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There are various types of treatments available for the spinal tumour. This mostly depends on aspects such as the extent and the location of the disease. Find out more below about spinal tumours and when spinal tumour surgery is considered.

Introduction to Spinal Tumours

Spinal tumours cover only a small percentage of reason why patients experience back pain and other related symptoms occurring in the spine. The majority of the tumours that originate from the spinal cord include metastases of visceral organ cancers. These are most commonly seen in elder patients. In young patients, usually, tumour-like lesions of the musculoskeletal system and some benign tumours are seen. These often compromise the spinal canal and cause instability.

 

spinal tumour
Picture Credit: Spine Universe

Spinal tumours are generally studied under two headings.

Primary Tumours

Primary tumours initiate from the spinal cord itself and its nearby structures. Primary tumours of the spine are rare and most of these lesions are asymptomatic. 

Following are some of the types of primary benign tumours of the spine:

  • Aneurysmal Bone Cyst (ABC)
  • Hemangioma
  • Giant Cell Tumour (GCT)
  • Osteoblastoma
  • Osteoid Osteoma

Primary malignant tumours of the spine include the following:

  • Chondrosarcoma
  • Chordoma
  • Osteosarcoma
  • Lymphoma
  • Plasmacytoma
  • Multiple Myeloma
  • Ewing’s Sarcoma

Metastatic or Secondary Tumours

These are tumours of distant organs that spread through the lymphatic system and blood circulation to the spine.

Treatment options

There are various types of treatments available for the spinal tumour. This mostly depends on aspects such as the extent and the location of the disease. The most common treatments for spinal tumour removal surgery are detailed below:

Chemotherapy

Chemotherapy drugs are administered into the vein or orally in the form of a pill. For some specific spinal tumours, these chemotherapy drugs are directly given into the cerebrospinal fluid.

Radiation therapy

Spinal tumour radiation therapy is a common technique used post-surgical resection of a tumour. This treatment terminates any microscopic tumour cells left behind.

Spinal tumour surgery

Surgery is performed to destroy a spine tumour that is confined to only one area of the spinal cord. In the case of metastatic spinal tumours, at a minimum, surgery is required just to relieve the symptoms.

Interventional radiology

Interventional radiology commonly focuses on performing procedures to treat pain and related complications. It may include performing biopsies, and tries to lessen a various symptom that may occur during the tumour treatment. 

Targeted therapy

Targeted therapy is usually combined with other spinal tumour treatments, similar to chemotherapy.

What are the advantages of spinal tumour surgery?

The main advantage of surgery is the possibility of eliminating or significantly reducing the volume of spinal tumours. This can help the patient live a long life. 

Sometimes, with the help of a minimum surgery, many symptoms can be relieved. 

What are the risks with spinal tumour surgery? 

Following are some of the risks related to surgery for treating spinal tumours:

  • Anaesthesia risks
  • Bleeding
  • Infection
  • Blood clots
  • Persistent pain
  • Paralysis
  • Spinal cord injury
  • Sexual dysfunction
  • Dural tear
  • Spinal instability
  • Pseudoarthrosis

How to prepare for the surgery?

The doctor will discuss the procedure in detail with the patient and advise them to:

  • Quit smoking and alcohol intake as it delays the process of healing after a surgical procedure
  • Perform exercises to fasten the recovery rate
  • Stop consuming any non-essential medications and herbal remedies. These may react with anaesthetics or other medications during the surgery
  • Inform the doctor about any past surgeries and medical problems in the past or present

What happens during the surgery?

Depending on the location and type of tumour, surgery may include the following steps: 

  • En bloc resection is usually given for primary or non-metastatic spinal tumours that may be required to be removed completely. The treatment is mainly palliative in patients with metastatic tumours. This means it is intended to preserve neurological function, alleviate pain, and stabilise the spine.
  • Surgical resection may require preoperative embolisation to allow an easier resection. In this procedure, a catheter is inserted through an artery in the groin. The catheter is guided up to the tumour site, where it renders a glue-like liquid embolic agent that blocks the vessels that feed the spinal tumour. Once these blood vessels are blocked, bleeding can often be controlled during surgery. This decreases the chances of developing surgical complications.
  • The back surgical approach enables the dura identification and nerve roots exposure. This approach is used for tumours at the back of the spinal column or to expose tumours inside the dura matter. The anterior surgical approach is excellent for tumours that are resent in the front of the spine. It also enables the reconstruction of defects caused by the removal of the vertebral parts, and placement of short-segment fixation devices. Thoracic and lumbar spinal tumours that affect both the front and back vertebral columns can be a challenge to resect completely.

What happens after surgery? 

Post-surgery treatment of spine cancer usually includes chemotherapy and/or radiation therapy. Pain-killers are mostly prescribed to control pain.

Outlook

The outcome of the spinal tumour surgery depends significantly on the overall health and age of the patient. It is also dependent on whether the spinal tumour is malignant or benign, metastatic or primary. 

In adults, major complications are reported in up to 14% of the surgeries for various spinal tumour types. Such common complications include systemic infections, surgical site infection, and deep venous thrombosis. 

Frequently asked questions

What are the common primaries which spread to the spine?

The common primaries to result in spinal metastases are breast, lung, and prostate carcinomas in adults and Ewing sarcoma, leukaemia, rhabdomyosarcoma, and neuroblastoma in children. In patients detected with cancer, spinal metastases is found in 10% and bone metastases in 40% patients.

Which areas of the spine are most commonly affected?

Following are some of the tissues and areas that may develop cancer and tumours in the spine:

  • Cartilage that protects the joints in the vertebrae
  • Bones that form the spinal vertebrae, including the bone marrow inside them
  • Spinal discs that cushion the space between the vertebrae
  • Peripheral nerves that exit the vertebrae
  • Blood vessels that supply nutrients to the spine
  • Dura mater, pia mater and arachnoid mater — three layers of membranes that encase the spinal cord
  • Spinal cord

What are the common symptoms?

Following are some of the common symptoms:

  • Neck pain and back pain
  • Neurologic problems related to spine tumours include:
    • Myelopathy (spinal cord compression)
    • Numbness, tingling and muscle weakness
    • Radiculopathy (pinching of the nerve roots)
    • Bowel and bladder issues due to compression of the nerves that provide sensation and function to these organs
    • Difficulty walking
    • Paralysis

What are the main reasons to do surgery in spine tumours?

Spine surgery may be advised to remove a malignant or a benign tumour, relieve its symptoms or reduce its size. When and why spine surgery is performed depends on some of the following factors:

  • Tumour size and its location
  • Type of spinal tumour; benign, malignant
  • Stage
  • Neurologic deficit such as spinal cord or nerve compression
  • Bowel or bladder dysfunction
  • Unrelenting pain unresponsive to non-surgical therapies
  • Spinal instability, vertebral fracture, or destruction of vertebral bone

What are the types of spine surgery for tumours ?

Following are the types of spine surgeries, performed for tumours:

  • Decompression
  • Embolotherapy
  • Vertebroplasty or Kyphoplasty
  • Spinal Stabilisation
  • Radiosurgery (CyberKnife)

Radiosurgery (CyberKnife), Embolotherapy, and Vertebroplasty or Kyphoplasty are minimally invasive techniques

Spinal stabilisation and decompression may be done using an open approach or as a minimally invasive procedure.

Will having spine surgery improve the pain?

Pain that occurs from spinal tumours is due to instability or nerve compression. This does tend to improve with surgery.