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Spinal Tumours: Symptoms, Tests and Treatment

Spinemathema picture card for Spinal Tumours

By Mr Ahmed-Ramadan Sadek, Neurosurgeon · 8 min read

🎧 Listen to this guideAudio version coming soon. Narrated in Mr Sadek’s voice using AI voice technology, from a script he has reviewed.

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Key points

  • Most spinal tumours are secondary (metastatic): they have spread from a cancer elsewhere in the body. Tumours that start in the spine are much less common.
  • Many tumours that do start in or next to the spine are benign (not cancer), such as meningiomas, nerve sheath tumours and haemangiomas. Some never need treatment.
  • Back or neck pain that is severe, keeps getting worse or wakes you at night should be checked, especially if you have had cancer.
  • If you have, or have had, cancer and develop new weakness, numbness, difficulty walking or bladder or bowel problems, treat it as an emergency: call the number your cancer team gave you for this if you have one, otherwise go to A&E or call 999.
  • Treatment depends on the type of tumour and can include monitoring with scans, radiotherapy, surgery, or cement injections for painful fractures.

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If you have, or have had, cancer, get help immediately if you develop:

  • New weakness in your arms or legs, legs that give way, or difficulty walking.
  • New numbness or pins and needles, or numbness around your bottom or genitals.
  • Problems controlling your bladder or bowels, difficulty passing urine, or new or worsening constipation.
  • New back or neck pain that feels like a band around your chest or tummy, or spreads down an arm or leg.
  • Back pain that is severe, getting worse, worse when you cough or strain, or keeping you awake at night.

If your cancer team has given you a number to call for these symptoms, call it straight away, even at night or at weekends. Otherwise, or if you cannot get through, go to A&E or call 999 and say you have cancer. If you have never had cancer, back pain with weakness or numbness in both legs, numbness around your bottom or genitals, or bladder or bowel changes still needs A&E or 999.

What is a spinal tumour?

A tumour is a growth of abnormal cells. In the spine, tumours can grow in the bones (the vertebrae), in the coverings around the spinal cord and nerves, or, more rarely, inside the spinal cord itself. Doctors call a tumour primary if it starts in the spine and secondary or metastatic if it has spread there from a cancer somewhere else.[4]

Secondary (metastatic) tumours are far more common

Most tumours affecting the spinal column are secondary cancers, and they are mainly seen in older people.[4] Any cancer can spread to the spine, but it happens more often with breast, prostate and lung cancer. Myeloma, a type of blood cancer, also often affects the spinal bones.[2]

Autopsy studies suggest about 30% of people with cancer have spinal metastases by the time they die, while a 2022 systematic review found that spinal metastases were diagnosed during life in about 16% of people with solid tumours.[8]

Primary tumours

Tumours that start in the spine are much less common, and primary cancers of the spinal bones (sarcomas) are rare.[4] Many primary tumours are benign. They do not spread around the body, but they can still cause problems if they press on the spinal cord or nerves. Inside the coverings of the spinal cord, the most common types are meningiomas and nerve sheath tumours. Ependymomas and astrocytomas grow within the spinal cord itself and are less common.[5]

  • Meningioma. Grows from the meninges, the thin layers that wrap the spinal cord.[5]
  • Schwannoma and other nerve sheath tumours. Grow from the covering of a nerve root. When small ones were followed with repeat MRI scans in one study, some grew steadily while others stayed the same size.[7]
  • Vertebral haemangioma. A cluster of small blood vessels inside a vertebra, and the most common benign tumour of the spinal column. It is usually found by chance on a scan. Old autopsy studies found haemangiomas in about 11% of adults.[6] Most never cause symptoms: older studies put the share causing symptoms at under 5%, although one hospital series of 75 patients found 35%.[6]

Symptoms

Some spinal tumours, especially haemangiomas, cause no symptoms at all.[6] When there are symptoms, pain is the most common, and back pain is the most common symptom of cancer in the spine.[2] NICE and the NHS describe pain features that should prompt a closer look:[1][3]

  • Severe back pain that does not let up, or that keeps getting worse.
  • Pain at night that disturbs your sleep, or pain that does not ease with rest.
  • Pain made worse by coughing, sneezing, straining or opening your bowels.
  • Pain made worse by standing, sitting or moving, or tenderness over one spot in the spine.
  • Pain in the upper back, between the shoulder blades, rather than the lower back.
  • Losing weight without trying, or a new lump or change in the shape of your back.

A tumour pressing on the spinal cord or nerves can cause neurological symptoms: weakness, numbness or pins and needles, unsteadiness or difficulty walking, pain that wraps around the chest or tummy like a band, pain running down an arm or leg, and bladder or bowel problems.[1][2] Benign tumours can do this too.[6]

Back pain is very common, and very rarely is it caused by a tumour.[3] The features above are reasons to get checked by your GP, not reasons to panic.

Metastatic spinal cord compression: an emergency

Metastatic spinal cord compression (MSCC) happens when cancer in the spine, or a vertebra weakened by it, squeezes the spinal cord or the nerves below it. If it is not treated quickly it can cause permanent nerve damage, including paralysis and loss of bladder and bowel control.[2] Sometimes it is the first sign that someone has cancer.[2]

A Canadian population study found that 2.5% of people who died of cancer had at least one episode in their last five years of life, ranging from 0.2% in pancreatic cancer to 7.9% in myeloma.[9] A 2022 systematic review found 2.84% of people with solid tumours, or about 1 in 10 of those with known spinal metastases.[8]

The NICE urgent pathway

NICE guideline NG234 (2023) says every area should have an MSCC coordinator, based in a cancer service and available 24 hours a day, as the first point of contact for health professionals.[1] It sets out how quickly things should happen:

SituationWhat NICE recommends
Past or current cancer, with symptoms or signs of cord compression (such as weakness, numbness, walking difficulty, bladder or bowel problems)Contact the MSCC coordinator immediately; treat as an oncological emergency. MRI as soon as possible and always within 24 hours.
Past or current cancer, with back pain suggesting spinal metastases but no nerve symptomsSeek advice through the MSCC coordinator within 24 hours. MRI within 1 week.
No known cancer, but these pain features and cancer is suspectedUrgent referral for cancer assessment.

In practice, if your cancer team has given you a number to call for new spinal symptoms, use it straight away. If you have not been given one, or cannot get through, seek urgent medical help: go to A&E, and tell staff that you have cancer and are worried about spinal cord compression.[2] NICE also says people with spinal metastases and their families should be told who to contact if new symptoms appear or existing ones get worse.[1]

While you wait for a scan or treatment, you may be asked to lie flat to protect the spine, and you may be given steroid medicine to reduce swelling around the cord. Pain relief should be given promptly.[1][2]

Tests

  • MRI scan of the whole spine. This is the main test. NICE specifies images of the whole spine to look for tumour deposits, plus more detailed views of any area of concern.[1] Read more in our guide to MRI scanning.
  • CT scan. Used if you cannot have an MRI, and to judge how strong and stable the spine is and plan surgery or cement treatment.[1] See our guide to CT scans of the spine.
  • Not plain X-rays. NICE advises against using an ordinary X-ray to diagnose or rule out spinal metastases or cord compression.[1]
  • Biopsy. If the type of tumour is not known, a small sample may be taken, usually with a needle guided by a scan, so that treatment can be matched to the diagnosis.[1][2]

Treatment

Treatment depends on the type of tumour, where it is, whether the spine is stable, your symptoms and your general health. For spinal metastases, NICE recommends that a team including cancer specialists and spinal surgeons agrees the plan, using scoring systems for spinal stability and outlook as part of a full assessment.[1] Besides the options below, these can include anti-cancer drugs, bone-protecting medicines for some cancers, a brace and physiotherapy.[1][2]

Observation

A benign tumour that causes no symptoms often needs no treatment. Haemangiomas that cause no symptoms do not need therapy.[6] A small nerve sheath tumour found by chance may simply be watched with repeat MRI scans, because some grow and others do not.[7]

Surgery

For benign tumours pressing on the nerves or cord, such as meningiomas and nerve sheath tumours, the usual aim is complete removal.[5] For spinal metastases, surgery can take pressure off the spinal cord (decompression), stabilise the spine with screws and rods, or both.[1] NICE says surgery to halt or reverse nerve damage should happen as soon as possible after symptoms start, and that stabilising surgery should be offered for an unstable spine causing pain that painkillers cannot control, if surgery is suitable for the person.[1]

The strongest evidence for surgery comes from a trial in the United States, published in 2005. It included 101 people whose spinal cord was being squeezed by cancer. After treatment, 84% of those who had surgery followed by radiotherapy could walk, compared with 57% of those who had radiotherapy alone.[10] Surgery is not suitable for everyone, so your team will weigh up your general health and the type of cancer when advising you.

Radiotherapy

Radiotherapy is the most common treatment for MSCC.[2] NICE recommends urgent radiotherapy, within 24 hours, for MSCC that is not suitable for surgery (with some exceptions), usually as a single treatment session, and radiotherapy after recovery from spinal surgery.[1]

Stereotactic radiotherapy delivers a high, precisely shaped dose that spares more of the healthy tissue around it. NICE suggests considering it for painful spinal metastases without cord compression in people with a good outlook, or with no more than three separate metastases.[1] In a 2021 trial of 229 people, 35% had complete pain relief at three months after stereotactic treatment, compared with 14% after conventional radiotherapy.[11]

Cement injections for painful fractures

If cancer makes a vertebra collapse, NICE lists vertebroplasty or kyphoplasty (injecting bone cement through a needle) among the options for uncontrolled pain or a spine that may be unstable.[1] In a trial of 134 people with cancer and painful spinal fractures, back-related disability improved markedly one month after kyphoplasty, but did not change with non-surgical care. The trial was funded by the device maker.[12] Our guide to vertebroplasty and kyphoplasty explains the procedure.

Living with a spinal tumour

NICE recommends support and rehabilitation from the point of diagnosis, focused on your own goals, such as staying independent, managing daily activities and quality of life.[1] Your team should also look at your emotional, psychological and financial needs, and offer families and carers practical training, for example with braces, wheelchairs and bladder and bowel care.[1] If radiotherapy is planned, the effect on fertility should be discussed with you, without delaying urgent treatment.[1]

  • If your cancer team gives you a number to call for spinal symptoms, keep it with you and make sure your family knows it.
  • Tell your team early about pain that is not controlled; NICE says a specialist pain or palliative care team can help when pain is hard to manage.[1]
  • Even after treatment, report any new or returning symptoms, as cord compression can happen again.[2]

Frequently asked questions

I have cancer and new back pain. What should I do?

Do not wait for your next appointment. If your cancer team has given you a number to call for new spinal symptoms, call it. Otherwise, get urgent medical help through your GP or NHS 111. If the pain comes with new weakness, numbness, difficulty walking or bladder or bowel problems, NICE treats this as an emergency, with an MRI scan within 24 hours: go to A&E or call 999.[1] If you have pain alone but it is severe, worsening, worse at night or worse when you cough or strain, NICE advises getting advice within 24 hours.[1] If you go to A&E, say that you have cancer and are worried about spinal cord compression.[2]

Is a spinal tumour always cancer?

No. Most tumours affecting the spine are secondary cancers that have spread from elsewhere,[4] but many tumours that start in or next to the spine are benign. The commonest inside the spinal coverings are meningiomas and nerve sheath tumours,[5] and the commonest benign tumour of the spinal bones is a haemangioma, which rarely causes symptoms.[6] Benign tumours do not spread, but they can still need treatment if they press on the spinal cord or nerves.

How can I tell if my back pain is caused by a tumour?

You usually cannot tell from the pain alone, and back pain is only very rarely caused by a tumour.[3] The NHS advises seeing a GP if back pain does not improve after rest or is worse at night, is worse when you sneeze, cough or poo, comes from between the shoulder blades, or comes with unexplained weight loss or a lump.[3] NICE adds pain that is severe and unrelenting, steadily getting worse, or tender over one spot.[1] These are reasons to be checked, not proof of a tumour.

Can an X-ray show a spinal tumour?

Not reliably. NICE advises against using a plain X-ray to diagnose or rule out spinal metastases or spinal cord compression, because the evidence showed X-rays had very low sensitivity for cord compression.[1] An MRI scan of the whole spine is the main test. A CT scan is used if you cannot have an MRI, and to check how stable the spine is.[1]

Is a vertebral haemangioma dangerous?

Usually not. Haemangiomas are the most common benign tumours of the spinal column and are often found by chance on a scan for something else.[6] Older studies suggest fewer than 5% cause symptoms, although one hospital series reported 35%.[6] Haemangiomas that cause no symptoms do not need treatment.[6] A small number behave more aggressively and can press on the spinal cord or nerves, and these may need surgery or other treatment.[6]

Can a spinal meningioma come back after surgery?

It can, but this is uncommon. A review of 24 studies including 1,811 people with spinal meningioma found that the tumour was completely removed in 94.5% and came back in 4.4%.[13] Most were the slow-growing, lowest-grade type, and around two thirds were in the upper and middle back.[13] Ask your surgeon what follow-up is planned, and report any new or returning symptoms.

Can you walk again after spinal cord compression?

Some people can, especially with prompt treatment. In a 2005 trial of people with cord compression from cancer who could not walk at the start, 62% regained walking after surgery followed by radiotherapy, compared with 19% after radiotherapy alone.[10] NICE says surgery should not be ruled out only because of how long paralysis has lasted.[1] Macmillan notes that nerve damage present at diagnosis can sometimes be permanent,[2] which is why acting early on new symptoms matters so much.

Are spinal tumours inherited?

A small number are linked to a genetic condition. Neurofibromatosis type 2 (NF2, also called NF2-related schwannomatosis) is a rare condition in which non-cancerous tumours grow on nerves, including in the spinal cord and its coverings.[14] It can be passed on, with a 1 in 2 chance of passing the altered gene to each child, although some people are born with it when neither parent has it.[14] If several family members have had nerve tumours, mention this to your doctor.

Further reading

References

  1. National Institute for Health and Care Excellence. Spinal metastases and metastatic spinal cord compression. NICE guideline NG234. Published 6 September 2023, last reviewed 19 March 2026. Link
  2. Macmillan Cancer Support. Metastatic spinal cord compression (MSCC). Reviewed 1 September 2024. Link
  3. NHS. Back pain. NHS website, page last reviewed 5 March 2026. Link
  4. Ciftdemir M, et al. Tumors of the spine. World J Orthop. 2016;7(2):109-16. Link
  5. Ottenhausen M, et al. Intradural spinal tumors in adults: update on management and outcome. Neurosurg Rev. 2019;42(2):371-388. Link
  6. Kato K, et al. Vertebral hemangiomas: a review on diagnosis and management. J Orthop Surg Res. 2024;19(1):310. Link
  7. Lee CH, et al. A longitudinal study to assess the volumetric growth rate of spinal intradural extramedullary tumour diagnosed with schwannoma by magnetic resonance imaging. Eur Spine J. 2015;24(10):2126-32. Link
  8. Van den Brande R, et al. Epidemiology of spinal metastases, metastatic epidural spinal cord compression and pathologic vertebral compression fractures in patients with solid tumors: a systematic review. J Bone Oncol. 2022;35:100446. Link
  9. Loblaw DA, et al. A population-based study of malignant spinal cord compression in Ontario. Clin Oncol (R Coll Radiol). 2003;15(4):211-7. Link
  10. Patchell RA, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005;366(9486):643-8. Link
  11. Sahgal A, et al. Stereotactic body radiotherapy versus conventional external beam radiotherapy in patients with painful spinal metastases: an open-label, multicentre, randomised, controlled, phase 2/3 trial. Lancet Oncol. 2021;22(7):1023-1033. Link
  12. Berenson J, et al. Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial. Lancet Oncol. 2011;12(3):225-35. Link
  13. Jamilson Araújo Pereira B, et al. Neuro-oncological features of spinal meningiomas: systematic review. Neurochirurgie. 2020;66(1):41-44. Link
  14. NHS. Neurofibromatosis type 2. NHS website, page last reviewed 24 April 2025. Link

This article is general information and is not a substitute for advice about your own situation. Please speak to your GP or specialist before making any change to your treatment.

Last checked: October 2026