Spinal masses vary in prevalence, type, and demographic distribution across different regions. Although primary spinal tumours are relatively uncommon, comprising only around 3% of all central nervous system (CNS) tumours in adults, they hold significant clinical importance within neurosurgical practice because of their potential to cause profound neurological deficits and functional disability.^1,2 Spinal tumours can produce sequelae such as neuropathic pain, pathological fractures, spinal instability, nerve root compression, and, in more severe cases, spinal cord compression.^2,3 Spinal tumours in South Africa, both primary and secondary, are less commonly encountered compared to infectious spinal pathologies such as tuberculosis (TB) with metastatic tumours, predominantly lung adenocarcinoma, breast cancer, and prostate cancer being the most frequent.^4.5

The differences in the occurrence of spinal masses are unclear but are likely influenced by demographic, environmental, and healthcare factors contributing towards the limited data on primary spinal tumours in South Africa. In addition, there are more comprehensive studies conducted by developed countries compared to developing countries making use of data registers.⁶ Recognising these variations is essential for developing targeted strategies to improve diagnosis, management, and resource distribution for spinal diseases both locally and internationally.

The primary objective of this study is to review the spinal masses encountered at Inkosi Albert Luthuli Central Hospital in Durban, South Africa from 2020 to 2024 to provide insights into the clinical presentation, surgical trends, and outcomes for South African patients with spinal masses. Furthermore, the study aims to compare local occurrences with international and explore potential reasons for any differences.

A total of 28 patients who underwent spinal surgery for spinal masses were included in the study. The mean age of the cohort was 37.74 years (s.d. 18.19), with 16 female (57.1%) and 12 male (42.9%) patients. The year 2021 saw the highest frequency of surgeries (46.4%). Schwannomas were the most frequent tumour type, accounting for 28.6% of cases (see Table 1). Meningiomas were the second most common tumour type, comprising 21.4% of cases. Other tumour types included neurofibromas (7.1%), ependymomas (7.1%), and haemangiomas (3.6%). Less common diagnoses included epidermoid cysts, arachnoid cysts, follicular papillary thyroid carcinoma metastases, adenocarcinoma metastases, atypical teratoid and/or rhabdoid tumour (ATRT), granulomatous inflammation, fibrofatty tissue and abscesses each accounting for 3.6% of cases (Figure 1). Laminectomy was the most frequently performed surgical procedure, comprising 60.7% of all surgeries. Laminoplasty accounted for 21.4% of surgeries, while fusion was performed in 7.1% of cases. Pearson correlation analysis revealed a significant negative correlation between age and follow-up duration (r = −0.579, p = 0.001), as well as between age and suspected lesion type (r = −0.568, p = 0.002). A significant positive correlation was found between surgical intervention and suspected lesion type (r = 0.541, p = 0.003). The histopathological distribution of spinal masses is depicted in Figure 1.

While age-specific and sex-specific tumour types were not found, the data analysis found that schwannomas, meningiomas and neurofibromas, total 11 (39.28%), were found predominantly in the 30 year to 50 year age group.

It was also found that most spinal masses in this cohort occurred in the 30 to 50 year age group, total 16, (57.14%), and the 0 to 29 year age group was the next largest group with a total of 7 (25%). There was also a female predominance of schwannoma, meningioma and neurofibromas, total 10, (35.71%) with a male predominance of ependymomas – total 2 (7.14%). The frequency of benign vs malignant tumours in this study is shown in Table 3.

In younger patients with age less than 30 years, there were mainly ependymoma, ATRT and epidermoid cyst found – total 3 (10.71%).

Spinal tumours have the potential to cause detrimental neurological consequences and their occurrence in South Africa is not well documented. In this study, we evaluated the occurrence of spinal masses that were operated at one major neurosurgical facility in the country between 2020 and 2024.

The median age of our study was 39.50 years (IQR 30.3–45.0) and the mean was 37.74. This was aligned to a recent large-scale study by Alvarez-Crespo et al., which reported the mean age of spinal schwannomas as 35.8 to 57.1.⁷ Often spinal meningiomas have a mean age of 60–69; however, this varies between individual studies. When assessing for gender disparities, there was a female predominance of 57.1%. This was in keeping with a global female predominance in some studies.⁸ However, this is contrasted by a male predominance in some countries such as Japan.⁹

In this study, spinal schwannomas (28.6%) and meningiomas (21.4%) were the most prevalent tumour types detected. These findings correlate with a study by Momin et al. where a higher incidence of meningiomas (21.4%) and a lower incidence of ependymomas (3.6%) were documented.¹⁰ According to a multicentre study by Hirano et al., schwannomas and meningiomas represent the two most frequently encountered intradural extramedullary tumours of the spine.¹¹ Conversely, intradural intramedullary tumours such as astrocytomas and ependymomas are more prevalent in paediatric populations. At Korle-Bu Teaching Hospital, meningiomas were reported as the most frequent tumour type between 2007 and 2023.¹ The predominance of schwannomas may be reflective of a higher incidence of peripheral nerve sheath tumours within our cohort; however more large-scale studies are warranted.

Understanding the aetiology of spinal masses allows for the appropriate course of management to be followed. Spinal tumour aetiology encompasses neoplastic and infectious causes. There is a link between advancing age and the probability of the tumour being metastatic. Previous studies support the notion that older age is associated with the risk of high-grade tumours and younger age with benign tumours.^2,5,12 This study found a predominance of primary benign spinal tumours, however, it is important to note that both locally and internationally, metastatic or secondary spinal tumours, often arising from primary cancers such as those of the lung, breast, or prostate, are more frequently encountered than primary spinal tumours (Table 4).^4,9 Less common were high-grade tumours that mimicked low-grade tumours on MRI. There was a predominance of intradural extramedullary tumours compared to intradural intramedullary tumours, which is in keeping with globally reported data (see Table 2).^1,10 It was, however, in contrast to a study in China that found the primary malignant tumour was chordoma followed by ependymoma and primary benign tumours were haemangioma; however, the study looked at spinal bone tumours.^13,14

Our study found that 18% of the masses encountered were non-neoplastic in nature, with granulomatous inflammation accounting for 3.6% of these cases. Although this percentage is relatively low, it remains clinically significant in our setting, particularly in HIV and/or TB-endemic regions, where infectious aetiologies must be carefully considered in the differential diagnosis.^4,5 Spinal tuberculosis continues to be a major contributor to spinal disease in South Africa, largely attributable to the high burden of tuberculosis and HIV infection. Radiologically, spinal TB may closely resemble neoplastic processes, particularly in the presence of vertebral body destruction, paraspinal or epidural abscess formation, and spinal canal compromise. A 2013–2016 cohort from Groote Schuur Hospital found granuloma formation correlated with CD4 count (r = 0.503, p = 0.02), alongside vertebral collapse in HIV-positive patients with spinal tuberculosis.¹⁵

Laminectomy is a well-established surgical approach in the management of spinal tumours, providing access for tumour excision and decompression of neural structures. The most common surgical approach is posterior and via a laminectomy (60.7%) or laminoplasty (21.4%). This approach is likely favoured as it is less destructive of bony elements, causing a lower incidence of post-surgical spinal instability, as most commonly a single-level or two-level laminectomy is employed.^7,8 A significant positive correlation was found between surgical intervention and suspected lesion type (r = 0.541, p = 0.003).

The findings of this study offer important insights into the spectrum of spinal masses encountered in Durban, KwaZulu-Natal, South Africa. Expanding knowledge of the causes of spinal masses aids clinicians in making informed decisions and optimising patient management.

This retrospective study provides important insights into the occurrence and management of spinal masses at a major neurosurgery centre in Durban, South Africa. Schwannomas and meningiomas were the most encountered benign tumours, with laminectomy being the predominant surgical procedure. The correlations observed between patient age, mass type, and surgical intervention offer important implications for clinical practice and future research in spinal pathology locally. This study highlights the need for further research into spinal masses in South Africa, with the aim of improving diagnostic and management strategies. A potential next step could incorporate a multicentre study with a larger sample size, which evaluates spinal masses for an extended time frame and assesses the functional outcomes of patients.