Spine Tumors
Spine Tumor Care from a Memorial Sloan Kettering Fellowship-Trained Neurosurgeon in Bergen County.
A diagnosis involving a spinal tumor is one of the most frightening things a patient can hear. The word tumor carries weight that other diagnoses do not, and the spine being involved adds a dimension of urgency that is completely understandable. The first thing worth knowing is that not all spinal tumors are malignant, and not all of them require the same response. The second thing worth knowing is that who evaluates and treats a spinal tumor matters enormously.
Rishi N. Sheth, MD completed his fellowship in neurosurgical oncology at Memorial Sloan Kettering Cancer Center in New York, one of the world’s foremost institutions for the diagnosis and surgical treatment of tumors affecting the spine and nervous system. He trained directly under Philip Gutin, MD, the chief of neurosurgery at Memorial Sloan Kettering, gaining the subspecialty expertise in spinal oncology that defines this page as something genuinely different from what most Bergen County spine practices can offer.
Dr. Sheth is the only spine neurosurgeon in Bergen County with this fellowship. For patients facing a spinal tumor diagnosis in northern New Jersey, that distinction means access to a level of neurosurgical oncology expertise that has historically required traveling to a major academic medical center in New York City.
At Spine Care New Jersey, every patient with a spinal tumor receives a thorough, honest evaluation of their diagnosis, the full picture of available treatment options, and the unhurried time to ask every question they have.
TypesNot All Spinal Tumors Are the Same — and the Distinction Matters.
Understanding what type of spinal tumor is present is the foundation of every treatment decision. Spinal tumors are classified in two primary ways: by where they originate, and by where they are located within or around the spine.
Primary vs. Metastatic Spinal Tumors
Primary spinal tumors originate directly from the cells of the spine itself — the vertebrae, the spinal cord, the nerve roots, the meninges, or the surrounding soft tissues. They are relatively uncommon. Many primary spinal tumors are benign, meaning they do not invade surrounding tissues or spread to other parts of the body, though they can still cause significant symptoms by compressing the spinal cord or nerve roots as they grow.
Metastatic spinal tumors are far more common. They occur when cancer that originated elsewhere in the body, most frequently the lung, breast, prostate, kidney, or thyroid, spreads to the vertebrae or the spinal canal. The spine is the third most common site of cancer metastasis in the body, which means that patients already diagnosed with cancer elsewhere may encounter spinal involvement as part of their disease.
Location Within the Spine
Extradural tumors are located outside the dura, the protective covering of the spinal cord and nerve roots. Most metastatic tumors and many primary bone tumors of the vertebrae fall into this category.
Intradural extramedullary tumors are located inside the dura but outside the spinal cord itself. Meningiomas and nerve sheath tumors such as schwannomas and neurofibromas are the most common types in this category. Many are benign and grow slowly.
Intramedullary tumors originate within the substance of the spinal cord itself. These include ependymomas and astrocytomas. They are less common and require particularly specialized neurosurgical expertise to treat.
SYMPTOMS Recognizing the Symptoms of a Spinal Tumor.
Spinal tumor symptoms vary depending on the type of tumor, its location in the spine, and how much it is affecting the surrounding structures. What makes spinal tumors particularly challenging to recognize is that many of their symptoms overlap significantly with far more common conditions like herniated discs and spinal stenosis. This overlap is one of the reasons an experienced neurosurgical oncologist is essential for accurate diagnosis.
The following symptoms warrant a thorough evaluation, particularly when they occur in combination or do not respond to standard treatment for more common spine conditions.
Back or neck pain that is persistent, progressive, and notably worse at night or when lying down is one of the more distinctive features of spine tumor-related pain. Unlike mechanical back pain from disc or joint problems, which typically improves with rest, tumor-related spinal pain often intensifies at night and can wake patients from sleep.
Radiating pain, numbness, or tingling into the arms or legs can occur when a spinal tumor compresses a nerve root, producing symptoms identical in character to those of a herniated disc or stenosis. When these symptoms do not improve with standard treatment or occur in a patient with a known cancer diagnosis, a spinal tumor must be considered.
Progressive weakness in the arms, legs, or both is a more serious sign indicating that the tumor may be compressing the spinal cord. This can develop gradually or, in some cases, more rapidly as a tumor expands.
Loss of bladder or bowel control, difficulty walking, or a significant change in balance in the setting of back or neck pain represents an urgent clinical situation requiring immediate evaluation.
Unexplained weight loss, fatigue, or a history of cancer elsewhere in the body combined with new or worsening spine pain should always prompt a thorough evaluation to rule out spinal metastasis.
DIAGNOSIS Accurate Diagnosis Is the Foundation of Every Spine Tumor Treatment Decision.
The evaluation of a suspected spinal tumor requires a specific and systematic approach that goes beyond the standard workup for common spine conditions. At Spine Care New Jersey,
Rishi N. Sheth, MD personally leads every step of the diagnostic process for patients with a known or suspected spinal tumor.
MRI
MRI with contrast is the gold standard imaging study for spinal tumors. It provides detailed visualization of the tumor's size, location, relationship to the spinal cord and nerve roots, and degree of any cord compression. The contrast agent highlights areas of abnormal vascularity that distinguish tumor tissue from normal structures. If you have already had an MRI performed elsewhere, Dr. Sheth will review it personally as part of your consultation.
CT Scan
CT scanning provides complementary information about the bony anatomy of the involved vertebrae. It is particularly important when evaluating tumors that involve the vertebral body, as it shows the degree of bone destruction and helps with surgical planning for cases requiring spinal reconstruction.
CT-Guided Biopsy
CT-guided biopsy may be recommended when the diagnosis is uncertain and tissue confirmation is needed before treatment planning. This minimally invasive procedure samples the tumor directly to identify its cell type, which has a significant impact on treatment decisions.
Comprehensive Evaluation
A comprehensive medical evaluation including laboratory studies, systemic imaging, and oncology consultation is coordinated for patients with known or suspected malignancy. Rishi N. Sheth, MD works collaboratively with medical oncology, radiation oncology, and other specialists to ensure that every patient's care is coordinated and comprehensive.
TREATMENTsA Fellowship-Trained Neurosurgical Oncologist Guides Every Treatment Decision.
Treatment for spinal tumors is highly individualized. The approach depends on whether the tumor is primary or metastatic, benign or malignant, the degree of neurological compromise present, the patient's overall health and cancer status, and the goals of treatment. Rishi N. Sheth, MD's fellowship training at Memorial Sloan Kettering Cancer Center prepared him specifically for the complexity of these decisions.
Observation and Monitoring
Some benign spinal tumors, particularly small meningiomas and nerve sheath tumors that are not causing neurological symptoms, can be safely monitored with periodic MRI rather than treated immediately. Dr. Sheth will discuss this option honestly when appropriate, because not every spinal tumor requires immediate intervention.
Surgical Treatment
Surgery for spinal tumors serves several goals depending on the clinical situation. For benign primary tumors, the goal is typically complete or near-complete removal of the tumor while preserving neurological function. For malignant or metastatic tumors, surgery may focus on spinal cord and nerve root decompression to relieve neurological compromise and stabilize the spine to restore function and quality of life.
Rishi N. Sheth, MD performs spinal tumor surgery using minimally invasive techniques where feasible, with Mazor robotic assistance for cases involving spinal reconstruction and instrumentation. The combination of neurosurgical oncology fellowship training and advanced minimally invasive surgical technology means patients benefit from both the diagnostic sophistication of a specialist and the technical precision of a surgeon at the forefront of his field.
For tumors involving the vertebral body with resulting instability, spinal reconstruction using instrumentation and bone grafting restores the mechanical integrity of the spine and allows patients to mobilize and recover more effectively.
Radiation Therapy
Radiation therapy, including stereotactic radiosurgery techniques, plays an important role in the treatment of many spinal tumors, particularly metastatic disease. Dr. Sheth coordinates radiation oncology referrals as part of an integrated treatment plan for patients whose tumors are amenable to this approach.
Vertebroplasty and Kyphoplasty
For patients with painful vertebral fractures caused by metastatic tumor involvement, minimally invasive vertebral augmentation procedures can stabilize the fractured vertebra and provide significant and rapid pain relief.
All procedures at Spine Care New Jersey are performed using minimally invasive techniques with Mazor robotic assistance when appropriate.
Getting to the Real Cause of Your Nerve Pain — the First Time.
One of the most frustrating experiences for pinched nerve patients is being treated for the wrong thing. Arm or shoulder pain that gets months of physical therapy aimed at the shoulder, when the actual problem is a compressed nerve root in the cervical spine. Leg pain that gets treated as a hamstring or hip issue, when the nerve is being compressed in the lumbar spine.
Rishi N. Sheth, MD is trained to read the clinical pattern of nerve compression accurately. The specific distribution of pain, the pattern of numbness, the reflex changes on examination, and the MRI findings together tell a clear story about which nerve is involved, at which level, and why. Getting that story right from the beginning is what makes the difference between a treatment plan that works and months of ineffective care.
As a fellowship-trained spine neurosurgeon at Memorial Sloan Kettering Cancer Center, Rishi N. Sheth, MD has evaluated and treated pinched nerves at every level of complexity, from straightforward single-level herniations to multi-level compression in patients with significant prior surgical history. For patients in Bergen County who are tired of being managed rather than treated, Spine Care New Jersey offers the kind of thorough, specific, expert evaluation that pinched nerve patients deserve.
Common Questions About Spine Tumor Evaluation and Treatment at Spine Care New Jersey.
Spine Care New Jersey in Bergen County is led by Rishi N. Sheth, MD, the only spine neurosurgeon in Bergen County fellowship-trained in neurosurgical oncology at Memorial Sloan Kettering Cancer Center. His training under Philip Gutin, MD at MSK gives patients in northern New Jersey access to spinal oncology expertise comparable to major academic centers, without traveling to New York City. New patients can request a consultation or submit imaging for a free expert review.
Benign spinal tumors often grow slowly and may cause no symptoms initially. When symptoms develop, they typically include localized back or neck pain that is worse at night, radiating arm or leg pain from nerve root compression, and in more advanced cases, progressive weakness or sensory changes. Unlike mechanical spine pain, tumor-related pain often does not improve with rest and may actually worsen when lying down. Any of these patterns in a patient with no clear structural cause warrants MRI evaluation.
The top spine tumor surgeons in the United States are those with specific fellowship training in neurosurgical oncology, not just general spine surgery. Institutions like Memorial Sloan Kettering Cancer Center train the highest level of spinal oncology specialists in the country. Rishi N. Sheth, MD completed his neurosurgical oncology fellowship at MSK and brings that expertise to his private practice in Bergen County, New Jersey. When evaluating any surgeon for a spinal tumor, confirm their specific fellowship training and experience with your tumor type.
The main spine tumor treatment options include surgical removal, radiation therapy or stereotactic radiosurgery, observation for slow-growing benign tumors, and vertebroplasty for painful fractures caused by metastatic disease. The right approach depends on whether the tumor is benign or malignant, primary or metastatic, its specific location relative to the spinal cord, and the degree of neurological involvement. Rishi N. Sheth, MD evaluates each patient’s complete clinical picture personally and coordinates multidisciplinary care when needed.
Nighttime back pain that wakes you from sleep or consistently worsens when lying down is a recognized warning sign that distinguishes tumor-related spinal pain from common mechanical back pain, which typically improves with rest. That said, it is not exclusive to tumors and has other possible causes. If you have persistent back or neck pain that follows this pattern, particularly combined with unexplained weight loss, fatigue, or a history of cancer, an MRI evaluation by a spine specialist is strongly warranted. Dr. Sheth offers a free MRI review for patients concerned with imaging findings.