Surgical Treatment of Spine Cancer
Edited By: Sohail K. Mirza, M.D. MPH
Last updated Friday, December 30, 2005
Considering surgeryTypes of surgery recommended In most cases, spinal tumor surgery is a treatment of last
resort, i.e. other non-surgical treatments, such as radiation and chemotherapy
have already been tried and often will continue to be used in the patient’s
treatment regimen. The goal in spinal tumor surgery for metastatic cancer is to
perform the minimum surgery necessary to provide the patient as rapid a
recovery as possible. When the cancer is limited only to one portion of the
spinal column, the goal of surgery is often to completely remove the cancer, if
possible, with the hope of potentially curing the cancer.
In general, spinal tumor procedures include:
- Percutaneous
spinal tumor surgery usually involves cement being injected into a
fractured vertebra. Often, the tumor can be indirectly scraped and removed
through these minimally-invasive techniques (percutaneous curettage).
Percutaneous surgical procedures involve the passage of substances and/or
instruments, such as a needle, wires, drills, or catheters through the
skin without a formal incision. These procedures are used if there are no
neurological symptoms.
- If
there are neurological symptoms, an open procedure is usually necessary
where an incision is made to remove tissue pressing against the spinal
cord and nerves. These open procedures usually require insertion of rods,
screws and cement to reinforce the spinal column. If an open procedure is
needed, often a pre-operative embolization
(where a radiologist threads a small
catheter into the artery in the groin and through this catheter, seals off
the blood flowing into the cancer area) is performed to block the flow
of blood to the spinal tumor and help reduce blood loss during surgery.
- Sometimes
a more extensive approach is required, particularly when aiming for a cure
in excising primary tumors of the spinal column or excising an isolated
metastasis from the spinal column. The more extensive procedure is usually
completed in stages. A first surgery may be performed from the back to
separate the tumor from the spinal cord and to reinforce the vertebral
column. A second operation is then performed from the front. The second
procedure is usually done through the chest or abdomen to release the
tumor from blood vessels and other organs, to remove the tumor and to
further reinforce the spinal column. Sometimes both stages can be completed
on the same day, under one anesthetic. More often, because the first
operation may take a long time, or involve a lot of blood loss, the
patient is allowed to recuperate for five to seven days before the second
stage of the operation. Whether staging is necessary, and selecting the
particular sequence of steps (i.e. whether the first part is done through
a back or a front incision), depends on the tumor location, and the
patient’s symptoms among other factors.
Who should consider spine tumors; neoplasms of the spine; spine cancer; pathological fractions of the spine? If possible, patients with metastatic tumors of the spine
should seek consultation from a spinal surgeon prior to the onset of
neurological symptoms or development of a spinal fracture. Spinal tumors are
often easier to treat if the disease diagnosis is made early and treatment is
started soon thereafter. In addition, neurological recovery is frequently more
successful if treatment is begun early. This means early evaluation with an MRI
if a patient with a diagnosis of cancer develops back or neck pain that does
not go away within a few days. If a spinal cancer is identified, consultation
with a spine surgeon should be considered.What happens without surgery? If nothing is done for spinal cancer, the response varies.
Usually generalized treatment (e.g. chemotherapy and radiation, etc.) of spinal
metastases is enough to stop the spread of cancer. However, for some patients
with spinal involvement who do not have surgery, a possible outcome is
paralysis. This is why whether or not a patient has surgery, he or she should
be closely monitored by his or her oncologist and/or primary care provider so
that if a spinal fracture or neurological problems occur, or are imminent, they
are identified and treated early.Surgical options In general, spinal tumor surgical procedures include:
- Percutaneous,
minimally invasive outpatient surgery using local anesthesia.
- Percutaneous
minimally invasive surgery using general anesthesia and involving a short
hospital stay.
- Surgery
with an incision in the back or neck to free-up the space around the
spinal cord and to insert rods, screws, and cement to reinforce the spinal
column (for example, laminectomy, fusion, pedicle screw fixation,
posterior instrumentation, and methyl-methacrylate/ bone cement
augmentation).
- Surgery
with an incision across the abdomen, chest, or front of the neck to free
up the space around the spinal cord and insert plates and screws to
reinforce the spinal column (for example, corpectomy, vertebrectomy,
anterior fusion, and anterior instrumentation).
- Extensive
surgery with two incisions, one in the back and one in the front, to free
up the spinal cord and reinforce the spinal column. Often, the anterior
and posterior procedures are staged one week apart.
Percutaneous spinal tumor surgery
usually involves cement being injected into a fractured vertebra. Often, the
tumor can be indirectly scraped and removed through these minimally-invasive
techniques (percutaneous curettage). Percutaneous surgical procedures involve
the passage of substances and/or instruments, such as a needle, wires, drills,
or catheters through the skin without a formal incision. This procedure is used
if there are no neurological symptoms.
If there are neurological
symptoms, an open procedure is usually necessary. In this procedure, an incision is made to
remove tissue pressing against the spinal cord and nerves. This procedure
usually requires insertion of rods, screws and cement to reinforce the spinal
column. If an open procedure is needed, often a pre-operative embolization is
done to block the flow of blood to the spinal tumor and help reduce blood loss
during surgery.
Sometimes a more extensive approach is required,
particularly when aiming for a cure in excising primary tumors of the spinal
column or excising an isolated metastasis (spread of cancer at a location away
from where it started) from the spinal column. This more extensive procedure is
usually done in stages. A first surgery may be performed from the back to
separate the tumor from the spinal cord and to reinforce the vertebral column.
A second operation is then performed from the front, usually through the chest
or abdomen, to release the tumor from blood vessels and other organs, remove
the tumor, and further reinforce the spinal column. Sometimes both stages can
be performed on the same day, under one anesthetic. More often, because the
first operation may take a long time or involve a lot of blood loss, the
patient is allowed to recuperate for five to seven days before undergoing the
second stage of the operation. Whether staging is necessary, selecting the
particular order and sequence of steps, and the choice of incision approach
depend on the tumor location, and the patient’s symptoms, among other factors.Effectiveness At major medical centers with a highly trained and
experienced staff, where there is a multidisciplinary team available (often
consisting of orthopaedics or neurosurgery trained spine surgeons, oncologists,
radiation oncologists, general surgeons, hematologists, infectious disease
specialists, neuro-radiologists and critical care specialists, etc.), most
patients generally tolerate spinal cancer surgery well and usually experience
favorable outcomes.
Spine cancer can recur. The duration of benefit depends on
the specific circumstances of each patient, including the type of cancer,
location of cancer, and the particular details of treatment. Urgency Surgery for spinal cancer is urgent if a patient experiences
neurological symptoms, such as numbness, weakness, inability to walk,
persistent urinary incontinence or retention (unable
to empty bladder or sense bladder fullness),
loss of bowel control, loss of sexual function, partial or complete paralysis.
Surgery is also urgent if a patient’s spinal tumor is so
large that a spinal fracture has occurred or is imminent.
Patients should consider surgery if their quality of life is
impacted by the cancer. This may occur when patients have trouble sitting,
standing, and walking due to back or neck pain from spinal cancer.
Without paralysis, spinal fracture, or intolerable pain,
spinal cancer surgery is not urgent and can be delayed until the patient can
best tolerate the procedure. The optimal timing of surgery should be determined
by the patient in collaboration with his or her physician. The decision should
take into consideration the patient’s health, cancer treatment status, such as
blood counts, and his or her personal life. Risks Spinal surgery for cancer tumors is very complex and the
risk of complication is higher than many other surgeries.
The rare but most serious possible risks include:
- Paralysis—either partial or complete
- Stroke
- Blindness
- Heart attack
The most common possible risks include:
- Wound
infection
- Recurrent
tumor
Other possible risks include:
- Dislodgement
of fixation devices
- Bone
healing difficulties
- Broken
rods
Managing risk If risks occur following spinal cancer surgery, treatment is
usually provided immediately. At major medical centers, the resources are
readily available to address any major complication immediately. The
availability of a dedicated multidisciplinary team and the necessary ancillary
services are essential to ensure the patient’s condition is closely monitored
before, during and after surgery. And to
assist in the management of any adverse occurrences while ensuring the
patient’s health and safety.Surgery for Spine tumors; neoplasms of the spine; spine cancer; pathological fractions of the spine at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 (outside the Seattle area: 800-440-3280) to make an appointment.
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