26th June 2023

Common symptomatology of spinal tumours

Spinal tumours (both primary and secondary) can give rise to back pain, which may be associated with tenderness to palpation at a specific vertebral level. Numbness and neuropathic pain can arise from compression of nerves by the tumour or surrounding oedema. Compression below the level of the termination of the spinal cord in adults at L1-L2 may result in cauda equina syndrome, which may present with bladder and bowel dysfunction, saddle anaesthesia, and sensory or motor changes in the lower limbs. This is an oncological emergency due to the risk of permanent neurological deficit. As with all cancers, symptoms such as weight loss, fatigue and night sweats may also be reported.

There are some background diagnoses, albeit rare, that can predispose to spinal tumours. Neurofibromatosis type 1 (NF1) is an autosomal dominant condition associated with the development of nerve sheath tumours, which are mostly benign neurofibromas, however, there is a small risk of malignant transformation. Other signs of NF1 include axillary freckling, café-au-lait spots, Lisch nodules of the iris, and optic gliomas. Neurofibromatosis type 2 (NF2) is associated with benign vestibular schwannomas, meningiomas and ependymomas. NF2 can be associated with sensorineural hearing loss due to the development of vestibular schwannomas (acoustic neuromas) around cranial nerve VIII. NF2 is more associated with symptomatic spinal tumours than NF1.

Von Hippel-Lindau syndrome (VHL) is another autosomal dominant hereditary condition associated with the development of tumours and cysts in multiple parts of the body. Haemangioblastomas are one of the types of tumours associated with VHL; these are benign tumours arising from the blood vessels of the brain, spinal canal, and retinas. VHL is also associated with the development of some cancerous tumours, especially of the kidneys, phaeochromocytomas and endolymphatic sac tumours.