Hearing that you have a spine tumor can stop you in your tracks. Your mind may immediately jump to what comes next — wondering what treatment will be like. For instance, are you going to need surgery?

“The type of tumor, its location, whether it is causing spinal cord compression and how it is likely to respond to other treatments all shape whether surgery is recommended,” says Dr. Sean Barber, a neurosurgeon who specializes in spine surgery at Houston Methodist. “And some spine tumors never need treatment at all.”

Here’s what you need to know about surgical vs. nonsurgical treatment of spine tumors.

Not all spine tumors are malignant, and not all require surgery

For starters, spine tumors are sometimes benign and only require treatment if they cause symptoms.

"A hemangioma, for instance, is a common incidental finding on an MRI that very rarely causes symptoms," Dr. Barber says. "It's a benign blood vessel tumor that many people have. They usually sit there your whole life and don't really grow or do anything and don't need any treatment."

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Other benign tumor types, such as schwannomas, require individualized treatment plans.

"Sometimes they can be left alone — we see them and just watch them,” says Dr. Barber. “But if they're growing or pushing on nerves and causing symptoms, we'll surgically remove them.”

Depending on size and location, they can often be removed using minimally invasive surgery (MIS) techniques, allowing for faster recovery, reduced tissue damage and less postoperative pain compared to open surgery.

Metastatic spine tumors make up the majority of cases

On the other end of the spectrum, spinal metastases — the most common type of malignant tumor of the spine — are often treated with radiation therapy.

The scale of metastatic spine disease is significant. In 2020, there were approximately 1.8 million new cancer diagnoses in the U.S., a number estimated to reach about 2.1 million by 2026. Of people diagnosed with cancer, about 20% will have it spread to the spine. Of those, roughly 20% will need surgery, which Dr. Barber estimates at approximately 150,000 people this year alone.

The encouraging news is that cancer death rates are declining. "People are living longer with these diseases," Dr. Barber notes, "but often metastatic disease doesn't require surgery. Sometimes we can just radiate, or sometimes chemotherapy can get rid of them."

When a spine tumor is first discovered and its origin is unknown, a biopsy is typically the first clinical step. That result guides everything that follows — from whether to operate to which type of radiation or chemotherapy may be most effective.

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Radiation technology has changed what surgery is necessary

Stereotactic body radiotherapy, or SBRT, has transformed spine tumor treatment over the past 15 years. Unlike older external beam radiotherapy, which Dr. Barber describes as a "shotgun blast" to the area, SBRT delivers high-dose radiation precisely to the tumor while sparing surrounding tissue.

"It's sort of like a sniper rifle way of attacking a tumor," Dr. Barber says. "Some spinal metastases previously thought to be resistant to radiotherapy, like renal cell carcinoma, can now be treated relatively effectively with this newer method."

This advancement means that patients who once would have needed surgery may now be candidates for radiation-based treatment instead, particularly when the tumor is not compressing the spinal cord or causing neurological symptoms.

Surgery is reserved for specific, well-defined situations

When surgery is needed for metastatic disease, the goal is not to remove every cancer cell. "The reason being that we know radiation and chemotherapy can kill what's left," Dr. Barber explains. "We just want to take the tumor off the spinal cord." This approach, called separation surgery, allows radiation to destroy remaining cancer cells.

Primary malignant tumors are a different matter. Chordomas and chondrosarcomas do not respond reliably to radiation or chemotherapy, which means surgery is often the most effective option. These operations aim for what is called an en bloc resection, removing not just the tumor but tissue around it.

"Those surgeries usually have to be more invasive and aggressive because we need to remove not only the tumor but a margin of healthy tissue around the tumor," Dr. Barber explains.

Where you get treatment matters, especially for rare tumors

For metastatic tumors, well-coordinated surgery and oncology teams are needed to manage treatment across many settings. And for rare primary malignancies, the choice of treatment center can directly affect the outcome.

"Chordoma and chondrosarcoma are rare spinal tumors, and not many institutions have the experience to treat them effectively. Sometimes that very first intervention can have a drastic impact on the outcome. If you're diagnosed with one of those, it’s important to find an established health care system with a multidisciplinary team that has extensive experience."

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Dr. Sean Barber, neurosurgeon

Your spine tumor treatment plan starts with the right team

A spine tumor diagnosis does not automatically mean surgery. Most people with metastatic spine disease — roughly four out of five — can be treated with radiation, chemotherapy or a combination of both. When surgery is necessary, the approach depends on the tumor type: minimally invasive separation surgery for metastatic disease, and more extensive en bloc resection for primary malignancies that do not respond to other treatments.

Whether you are experiencing persistent and severe back pain, have been diagnosed with cancer and want to know your spinal health risks or have already received a spine tumor diagnosis, connecting with an experienced specialist is one of the most important next steps you can take.