Intramedullary spinal cord metastatic tumors

Marc D Winkelman MD (Dr. Winkelman of Case Western Reserve University has no relevant financial relationships to disclose.)
Rimas V Lukas MD, editor. (

Dr. Lukas of Northwestern University Feinberg School of Medicine received honorariums from AbbVie as a guest speaker, from NewLink Genetics and Reneuron for consulting work, and from Monetris as an advisory board member.

Originally released May 9, 1997; last updated August 24, 2019; expires August 24, 2022


Intramedullary spinal cord metastasis refers to invasion of the spinal cord by solid tumors that arise elsewhere in the body. It is a relatively rare cause of myelopathy in patients with cancer; compression of the spinal cord by epidural metastatic tumor occurs approximately 25 times more often. Local back pain or radicular or referred pain in a limb is the most common initial symptom. Patients go on to develop a transverse myelopathy, a Brown-Sequard syndrome, or an ascending or descending myelopathy. The course of the illness is subacutely progressive. The most common primary tumors arise in the lung and breast. MRI is the diagnostic procedure of choice. The prognosis is poor: the majority of patients survive fewer than four months. The cause of death is usually widespread metastatic disease. Radiation therapy is the treatment of choice. Most patients achieve stabilization of spinal cord function, and some patients improve.

Key points


• Intramedullary spinal cord metastasis is an uncommon cause of myelopathy in patients with systemic cancer.


• It presents as a painful, subacutely progressive myelopathy.


• Untreated, it causes irreversible paraplegia or tetraplegia.


• Treatment with radiotherapy, if performed when the patient can still walk, is likely to stabilize, if not improve, spinal cord function.

Historical note and terminology

The term "intramedullary spinal cord metastasis" refers to invasion of the parenchyma of the spinal cord by solid tumors that arise elsewhere in the body. Willis was the first to review the pathologic aspects of the subject (Willis 1934). He pointed out that carcinomas of the lung and breast were the most frequent primary tumors and that cerebral metastases were also often present. He hypothesized that intramedullary spinal cord metastases spread to the cord hematogenously or by direct extension from leptomeningeal deposits, that they were usually multiple, and that syringomyelia and hematomyelia were complications. Finally, he found that the frequency of intramedullary spinal cord metastases was hard to determine because the spinal cord was seldom examined at autopsy. The condition is so uncommon that no major clinical series appeared until 1972, and it contained only nine patients (Edelson et al 1972). The authors found that the neurologic features were identical to those of compression of the spinal cord by epidural metastatic tumor, that the myelogram was often normal, and that radiation therapy was the treatment of choice. Schiff and O'Neill reported the largest clinical series (40 patients) (Schiff and O'Neill 1996). They concluded that long-term survival is poor because of widespread metastatic disease, and that radiation treatment preserves but does not restore neurologic function.

The content you are trying to view is available only to logged in, current MedLink Neurology subscribers.

If you are a subscriber, please log in.

If you are a former subscriber or have registered before, please log in first and then click select a Service Plan or contact Subscriber Services. Site license users, click the Site License Acces link on the Homepage at an authorized computer.

If you have never registered before, click Learn More about MedLink Neurology  or view available Service Plans.