Surgery for Spine Tumors

Depending on the type of tumor, where it’s located, and the patient’s medical condition, treatments may include chemotherapy, radiation therapy and/or surgical removal of the tumor. However, surgical removal is not always possible if the tumor is located in an area of the spine that is difficult to reach. Sometimes, embolization is necessary as in the cases of aneurismal bone cysts, kidney cancer and multiple myeloma. This is a procedure that limits blood flow to the tumor. Other times, a combination of treatments is used to ensure that cancer does not spread to other areas of the body. Keep in mind, there is no evidence to show that any of these therapies improve the prognosis or change survival rates.
Whether benign or malignant, a spinal tumor is a very serious medical condition. However, if diagnosed early, patients with spinal tumors have a better chance of a full recovery. Patients who are experiencing any of the symptoms listed in this article should seek medical help right away.
Spinal Tumors: Surgery and Recovery
Some spinal tumors, benign or malignant, require surgical intervention before or after non-operative treatments. When pain is unresponsive to non-operative treatment, neurologic deficit progresses, a specimen is needed, neural elements (e.g. nerves) are compressed, vertebral destruction exists, or when spinal stabilization is necessary – surgery is considered. The primary goals in surgery are to reduce pain caused by the spinal tumor, restore or preserve neurologic function, and provide spinal stability. The spinal tumor may be approached surgically from the front (anterior) or back (posterior) of the body. Surgery may include tumor resection (partial removal) or excision (complete removal). When the tumor is removed (partially or completed) pain and neurologic problems may clear up.
Spinal instrumentation and Fusion are procedures used to reconstruct and stabilize the spine. These procedures join and solidify the level (or levels) where a spinal element (e.g. vertebral body) has been damaged or removed. Instrumentation uses medically designed hardware such as rods, bars, wires, and screws. These devices hold the spine straight during fusion. Fusion is the adhesive process joining bony spinal elements.The number of days spent the patient will spend in the hospital after surgery is partially dependent on the procedure(s) performed. Thereafter, the patient’s care is monitored by periodical office visits and re-evaluation by the treating physician.
The patient’s care is monitored by periodical office visits and re-evaluation by the treating physician. This is important because some tumors, benign or malignant, may reoccur. Treatment may include radiation and/or chemotherapy. The side effects from radiation can be severe including reddened or painful skin at the treatment site, nausea, vomiting, loss of appetite, and fatigue. Chemotherapy can cause similar side effects. However, many of these side effects can be treated with drugs.
Usually when the treatment period has ended, the symptoms clear up. Analgesics are given to control post-operative pain and cancer pain. Cancer pain may be difficult to control (e.g. ‘break through pain’). A pain management specialist may provide assistance if conventional drugs (e.g. pill, skin patch) do not provide relief.
Any surgery, radiation treatment, or chemotherapy can drain the patient nutritionally. Therefore, a proper diet is important to regain strength, lost weight, and a measure of health. A professional nutritionist can provide guidance. Depending on the extent of the surgery and the patient’s medical status, a course of physical therapy may be prescribed. Through exercise and modalities the patient can build strength, endurance, and flexibility.
Spinal Tumors: Diagnosis and Non-Surgical Treatment
The patient’s medical status is evaluated with particular attention given to back pain and neurologic deficit. Although back pain is often the primary symptom, some patients present with paraparesis (slight paralysis), spinal deformity (e.g. scoliosis, kyphosis), and malaise. Plain radiographs (x-rays) may demonstrate the presence of a spinal tumor. A CT Scan and/or MRI can provide further tumor detail including neural elements (e.g. spinal canal).
An angiogram demonstrates the vascularity of the tumor (e.g. blood supply). Further, a biopsy of the tumor is necessary to establish the diagnosis (e.g. tumor type, benign or malignant). Staging classifies neoplasms (abnormal tissue) according to the extent of the tumor including bony and soft tissue involvement, and spinal canal intrusion. A whole body Technetium-99 bone scan is required and may include a chest x-ray, and CT scan of the lungs and abdomen. The above findings and results from laboratory tests (e.g. complete blood count, urinalysis) are compared to the patient’s symptoms to confirm the diagnosis.
A coordinated multidisciplinary approach is used to treat spinal tumors. The expertise of a neuroradiologist, pathologist, angiographer, oncologist, and spinal surgeon may be combined during the patient’s treatment. The type of tumor, neurologic deficit, spinal deformity (e.g. scoliosis), bony involvement, prior treatment, patient’s medical status, pain, and life expectancy are considered prior to treatment.
Aggressive tumors may require surgical resection (partial removal) or excision (complete removal). Others require non-surgical treatment that may include bracing, radiation, chemotherapy, or embolization. Some tumors require both surgery and non-operative treatment. Analgesics are given for pain.
If pain is difficult to manage, a pain management specialist may be consulted. Steroids may be prescribed to reduce edema (swelling) that can occur around tumors. Bracing may be used to control pain and provide spinal stability. Radiation and/or chemotherapy may shrink tumors. The dose and frequency of radiotherapy (e.g. radiation) is carefully calculated to destroy cancer cells while preserving healthy cells. Chemotherapy drugs can be administered orally or intravenously.
Surgery may be indicated when:
Pain is unresponsive to non-operative treatment.
Neurologic deficit progresses.A specimen is needed (open biopsy).
The tumor requires debulking (reduce size) to decompress neural elements (e.g. nerves).
Vertebral destruction exists
Spinal stabilization is necessary.
Wound healing and the risk of infection are concerns which factor into surgical decision-making. The patient’s immunity, nutritional health and pulmonary (e.g. lungs) status are evaluated:
If the patient has recently undergone radiation or chemotherapy, their white blood cell count may be too low to fight infection and could compromise healing.
Cancer can affect appetite and eating, which may lead to weight loss and deterioration of general health.
Good pulmonary function is needed to properly oxygenate blood to augment wound healing.
Whether the treatment course is non-operative or surgical, periodic follow-up visits with the treating physician(s) is essential.