Back pain is something almost everyone experiences, and the vast majority of the time it is nothing to worry about. But every so often, back pain is the first clue to something more significant happening in the spine — including a spinal tumour. As a spinal neurosurgeon based in Adelaide, I see patients across this whole spectrum, from simple mechanical strains through to spinal tumours requiring urgent treatment. This article walks through what spinal tumours are, how they can cause back pain, the warning signs to watch for, and how they’re diagnosed and treated.
Understanding Spinal Tumours: Primary vs Secondary, Benign vs Malignant
When discussing spinal tumours, it’s important to first distinguish between primary and secondary tumours, and then whether they are benign or malignant (cancerous).
Primary tumours — those arising from the spine itself — are usually benign, though some malignant primary tumours do occur, such as sarcomas and blood- or lymph-derived tumours like myeloma and lymphoma. By far the most common spinal tumours, however, are those that have spread from elsewhere in the body (metastatic spinal tumours), most commonly from lung, prostate, and breast cancer, though other primary cancers can also spread to the spine.
Some cases I see are also linked to kidney (renal cell) and thyroid cancer, and in principle almost any primary cancer can spread to the spine.
There is also a separate category of tumours arising from neural tissue rather than bone. These are classified as intradural tumours — found within the lining of the spinal cord — and can be further divided into intramedullary (within the spinal cord itself) or extramedullary (outside the spinal cord but compressing it), generally arising from the dura (meningiomas) or the nerves themselves (schwannomas and neurofibromas). Intramedullary tumours such as ependymomas and astrocytomas, and vascular tumours called haemangioblastomas, are less common but important causes too.
Can Spinal Tumours Cause Back Pain?
Yes. Pressure on a nerve can cause back pain, as can vertebral collapse leading to weakness and a pathological fracture. This pain generally falls into one of three categories: nerve compression, inflammation around the spinal cord or nerves, or structural bony changes causing instability.
Spinal Tumour Symptoms: Warning Signs to Watch For
Spinal Tumour Back Pain vs “Normal” Back Pain
Pain from a spinal tumour can be present at rest and at night, and may be associated with other red flag features — a history of immunosuppression, a history of cancer, or a fracture occurring with relatively low trauma, such as coughing or sneezing.
Common Spinal Tumour Symptoms
Beyond back pain itself, the symptoms I look out for include:
- Back or neck pain that is progressive, severe, or worse at night, and doesn’t improve with rest or the usual painkillers
- Weakness or numbness in the arms or legs, depending on where in the spine the tumour sits
- Loss of sensation in the trunk or limbs, or changes in pain/temperature sensation
- Bowel or bladder dysfunction, including incontinence or difficulty passing urine
- Unintentional weight loss, fatigue, fevers or feeling generally unwell
- Difficulty walking or unsteadiness (ataxia)
Symptoms can develop gradually over weeks to months, or — if the tumour causes vertebral collapse or bleeding — quite suddenly.
Red-Flag Spinal Tumour Symptoms
The most important red flags for spinal tumours are a prior history of cancer, unexplained weight loss (in association with back pain or on its own), and neurological symptoms such as bowel or bladder problems, or neurological signs and symptoms — pain, weakness, or other signs in the lower limbs — which may indicate spinal cord compression or a serious underlying condition.
Spinal Tumour Diagnosis: How Spinal Tumours Are Diagnosed
As with everything in medicine, taking a thorough history is key and will give strong pointers as to whether the presentation may represent a serious diagnosis. A neurological examination then helps localise the pathology anatomically.
Investigations Used for Spinal Tumour Diagnosis
This is followed by specific investigations, which may include:
- Whole spine MRI — to look for tumours, bearing in mind these can sometimes be multiple
- CT scan — to assess structural causes
- Biopsy of the lesion, or bone marrow or lymph node sampling if a blood-borne or lymphatic cause is suspected
- PET-CT or bone scan — to check for further deposits elsewhere in the skeleton when a metastatic tumour is suspected
- Spinal angiography — occasionally used for tumours thought to have a rich blood supply
Spinal Tumour Treatment Options
Non-Surgical vs Surgical Spinal Tumour Treatment
Treatment depends on the pathology, location, and presence of any neurological deficit. Benign tumours with no other concerning features can generally be monitored with serial MRI scans and clinical examination. Malignant tumours require treatment tailored to the specific pathology, with involvement of other specialists such as radiation and medical oncologists, as radiotherapy and chemotherapy — including newer targeted therapies for some cancers — form a major part of treatment.
Surgery is generally reserved for benign tumours that can be removed entirely — such as the intradural tumours discussed above — as well as for spinal stabilisation and decompression of neural structures or the spinal cord, with the goal of removing as much tumour as possible so the remaining tumour can be targeted with chemotherapy and radiotherapy.
Radiation, Pain Management and Supportive Care
Other treatments that often form part of the overall plan include:
- Stereotactic radiosurgery (especially stereotactic ablative radiation therapy— a highly targeted form of radiotherapy used to control tumour growth while preserving neurological function
- Corticosteroids — to reduce swelling around the spinal cord and improve neurological symptoms acutely
- Pain management — including analgesia, complex pain procedures such as cordotomy, palliative radiotherapy, vertebroplasty/ kyphoplasty (cement treatment for painful metastases)
- Supportive care and rehabilitation — physiotherapy, mobility aids and symptom management, which plays a genuinely important role in recovery and quality of life
The Evidence Behind Spinal Tumour Treatment
The evidence base here matters. A landmark randomised trial by Patchell and colleagues (2005) found that patients with spinal cord compression from metastatic cancer who had surgery followed by radiotherapy were significantly more likely to walk after treatment than those treated with radiotherapy alone, and retained that ability to walk for much longer. This trial remains a key reason why decompressive surgery is considered in appropriate patients rather than radiotherapy alone.
For intradural tumours, a 2024 systematic review of patient-reported outcomes (which I contributed to, along with colleagues Ali, Mustafa and others) found that while quality of life is lower than in healthy people both before and after surgery, extramedullary tumours tend to show good improvement in physical, social and mental wellbeing after surgery, while intramedullary tumours often don’t show the same degree of improvement — useful context for setting realistic expectations with patients.
For metastatic spinal cord compression specifically, my colleagues and I discuss the use of decision frameworks such as NOMS (neurologic, oncologic, mechanical and systemic) in a recent review (Gandham, Clark & DeMatas, 2024), which helps guide clinicians through the choice between surgery, radiotherapy, or a combination, based on a structured assessment of these four domains.
Spinal Tumour Treatment in Adelaide: When to See a Specialist
A history and examination suggestive of a spinal tumour should prompt urgent referral to a spinal specialist to prevent delay, particularly if neurological symptoms or signs are present. Such cases are managed through a treatment pathway involving metastatic spinal cord coordinators, who coordinate imaging and liaison with oncologists, generally through the public system.
For less urgent cases, including benign intradural tumours, referral to a spinal specialist for neurological assessment, history-taking, and relevant investigations allows a decision to be made as to whether surgery is of benefit.
If you have back pain along with any of the red flags discussed above, the appropriate first step is to raise this with your GP, who can arrange referral to a spinal specialist. A referral is generally recommended, as it brings important past medical history with it and helps ensure your care is well coordinated.
A Note for Physiotherapists, GPs and Allied Health Professionals
If you’re screening a patient with back pain, the same red flags outlined above should prompt onward referral rather than continued conservative treatment: a history of cancer, unexplained weight loss, pain that is constant and unrelated to movement or worse at night, or any new neurological signs such as changes in power, sensation, reflexes or bladder/bowel function. Physiotherapy and supportive rehabilitation remain valuable even once a tumour diagnosis is confirmed, particularly around mobility, strength and symptom management — but this should run alongside, not instead of, specialist and oncology input once a tumour is suspected or confirmed.
Is Back Pain Always a Sign of a Spinal Tumour?
Not always. As mentioned, pressure on a nerve may present as radicular (nerve) pain that can mimic sciatica. Some patients present with acute back pain after coughing or sneezing, which, in the presence of red flags, may point to a pathological spinal fracture. The key is maintaining a high index of suspicion for a spinal tumour in anyone with back pain accompanied by any of the red flags above, or back pain that isn’t settling with normal conservative measures.
Frequently Asked Questions
How common are spinal tumours as a cause of back pain?
Most back pain is mechanical and not related to a tumour. Spinal tumours are a much less common cause, which is exactly why the red flags above are so important — they help separate the large majority of straightforward cases from the small minority that need urgent, specific attention.
Can spinal tumours be cured?
It depends entirely on the type. Many benign tumours, such as schwannomas and meningiomas, can be completely removed surgically and effectively cured. Malignant and metastatic tumours are managed rather than cured in most cases, with treatment aimed at controlling growth, protecting neurological function and maintaining quality of life.
What does recovery look like after spinal tumour surgery?
This varies significantly depending on the tumour type, its location, and how much neurological involvement was present before surgery. Physiotherapy and rehabilitation often play an important role in recovery, and your surgical team will guide you on expected timeframes for your specific situation.
Who is most at risk of a spinal tumour?
Anyone with a personal history of cancer is at higher risk of a metastatic spinal tumour, which is why this is one of the key red flags. Certain intradural tumours are also associated with genetic conditions such as neurofibromatosis. Outside of these groups, spinal tumours can still occur, which is why persistent or unusual back pain should always be assessed on its own merits.