Surgical treatment of spinal tumors

Indications for surgical treatment of a spinal tumor include uncontrollable pain, spinal cord compression, and spinal instability. Similar to other treatments, your doctor will recommend a treatment plan that considers your tumor type, health status, and age. The benefits, risks and complications, as well as projected outcome (prognosis) are weighed as art of the decision process shared by you and your doctor.

Embolization
Embolization is an invasive technique suitable to treat different types of spine tumors. It works by obstructing the tumor's blood supply. The procedure is performed using x-ray or CT-guidance and may employ the use of different materials to block vessels that feed the tumor. Types of materials include coils, foam, dissolving sponge, and medical liquid glue. A catheter (hollow tube) delivers the materials used to embolize a blood vessel.

Surgical Removal
The goals of spine tumor surgery include restoring spinal stability, function, decompression of neural elements (e.g. spinal cord), pain reduction, and preventing tumor recurrence or spread. Part of, or the entire spinal tumor is removed (terms include debulking, excision or resection).

The type of surgical procedure considered appropriate depends on several factors such as the tumor's location, type, and size; patient's general health; and, need for spinal stabilization. Spinal stabilization means using instrumentation (e.g. interbody devices, screws) and fusion (e.g. bone graft) to secure the spine in position - also called fixation.

Spinal Fracture Treatment
Vertebroplasty and kyphoplasty techniques are performed using fluoroscopic (real time x-ray) or CT guidance to stabilize spinal fracture. Certain material called Polymethylmethacrylate (bone cement, abbreviated PMMA) is injected inside the compromised bone via a small needle. Bone cement hardens inside the body and helps to stabilize the fracture site. This decreases pain and prevents future collapse. Both procedures have a history of use in the treatment of vertebral compression fractures caused by osteoporosis and tumors. More recently, research has been published supporting the safety and effectiveness of cement augmentation in the treatment of sacral and pelvic malignancy. (1)

One difference between vertebroplasty and kyphoplasty is kyphoplasty utilizes a balloon device to create the cavity into which bone cement is injected. A drawback of kyphoplasty in treatment of malignancy-related fracture is the balloon can result in tumor displacement and cause spinal cord and/or nerve compression. A newer approach (2) employs the use of radiofrequency-based plasma ablation to debulk the tumor tissue and create the cavity for the bone cement. Simplified, this method uses radio wave energy to break the tumor's cellular molecular bonds to ease tissue removal and formation of a cavity for better control over cement deposition especially in advanced cases.

Recovery
Your doctor will outline specific guidelines to help you to obtain the best treatment whether nonsurgical and/or surgical. Short- and long-term recovery depends much on tumor type (e.g. benign, malignant), treatment, your overall health, and age.

A period of hospitalization after surgery is to be expected. Thereafter, some patients are discharged home or may spend time at a physical rehabilitation facility prior to going home. These decisions are in part based on the patient's ability to care for her/himself and/or spouse/partner, family, friend, or caregiver involvement.