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Spinal Tumors

Updated : June 5, 2024





Background

Spinal tumors are the abnormal growths or masses that occur in the spinal cord or the structures that surround it. The tumors can be classified into intra-axial that occur in the spinal cord itself and extra-axial that are in the structures next to the spinal cord. They may be harmless and they can cause symptoms by the compression of the spinal cord or nerve roots, thus, the neurological deficits and the pain are caused. 

Types of Spinal Tumors: 

Intramedullary tumors: These tumors are formed within the cells of the spinal cord and include ependymomas, astrocytomas and hemangioblastomas. 

Extramedullary tumors: These tumors are found outside the spinal cord in structures such as meningiomas, schwannomas, and metastatic tumors (tumors that have spread to the spine from other parts of the body). 

Intradural-extramedullary tumors: These tumors develop in the dura mater (the protective layer of the spinal cord) but outside the spinal cord. Examples are meningiomas and schwannomas. 

Extradural tumors: These tumors are growth outside the dura mater and they are metastatic tumors, lymphomas, and chordomas. 

Epidemiology

In the United States, it’s believed that there are around 7,500 new cases of primary spinal tumors every year, whereas the number of metastatic tumors is about 90,000. Out of all the rare primary tumors, hemangioma is the most common one, making up about 30% of all cases, with most of the patients having benign lesions. Several of these lesions display no symptoms and are typically found during spinal imaging procedures. On the other hand, plasmacytoma is the most common malignant tumor of the spine that occurs in 20 to 30% of the cases. 

As many as 10% of cancer patients may have had symptomatic metastases to the spine. 

Anatomy

Pathophysiology

In the realm of tumors (neoplasms), they are broadly categorized as either primary or metastatic. Primary tumors originate directly from the tissue they affect— for instance, chordoma arises from the tissues composing the spinal column. Conversely, metastatic tumors originate elsewhere in the body and either infiltrate nearby structures or disseminate distantly through the bloodstream or lymphatic system. The spine, being richly vascularized and interconnected with extensive venous and lymphatic networks, serves as a prime site for metastatic spread. Remarkably, approximately 97% of spinal tumors are metastatic in nature. 

Local erosion of the bony spinal column can induce pain due to spinal instability. Furthermore, tumors may protrude from the spinal bones, exerting pressure on neural structures. Damage to these neural elements can manifest as pain, altered sensation, muscle weakness, spasms, or other neurological abnormalities. Metastatic tumors often reach the spine via the epidural venous plexus, where they grow within the epidural space, leading to neurological symptoms. 

Etiology

The pathogenesis of spinal tumors is multifactorial including genetic predispositions, changes in reproductive hormones, and plant-related factors that contribute developing them. 

Genetic Predisposition: Inherited genetic mutations or syndromes, for example, neurofibromatosis type I and II, von Hippel-Lindau disease, Li-Fraumeni syndrome and hereditary retinoblastoma, can predispose to the development of spinal tumors. 

Environmental Factors: Certain environmental pollutants and exposure to radiation or chemicals are believed to be involved in the development of spinal tumors.  

Cellular Abnormalities: Disruptions in cellular operations, e.g., uncontrolled cell growth and division, and differentiation are the basis for the origin of malignancies. These anomalies could be caused by alterations in genes that are responsible for cell cycle regulation, DNA repair, and apoptosis (a natural process of cell death). 

Genetics

Prognostic Factors

Spinal tumors that are benign normally have a better prognosis, as they can be simply managed conservatively by monitoring rather than aggressive treatment. The surgical removal may be required when benign tumors that produce symptoms or grow rapidly, but under appropriate follow-up, most patients have a favorable outcome and low recurrence. The non-cancerous primary tumors like chordomas, osteosarcomas, and Ewing sarcomas, are usually very dense and spread quickly therefore, they have poor prognoses due to factors such as aggressiveness, spread and response to treatment. Tumors with metastasis are poor prognosis because they are usually in a more advanced stage with disease widespread. 

Clinical History

Age Group: 

Children and Adolescents: In young patients, spinal tumors often present as non-specific symptoms such as back pain, limb weakness, walking disorders or scoliosis.  

Adults: Spine tumors in adults may have characteristics that are observed in children initially such as back pain, neural deficits, and changes in bowel function or urination. However, spinal degenerative conditions, including disc herniation and spinal stenosis that are more common in adults, can lead to a more difficult diagnosis of spinal tumors. 

Physical Examination

The neurological examination looks for evidence of spinal cord compression or cerebellar dysfunction by assessing muscular strength, sensory reflexes, balance, coordination, and gait.  

Examining the spine involves determining its range of motion, pain, abnormalities, and indications of cord compression. Extreme muscular size, tone, and symmetry assessment in the upper and lower limbs is part of the peripheral examination.  

Age group

Associated comorbidity

Osteoporosis: In bone health osteoporosis, patients become vulnerable to the process where tumors expand due to back pain and pressure on spinal nerves which lead to fractures and ultimately compression of vertebrae. 

Cancer: Cancer survivors have an elevated risk of developing bone metastasis or cancer of the spinal cord. Symptoms could be more pronounced in these patients because of the rapid nature of the disease. 

Trauma or Injury: If trauma occurs somewhere on the spinal cord or if someone sustains any sort of a traumatic injury, this can lead to the exposure of a previously undetected spinal tumor or increase the intensity of the symptoms that were already present.  

Associated activity

Acuity of presentation

Acute Onset: Some spinal tumors may display acutely with a sudden, severe backache, neurological deficits (such as muscle weakness or numbness) or bowel and bladder problems. The reason behind this may be tumor bleeding, enough space for tumor growing, or pinching of nervous system structures. 

Chronic Progression: While in other spinal tumors, for instance, the presence may occur, but with a more gradual and over time development of symptoms. Patients might first feel a mild common backache or stiffness then after their condition’s difficulties expanded as the tumor grew and compressed the adjacent structure. 

Differential Diagnoses

Degenerative disc disease 

Facet joint arthropathy 

Spinal epidural abscess 

Spinal tuberculosis  

Spinal sarcoidosis 

Ankylosing spondylitis 

Spinal stenosis 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

Surgery 

Resection: Primary surgery that involves removal of the tumor is frequently a recommended treatment for the spinal tumors especially the localised or the accessible growths. The aim is to reach as many areas as possible and maintain neurological function, as well as spinal stability during the process. 

Decompression: Surgery can be performed to release pressure on the spinal cord or the nerve roots that would cause compression if the tumor is associated with spine instability and deficits in neurological function. 

Instrumentation and Fusion: In situations where the column of spine is involved, instrumentation (e.g. rods, plates, and screws) is added in addition to the fusion procedures to stabilize the spine after the tumor excision is complete. 

Minimally Invasive Techniques: Minimally invasive procedures may be beneficial in cases where indicated with shorter periods of hospital stays, less postoperative pain and quicker recueps. 

 

by Stage

by Modality

Chemotherapy

Chemotherapy will be used to treat tumors along with other methods depending on type of tumor, with malignant/metastatic tumors being the most suitable case for this method. The agents of chemotherapy applied based on tumor types: sensitivity and response rate. 

Targeted Therapy: 

Patient-specific approaches such as molecularly targeted agents and immunotherapies are used for the treatment certain tumors. In immunotherapy, the immune system is targeted to eradicate the tumor cells through either activating the immune system or using antibodies. The goal is to specifically attack the tumor pathways or antigens, like in traditional chemotherapy, but less toxic. 

Palliative Care: Palliative care represents a key sub speciality conducting symptom management, enhancing patients’ quality of life and offering support for patients with advanced or incurable spinal neoplasms .  

Clinical Trials: Taking part in case studies may be offered to the patients whose case fits the clinical trial criteria and this may give an opportunity to these patients to receive innovatory treatment regimens and their new approaches that are now not available to the general population.  

Radiation Therapy

External Beam Radiation Therapy (EBRT): EBRT being beam radiation delivered in a focused fashion to the tumor site, can be employed as the adjuvant therapy following the surgery’s end to eradicate any remaining malignant cells or as the primary treatment for the inoperable or not resectable tumors. 

Stereotactic Radiosurgery (SRS): SRS accomplishes this by using highly charged particles and without more than submillimeter accuracy towards the tumor, SRS leaves surrounding healthy tissues unharmed. Such a technique is usually applied to instantiating small and well-defined tumors or for salvaging recurrent tumors. 

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Use of a non-pharmacological approach for treating Spinal Tumors

Physical Therapy: The basis of physical therapy is to enhance mobility, strength, flexibility, and function through modified exercises only. Therapeutic exercises could take away pain and reduce muscle tension, but they also can improve your posture and balance. Approaches like manual therapy, stretching, as well as the core stabilization exercises can help people with spinal tumors. 

Occupational Therapy: Occupational therapy primarily helps to optimize activities of daily living (ADLs) and improve functional independence. Occupational therapists will provide modified adaptive equipment, fluid ergonomics as well as assistive devices to allow patients to handle tasks safely and with ease despite any physical constrains. 

Pain Management: Non-narcotic interventions including TENS, acupuncture, and chiropractic may be utilized for pain relief and enhancement of general well-being. Unlike behavioral therapies, which utilize strategies like cognitive-behavioral therapy (CBT) and relaxation techniques, and mindfulness meditation, psychological approaches can help with chronic pain management and reduce stress. 

Bracing and Orthotics: Custom orthoses, braces, or supports may be ordered to keep the spine stable and reduce spinal deformity, as well as relieve pain associated with spinal tumors. Through providing a limited amount of support, orthotic devices can help reduce the load on injured spinal segments and enhance daily activities. 

Nutritional Support: Dietary advice from registered dietitians can enable individuals to determine the right number of foods they need to ensure they are on the right weight and have what it takes to fight diseases during cancer treatment.  

Role of chemotherapy in the tretament of spinal tumor

Chemotherapy is a drug which is limited for treating central nervous system tumors as the blood brain barrier and potential for development of resistance to the cytotoxic substances. Even if it is possible as a part of a multimodal treatment approach, it can be used in necessitated situtations only. Systemic chemotherapeutic drugs are given to patients with metastatic spinal tumors since they help to contain growth of the tumor to prevent its further spread, alleviate symptoms and improve life expectancy. The administration of anticancer drug agents as a neoadjuvant or adjuvant for the management of high-grade primary spinal tumors like chordomas, osteosarcomas, and Ewing sarcomas have been adopted as the treatment options of choice. Intrathecally administered or systemically delivered chemo helps to remove tumor cells accumulated in the meninges and spinal cords.  

Role of Stereotactic body radiotherapy in the treatment of spinal tumours

Stereotactic body radiotherapy (SBRT), which is also named stereotactic ablative radiotherapy (SABR), is an advanced radiotherapy approach that accurately and selectively redirects radiation beams to tumor areas by minimizing surrounding normal tissue exposure via this method. SBRT has shown to be a promising treatment and has provided us with high local control rates and low toxicity. 

SBRT is a minimally invasive treatment technique for primary tumors of the spinal cord such as schwannomas, meningiomas, and chordomas, which provide tumor control, symptom relief and maintaining neurological functioning. 

It can also manage metastasis of spinal tumors from primary cancers like lung, breast, prostate and renal cell carcinoma. For instance, a breast cancer metastatic tumor that relies on the spinal area alone can be controlled by giving high dose radiation for the tumor tissues and not affecting the surrounding soft tissues. Along with SBRT being useful for initial irradiation of spinal tumors in patients who have been given radiotherapy before, it can also be utilized for re-irradiation of recurrent or progressing tumors. 

Use of Intervention with a procedure in treating Spinal Tumors

Biopsy: By the biopsy approach using targeted imagery, tissue is analyzed to discern the type of the tumor as well as grading and molecular features. Biopsy results guide treatment options, that are actuated by the choosing of appropriate therapy modalities among chemotherapy, radiation therapy or targeted agents. 

Vertebroplasty and Kyphoplasty: It is the minimally invasive procedures used to treat the component secondary pain caused by compression vertebral fractures (VCFs) from spinal tumors. When applying vertebroplasty the bone cement gets directly into fractured vertebral body for strengthening its structure and relieving pain levels. Kyphoplasty is a technique involving placement of a balloon tamp into the affected vertebra to restore it to the original vertical alignment. Then a bone cement is injected into the space to hold the bone firmly, thus decreasing kyphosis and improving the spinal alignment. 

Radiofrequency Ablation (RFA): RFA is one of the burn methods which use the currant of high frequency to heat and acquire the portion of cancer tissue. RFA may be used for the treatment of smaller tumors that are localized and specifically osteoid osteomas and distant tumors metastatic to the spine; this technique allows for the creation of a necrotic zone in the tumor, while at the same time it spares the surrounding healthy tissue. 

Cryoablation: The Cryoablation procedure uses freezing of cold temperatures between -196 and -150 degrees Celsius to wipe out and kill tumor cells. The cryoablation can also serve as an alternative to the thermal ablation in treating the spinal cord tumors, especially when the tumoral mass is too small to cauterize. The ablation procedure can be done in most cases with no damage to surrounding adjacent structures. 

Percutaneous Cement Augmentation (PCA): PCA techniques, for instance, PPSF, PPC and percutaneous cementoplasty, are vertebral augmentation coupled with spinal stabilization through instrumentation require for the purpose of relief of pain and instability for patients with vertebral tumors and spinal injuries. The percutaneous cementoplasty is the ascent of the bone cement into tumor-affected vertebrae that is for restoration of the spine and alleviation of pain. 

Percutaneous Tumor Ablation: Percutanous tumour ablation options like microwave ablation (MWA) and irreversible electroporation (IRE) is where the site of the intended tumour tissue is directly exposed to powerful energy in a bid to induce cellular destruction and tumour necrosis itself. This may include embolization via catheter to block blood flow into the vascular tumor, or MRI-guided lasers or real-time MR imaging-guided ultrasound cavitation used to directly destroy the tumor with minimal damage to nearby structures. 

Use of phases in managing Spinal Tumors

The evaluation and categorization of spinal tumors involve obtaining thorough past medical history, performing physical exam, and conducting diagnostic image studies. A multi-disciplinary team comprising of neurosurgeons, radiation oncologists, and medical oncologists performs in developing a patient-centered treatment plan based on the tumor subtype, stage, location and the patient’s overall health. Treatment modalities may involve surgery, radiation therapy, chemotherapy, targeted therapy, immunotherapy, or a combination of treatment methods.  

Preoperative optimization aims at optimizing the medical comorbidities, nutritional status and overall fitness to reduce postoperative complications and have better surgical outcomes. Surgical treatment should be directed to achieve maximal safe resection while retaining neurological function, spinal stability, and alignment. The surgical strategies may comprise of open procedures, minimally invasive techniques, decompression and reconstruction of vertebral defects.  

Adjuvant therapy, like radiation therapy or chemotherapy, may be applied after surgery to get rid of residual tumor cells and prevent local recurrence as well as improve the long-term disease control rate. Radiotherapy can be given by conventional fractionated radiation, by stereotactic body radiotherapy (SBRT), or by intensity-modulated radiation therapy (IMRT). Rehabilitation and supportive care thus act as complementary therapy with the aim of improving the prognosis of those patients being treated for spinal tumors. 

Medication

Media Gallary

Spinal Tumors

Updated : June 5, 2024




Spinal tumors are the abnormal growths or masses that occur in the spinal cord or the structures that surround it. The tumors can be classified into intra-axial that occur in the spinal cord itself and extra-axial that are in the structures next to the spinal cord. They may be harmless and they can cause symptoms by the compression of the spinal cord or nerve roots, thus, the neurological deficits and the pain are caused. 

Types of Spinal Tumors: 

Intramedullary tumors: These tumors are formed within the cells of the spinal cord and include ependymomas, astrocytomas and hemangioblastomas. 

Extramedullary tumors: These tumors are found outside the spinal cord in structures such as meningiomas, schwannomas, and metastatic tumors (tumors that have spread to the spine from other parts of the body). 

Intradural-extramedullary tumors: These tumors develop in the dura mater (the protective layer of the spinal cord) but outside the spinal cord. Examples are meningiomas and schwannomas. 

Extradural tumors: These tumors are growth outside the dura mater and they are metastatic tumors, lymphomas, and chordomas. 

In the United States, it’s believed that there are around 7,500 new cases of primary spinal tumors every year, whereas the number of metastatic tumors is about 90,000. Out of all the rare primary tumors, hemangioma is the most common one, making up about 30% of all cases, with most of the patients having benign lesions. Several of these lesions display no symptoms and are typically found during spinal imaging procedures. On the other hand, plasmacytoma is the most common malignant tumor of the spine that occurs in 20 to 30% of the cases. 

As many as 10% of cancer patients may have had symptomatic metastases to the spine. 

In the realm of tumors (neoplasms), they are broadly categorized as either primary or metastatic. Primary tumors originate directly from the tissue they affect— for instance, chordoma arises from the tissues composing the spinal column. Conversely, metastatic tumors originate elsewhere in the body and either infiltrate nearby structures or disseminate distantly through the bloodstream or lymphatic system. The spine, being richly vascularized and interconnected with extensive venous and lymphatic networks, serves as a prime site for metastatic spread. Remarkably, approximately 97% of spinal tumors are metastatic in nature. 

Local erosion of the bony spinal column can induce pain due to spinal instability. Furthermore, tumors may protrude from the spinal bones, exerting pressure on neural structures. Damage to these neural elements can manifest as pain, altered sensation, muscle weakness, spasms, or other neurological abnormalities. Metastatic tumors often reach the spine via the epidural venous plexus, where they grow within the epidural space, leading to neurological symptoms. 

The pathogenesis of spinal tumors is multifactorial including genetic predispositions, changes in reproductive hormones, and plant-related factors that contribute developing them. 

Genetic Predisposition: Inherited genetic mutations or syndromes, for example, neurofibromatosis type I and II, von Hippel-Lindau disease, Li-Fraumeni syndrome and hereditary retinoblastoma, can predispose to the development of spinal tumors. 

Environmental Factors: Certain environmental pollutants and exposure to radiation or chemicals are believed to be involved in the development of spinal tumors.  

Cellular Abnormalities: Disruptions in cellular operations, e.g., uncontrolled cell growth and division, and differentiation are the basis for the origin of malignancies. These anomalies could be caused by alterations in genes that are responsible for cell cycle regulation, DNA repair, and apoptosis (a natural process of cell death). 

Spinal tumors that are benign normally have a better prognosis, as they can be simply managed conservatively by monitoring rather than aggressive treatment. The surgical removal may be required when benign tumors that produce symptoms or grow rapidly, but under appropriate follow-up, most patients have a favorable outcome and low recurrence. The non-cancerous primary tumors like chordomas, osteosarcomas, and Ewing sarcomas, are usually very dense and spread quickly therefore, they have poor prognoses due to factors such as aggressiveness, spread and response to treatment. Tumors with metastasis are poor prognosis because they are usually in a more advanced stage with disease widespread. 

Age Group: 

Children and Adolescents: In young patients, spinal tumors often present as non-specific symptoms such as back pain, limb weakness, walking disorders or scoliosis.  

Adults: Spine tumors in adults may have characteristics that are observed in children initially such as back pain, neural deficits, and changes in bowel function or urination. However, spinal degenerative conditions, including disc herniation and spinal stenosis that are more common in adults, can lead to a more difficult diagnosis of spinal tumors. 

The neurological examination looks for evidence of spinal cord compression or cerebellar dysfunction by assessing muscular strength, sensory reflexes, balance, coordination, and gait.  

Examining the spine involves determining its range of motion, pain, abnormalities, and indications of cord compression. Extreme muscular size, tone, and symmetry assessment in the upper and lower limbs is part of the peripheral examination.  

Osteoporosis: In bone health osteoporosis, patients become vulnerable to the process where tumors expand due to back pain and pressure on spinal nerves which lead to fractures and ultimately compression of vertebrae. 

Cancer: Cancer survivors have an elevated risk of developing bone metastasis or cancer of the spinal cord. Symptoms could be more pronounced in these patients because of the rapid nature of the disease. 

Trauma or Injury: If trauma occurs somewhere on the spinal cord or if someone sustains any sort of a traumatic injury, this can lead to the exposure of a previously undetected spinal tumor or increase the intensity of the symptoms that were already present.  

Acute Onset: Some spinal tumors may display acutely with a sudden, severe backache, neurological deficits (such as muscle weakness or numbness) or bowel and bladder problems. The reason behind this may be tumor bleeding, enough space for tumor growing, or pinching of nervous system structures. 

Chronic Progression: While in other spinal tumors, for instance, the presence may occur, but with a more gradual and over time development of symptoms. Patients might first feel a mild common backache or stiffness then after their condition’s difficulties expanded as the tumor grew and compressed the adjacent structure. 

Degenerative disc disease 

Facet joint arthropathy 

Spinal epidural abscess 

Spinal tuberculosis  

Spinal sarcoidosis 

Ankylosing spondylitis 

Spinal stenosis 

Surgery 

Resection: Primary surgery that involves removal of the tumor is frequently a recommended treatment for the spinal tumors especially the localised or the accessible growths. The aim is to reach as many areas as possible and maintain neurological function, as well as spinal stability during the process. 

Decompression: Surgery can be performed to release pressure on the spinal cord or the nerve roots that would cause compression if the tumor is associated with spine instability and deficits in neurological function. 

Instrumentation and Fusion: In situations where the column of spine is involved, instrumentation (e.g. rods, plates, and screws) is added in addition to the fusion procedures to stabilize the spine after the tumor excision is complete. 

Minimally Invasive Techniques: Minimally invasive procedures may be beneficial in cases where indicated with shorter periods of hospital stays, less postoperative pain and quicker recueps. 

 

Chemotherapy will be used to treat tumors along with other methods depending on type of tumor, with malignant/metastatic tumors being the most suitable case for this method. The agents of chemotherapy applied based on tumor types: sensitivity and response rate. 

Targeted Therapy: 

Patient-specific approaches such as molecularly targeted agents and immunotherapies are used for the treatment certain tumors. In immunotherapy, the immune system is targeted to eradicate the tumor cells through either activating the immune system or using antibodies. The goal is to specifically attack the tumor pathways or antigens, like in traditional chemotherapy, but less toxic. 

Palliative Care: Palliative care represents a key sub speciality conducting symptom management, enhancing patients’ quality of life and offering support for patients with advanced or incurable spinal neoplasms .  

Clinical Trials: Taking part in case studies may be offered to the patients whose case fits the clinical trial criteria and this may give an opportunity to these patients to receive innovatory treatment regimens and their new approaches that are now not available to the general population.  

External Beam Radiation Therapy (EBRT): EBRT being beam radiation delivered in a focused fashion to the tumor site, can be employed as the adjuvant therapy following the surgery’s end to eradicate any remaining malignant cells or as the primary treatment for the inoperable or not resectable tumors. 

Stereotactic Radiosurgery (SRS): SRS accomplishes this by using highly charged particles and without more than submillimeter accuracy towards the tumor, SRS leaves surrounding healthy tissues unharmed. Such a technique is usually applied to instantiating small and well-defined tumors or for salvaging recurrent tumors. 

Physical Therapy: The basis of physical therapy is to enhance mobility, strength, flexibility, and function through modified exercises only. Therapeutic exercises could take away pain and reduce muscle tension, but they also can improve your posture and balance. Approaches like manual therapy, stretching, as well as the core stabilization exercises can help people with spinal tumors. 

Occupational Therapy: Occupational therapy primarily helps to optimize activities of daily living (ADLs) and improve functional independence. Occupational therapists will provide modified adaptive equipment, fluid ergonomics as well as assistive devices to allow patients to handle tasks safely and with ease despite any physical constrains. 

Pain Management: Non-narcotic interventions including TENS, acupuncture, and chiropractic may be utilized for pain relief and enhancement of general well-being. Unlike behavioral therapies, which utilize strategies like cognitive-behavioral therapy (CBT) and relaxation techniques, and mindfulness meditation, psychological approaches can help with chronic pain management and reduce stress. 

Bracing and Orthotics: Custom orthoses, braces, or supports may be ordered to keep the spine stable and reduce spinal deformity, as well as relieve pain associated with spinal tumors. Through providing a limited amount of support, orthotic devices can help reduce the load on injured spinal segments and enhance daily activities. 

Nutritional Support: Dietary advice from registered dietitians can enable individuals to determine the right number of foods they need to ensure they are on the right weight and have what it takes to fight diseases during cancer treatment.  

Chemotherapy is a drug which is limited for treating central nervous system tumors as the blood brain barrier and potential for development of resistance to the cytotoxic substances. Even if it is possible as a part of a multimodal treatment approach, it can be used in necessitated situtations only. Systemic chemotherapeutic drugs are given to patients with metastatic spinal tumors since they help to contain growth of the tumor to prevent its further spread, alleviate symptoms and improve life expectancy. The administration of anticancer drug agents as a neoadjuvant or adjuvant for the management of high-grade primary spinal tumors like chordomas, osteosarcomas, and Ewing sarcomas have been adopted as the treatment options of choice. Intrathecally administered or systemically delivered chemo helps to remove tumor cells accumulated in the meninges and spinal cords.  

Stereotactic body radiotherapy (SBRT), which is also named stereotactic ablative radiotherapy (SABR), is an advanced radiotherapy approach that accurately and selectively redirects radiation beams to tumor areas by minimizing surrounding normal tissue exposure via this method. SBRT has shown to be a promising treatment and has provided us with high local control rates and low toxicity. 

SBRT is a minimally invasive treatment technique for primary tumors of the spinal cord such as schwannomas, meningiomas, and chordomas, which provide tumor control, symptom relief and maintaining neurological functioning. 

It can also manage metastasis of spinal tumors from primary cancers like lung, breast, prostate and renal cell carcinoma. For instance, a breast cancer metastatic tumor that relies on the spinal area alone can be controlled by giving high dose radiation for the tumor tissues and not affecting the surrounding soft tissues. Along with SBRT being useful for initial irradiation of spinal tumors in patients who have been given radiotherapy before, it can also be utilized for re-irradiation of recurrent or progressing tumors. 

Biopsy: By the biopsy approach using targeted imagery, tissue is analyzed to discern the type of the tumor as well as grading and molecular features. Biopsy results guide treatment options, that are actuated by the choosing of appropriate therapy modalities among chemotherapy, radiation therapy or targeted agents. 

Vertebroplasty and Kyphoplasty: It is the minimally invasive procedures used to treat the component secondary pain caused by compression vertebral fractures (VCFs) from spinal tumors. When applying vertebroplasty the bone cement gets directly into fractured vertebral body for strengthening its structure and relieving pain levels. Kyphoplasty is a technique involving placement of a balloon tamp into the affected vertebra to restore it to the original vertical alignment. Then a bone cement is injected into the space to hold the bone firmly, thus decreasing kyphosis and improving the spinal alignment. 

Radiofrequency Ablation (RFA): RFA is one of the burn methods which use the currant of high frequency to heat and acquire the portion of cancer tissue. RFA may be used for the treatment of smaller tumors that are localized and specifically osteoid osteomas and distant tumors metastatic to the spine; this technique allows for the creation of a necrotic zone in the tumor, while at the same time it spares the surrounding healthy tissue. 

Cryoablation: The Cryoablation procedure uses freezing of cold temperatures between -196 and -150 degrees Celsius to wipe out and kill tumor cells. The cryoablation can also serve as an alternative to the thermal ablation in treating the spinal cord tumors, especially when the tumoral mass is too small to cauterize. The ablation procedure can be done in most cases with no damage to surrounding adjacent structures. 

Percutaneous Cement Augmentation (PCA): PCA techniques, for instance, PPSF, PPC and percutaneous cementoplasty, are vertebral augmentation coupled with spinal stabilization through instrumentation require for the purpose of relief of pain and instability for patients with vertebral tumors and spinal injuries. The percutaneous cementoplasty is the ascent of the bone cement into tumor-affected vertebrae that is for restoration of the spine and alleviation of pain. 

Percutaneous Tumor Ablation: Percutanous tumour ablation options like microwave ablation (MWA) and irreversible electroporation (IRE) is where the site of the intended tumour tissue is directly exposed to powerful energy in a bid to induce cellular destruction and tumour necrosis itself. This may include embolization via catheter to block blood flow into the vascular tumor, or MRI-guided lasers or real-time MR imaging-guided ultrasound cavitation used to directly destroy the tumor with minimal damage to nearby structures. 

The evaluation and categorization of spinal tumors involve obtaining thorough past medical history, performing physical exam, and conducting diagnostic image studies. A multi-disciplinary team comprising of neurosurgeons, radiation oncologists, and medical oncologists performs in developing a patient-centered treatment plan based on the tumor subtype, stage, location and the patient’s overall health. Treatment modalities may involve surgery, radiation therapy, chemotherapy, targeted therapy, immunotherapy, or a combination of treatment methods.  

Preoperative optimization aims at optimizing the medical comorbidities, nutritional status and overall fitness to reduce postoperative complications and have better surgical outcomes. Surgical treatment should be directed to achieve maximal safe resection while retaining neurological function, spinal stability, and alignment. The surgical strategies may comprise of open procedures, minimally invasive techniques, decompression and reconstruction of vertebral defects.  

Adjuvant therapy, like radiation therapy or chemotherapy, may be applied after surgery to get rid of residual tumor cells and prevent local recurrence as well as improve the long-term disease control rate. Radiotherapy can be given by conventional fractionated radiation, by stereotactic body radiotherapy (SBRT), or by intensity-modulated radiation therapy (IMRT). Rehabilitation and supportive care thus act as complementary therapy with the aim of improving the prognosis of those patients being treated for spinal tumors.