Spinal Cord Cavernous Malformation
Cavernous malformation (CM) can also be found in the spinal cord. This is referred to as a spinal CM. Spinal CMs can affect people of any age. All genders are affected equally. The detection rate and population prevalence of spinal CMs are unknown but is estimated to be detected in ~5% of cases in adults and ~1% in children as referenced in the Guidelines for the Diagnosis and Clinical Management of Cavernous Malformations of the Brain and Spinal Cord. Spinal CM is thought to occur less frequently than cerebral CM.
What is the Spinal cord?
The spinal cord is a column of nerves that extends from the brain to your lower back. It consists of bundles of nerves that send incoming and outgoing messages between your brain and the rest of your body. These messages:
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Help process and interpret sensory information, including pressure and pain
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Manage reflexes
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Control voluntary and involuntary movements and functions
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Voluntary movements and functions are actions you consciously control, such as typing on a keyboard, swimming, running, and walking.
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Involuntary movements and functions happen automatically without consciously thinking about them, such as breaking, regulating heart rate and blood pressure, controlling urination, and producing bodily fluids (sweat, saliva, tears).
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There are 31 pairs of spinal nerves, and each nerve emerges in two roots:
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Motor roots: carry messages to skeletal muscles to control movements.
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Sensory roots: carry sensory information (temperature, position, vibration, and pain) to the brain from other parts of your body.
The spinal cord is divided into 4 regions:
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Cervical: located in the neck
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Thoracic: located in the upper back
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Lumbar: located in the lower back
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Sacral: located in the pelvis
Average spinal cord length: 45 cm in men, 43 cm in women
Average diameter: 1-1.5 cm
Clinical Presentation
Spinal CMs can cause symptoms that appear suddenly or develop gradually over time.
The clinical presentation varies depending on the size and location of the CM, and whether it has experienced hemorrhaging. Because the spinal cord has very limited space, even a relatively small CM can cause symptoms.
Depending on the location of the CM, symptoms include:
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Pain
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Sensory changes, such as numbness, burning, tingling, or an inability to feel pressure on the skin
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Motor issues, including weakness, difficulties with balance, difficulties controlling movements, or changes in mobility
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Bladder and bowel issues, such as incontinence, difficulty emptying the bladder, or constipation
People may experience a range of symptoms and many report more than one.
Diagnosis and Imaging
An MRI is the gold standard for diagnosing cavernous malformation. It is recommended for suspected spinal CMs to use specialized MRI sequences, such as 3-dimensional Multi-Echo Data Image Combination, in addition to standard T1-weighted and T2-weighted MRI sequences, which can help detect even tiny CMs. Once a CM is identified, contrast is often not needed for follow-up imaging. In urgent circumstances, CT imaging may be used, though it may not always show smaller CMs.
People diagnosed with an inherited form of cavernous malformation are at risk of developing a spinal CM. A study in 2014 found approximately 17% of patients also had cerebral cavernomas, and around 12% had a family history of cavernous malformation.
Treatment Options and Management
Microsurgery
Microsurgery is an option in some cases, especially when the spinal CM is causing significant symptoms such as weakness, pain, and loss of function. The goal of the surgery is to safely remove the lesion while preserving as much normal spinal cord function as possible.
The risks and potential outcomes of surgery depend on several factors, including:
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The location of the CM
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The person's neurological condition before surgery
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The experience of the surgical team and hospital.
These factors and other relevant information are highlighted here.
Conservative Approach: "Watch and Wait"
Not all spinal CMs need surgery. When symptoms are mild, stable, or not progressing, doctors may recommend a conservative, or "watch and wait" approach. This often includes:
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Regular MRI scans to monitor changes
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Ongoing neurological assessments with a specialist to track your symptoms
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Rehabilitation therapies, such as physiotherapy or occupational therapy to help maintain strength, mobility, and independence
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Pain management and other supportive treatments to help improve quality of life
Possible risks of this approach include:
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Bleeding or re-bleeding, which may cause new or worsening symptoms include step wise impact
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Progressive symptoms, such as weakness, numbness, or pain over time
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Nerve damage, repeated bleeding, or ongoing pressure in the spinal cord, which may affect movement or sensations
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Continued risk of hemorrhage
Research on spinal cord cavernous malformation is limited, but studies and expert guidelines provide useful insights. For information from a 2014 Meta-Analysis of 632 patients with spinal CM by Badhiwala et al, , access our Research Page.
Last Updated: November 23, 2025