurological deficit — urgent decompression is required
- Spinal instability from vertebral destruction — stabilisation prevents progressive deformity and neurological injury
- Tissue diagnosis is required — when biopsy is needed to confirm the tumour type
- A benign intradural tumour is growing and causing or risking neurological compromise — surgical excision offers cure
- Palliative decompression — to maintain or restore neurological function and quality of life in patients with metastatic disease
Surgical Treatment Options
Surgical approaches for spinal tumours depend on tumour type and location:
- Surgical excision of intradural tumours — meningiomas and schwannomas can often be completely excised with excellent long-term outcomes
- Separation surgery — for metastatic epidural tumours, the tumour is debulked away from the spinal cord to allow effective postoperative radiotherapy
- Vertebral stabilisation — screws, rods, and cages restore spinal stability when the vertebral body has been destroyed
- Vertebroplasty/kyphoplasty — minimally invasive cement augmentation for selected painful vertebral metastases without cord compression
Frequently Asked Questions — Spinal Tumours Melbourne
Are all spinal tumours cancerous?
No. Many spinal tumours are benign — including meningiomas, schwannomas, and neurofibromas. While these are not cancerous, they can still cause significant neurological problems if they compress the spinal cord or nerve roots, and surgical excision is often recommended.
What is the difference between a primary spinal tumour and spinal metastases?
A primary spinal tumour originates within the spine or spinal cord itself. Spinal metastases are secondary tumours — cancer cells that have spread to the spine from a cancer elsewhere in the body (e.g. breast, prostate, lung). Metastatic disease is far more common than primary spinal tumours.
How urgently do spinal tumours need to be treated?
The urgency depends on the degree of neurological compromise. Spinal tumours causing acute or rapidly progressive neurological deficit — weakness, loss of bladder/bowel control — require emergency surgical assessment and treatment. Slowly progressive or incidental tumours allow more time for thorough evaluation and multidisciplinary planning.
Can spinal tumours be treated without surgery?
Some spinal tumours — particularly certain metastatic lesions — can be effectively managed with radiotherapy, targeted therapy, or systemic treatment without surgery. Surgery is recommended when there is neurological compromise, spinal instability, or when tissue diagnosis is required.
Why Choose One Brain and Spine for Spinal Tumours in Melbourne?
One Brain and Spine is a specialist neurosurgical group practice in Melbourne, formed by three experienced neurosurgeons committed to the highest standard of spinal care. We offer the full spectrum of evidence-based treatments from conservative management through to the most advanced minimally invasive and endoscopic surgical techniques available in Australia.
- Specialist neurosurgeons — all fellowship-trained with subspecialty expertise in spinal surgery
- Latest surgical technology — robotic-assisted navigation, endoscopic techniques, and microsurgery
- Conservative-first approach — surgery recommended only when clearly indicated
- Multidisciplinary care — working with physiotherapists, pain specialists, and radiologists across Melbourne
- Transparent, patient-centred consultations — your diagnosis and all options explained clearly
- Privately insured patients welcome — all major health funds accepted