Surgery for Spinal Tumors
Not all spinal tumors require immediate surgical treatment. Sometimes the tumor is observed over time for change. This is a common approach in small benign (non-cancerous) tumors. Larger benign tumors, certain types of spine cancer (malignant), and progressive tumors may require surgical intervention.
Spine surgery may be recommended to remove a benign or malignant tumor, reduce its size, and/or relieve persistent back or neck pain, balance problems, difficulty walking, and bowel or bladder dysfunction. When and if surgery is performed depends on many factors, such as:
- Type of spinal tumor; benign, malignant
- Tumor size and its location
- Neurologic deficit such as spinal cord or nerve compression
- Spinal instability, vertebral fracture, or destruction of vertebral bone
- Bowel or bladder dysfunction
- Unrelenting pain unresponsive to non-surgical therapies
- 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.
The goals of surgery to treat spinal tumors include:
- Remove the spinal tumor, or as much of it as possible
- Stabilize the spine
- Reduce pain
- Improve function and quality of life
Possible Surgical Procedures for Spinal Tumors
Be assured that your spine surgeon will explain the recommended procedure, including how to prepare for surgery, if hospitalization is necessary, and basically what to expect. Of course, he will answer all of your questions so you can make a fully informed decision.
Depending on the type of spinal tumor and its location, surgery may include one or more of the following procedures:
Decompression: Remove the entire tumor or part of it. Medical terms used include debulk (make smaller), excise (complete removal), or resection (partial removal). These types of procedures decompress or relieve pressure to the spinal cord and nerve roots, thereby helping to reduce pain and other symptoms.
Embolization: An interventional technique, usually performed by a radiologist, that slows or cuts off the tumor's blood supply. Embolization (embolotherapy) causes the tumor to shrink.
Kyphoplasty or Vertebroplasty: Both are minimally invasive surgical procedures that stabilize a fractured vertebra and help relieve pain. A spinal tumor that develops within or invades (metastasize, spread) a vertebra may cause bony compression or fracture. While kyphoplasty and vertebroplasty both involve injection of a surgical bone cement into the fracture to stabilize it, each procedure is different.
- Kyphoplasty uses orthopaedic balloons that are inserted into the fracture, inflated to create a hole or cavity, and removed before the bone cement is injected.
- Vertebroplasty does not use balloons. However, a newer technique combines vertebroplasty with radiofrequency ablation to remove the tumor tissue and create a cavity for the bone cement. Radiofrequency ablation uses radio wave energy to break the tumor's cellular molecular bonds to help remove tissue and create the cavity.
- Both procedures provide immediate fracture stabilization.
Radiosurgery (CyberKnife): This is a non-surgical procedure that delivers precisely targeted radiation to treat certain spine tumors1. Radiosurgery treatment is administered during one or more sessions using high-dose of radiation. This treatment does not immediately remove the tumor like surgery. Rather, the tumor disappears with time.
Spinal Stabilization: A spinal tumor can cause your spine to become unstable, especially after a decompression procedure (or other surgery) removes bony parts or tissues, such as an intervertebral disc. Spinal instability increases the risk for serious neurologic injury, such as bowel or bladder dysfunction or paralysis.
Spinal stabilization may be included with another surgical procedure to treat your tumor. Stabilization usually involves spinal instrumentation and bone graft. Instrumentation may include implantation of plates, interbody devices, and screws to immediately stabilize the spine. Bone graft, either taken from your body (autograft), donor bone (allograft), or other type, helps to stimulate new bone growth to join the spinal segment together as it heals. Fusion occurs when new bone growth joins vertebrae together.
- Spinal decompression and stabilization may be performed as a minimally invasive procedure or by using a more traditional open approach (longer incision, longer recovery time).
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 can help you get back to your regular activities of daily living.