Surgery for Spinal Tumors

Spine surgery to remove or resect (partially remove) a benign (non-cancerous) or malignant (cancerous) spinal tumor can help reduce or relieve persistent back or neck pain, balance problems, difficulty walking, and bowel and bladder dysfunction. When and if surgery is performed depends on many things, such as:

• Tumor type, including benign or malignant
• Tumor size and its location
• If the tumor causes spinal cord or nerve compression (if there's neurologic deficit—aka, nerve problems)
• If the tumor causes spinal instability, vertebral destruction, or vertebral fracture
• If there is bowel or bladder dysfunction
• If there is unrelenting pain unresponsive to non-surgical therapies
• Your general health, immunity, and infection risk*

*Some patients who have undergone radiation therapy and / or chemotherapy may be at risk for infection and poor wound healing. These therapies reduce the body's normal white cell blood count and may make healing more difficult; chemotherapy and / or radiation therapy may also increase resistance to infection. Nutrition is a concern as many cancer patients experience poor appetites and significant weight loss causing poor health.

Surgery Goals
The goals of surgery for spinal tumors include:

• Remove the spinal tumor, or as much of it as possible
• Reduce pain and improve function and life
• Restore spinal stability

Possible Surgical Procedures for Spinal Tumors
Depending on the type of spinal tumor and its location, surgery may include one or more of the following procedures:

• Decompression: Remove the tumor, bone, and other tissues compressing the spinal cord and / or spinal nerve roots.
  
  
• Spinal Stabilization: Your spine can become unstable after part of the bone or other tissues (e.g., intervertebral discs) are taken out. An unstable spine can move in abnormal ways, putting you more at risk for serious neurological injury. In this case, the surgeon will want to stabilize your spine by using instrumentation and fusion.
  
  In spine stabilization by fusion, the surgeon creates an environment where the bones in your spine will fuse together over time (usually over several months or longer). The surgeon uses a bone graft (usually using bone from your own body, but it's possible to use donor bone as well) or a biological substance (which will stimulate bone growth).
  
  Your surgeon may use spinal instrumentation—wires, cables, screws, rods, and plates—to increase stability as the bones fuse. The fusion will stop movement between the vertebrae, providing long-term stability.
  
  
• Combination: You may need to have both a decompression and spinal stabilization. Decompression and stabilization spine surgeries may be performed as a minimally invasive procedure or by using a more traditional open approach (longer incision, longer recovery time).
  
  
• Kyphoplasty or Vertebroplasty: These are similar minimally invasive surgical procedures performed to stabilize a fractured vertebra. Spinal tumors that invade vertebrae may cause it to break and can cause severe pain.
  
  Kyphoplasty uses a special orthopaedic balloon. It's inserted into the fractured vertebra. Then, the balloon is inflated in an effort to return the vertebra to the correct height and position. The balloon creates a void—a hole—in your vertebra, and it's then removed. The void is filled in with a surgical cement that should support the vertebra and keep it from fracturing again.
  
  Vertebroplasty does not use a balloon, but it does involve injecting surgical cement into the vertebral body. Both procedures provide immediate fracture stabilization.
  
  
• Radiosurgery (CyberKnife): This is a non-invasive procedure using precisely targeted radiation to treat certain spine tumors (1). Radiosurgery can help remove tumors using a high-dose of radiation.

Recovery
Most patients need some rehabilitation after surgery. Whether you are transferred to a rehab center directly from the hospital or go as an outpatient, rehab should help you get back to your regular activities of daily living.

Certain treatments may be prescribed as part of your continued care. If your spinal tumor is malignant, radiation therapy and / or chemotherapy may be recommended.

Reference

1. Stanford CyberKnife. Stanford Hospital and Clinics, Stanford University Medical Center. http://www.stanfordhospital.com/clinicsmedServices/COE/cyberknife/default. Accessed October 15, 2008.