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Spinal Tumors Surgery

Spinal Tumors are uncontrolled tissue growth located in either the vertebral column or the spinal cord. The Spinal Tumors classified on basis of their location:

1. Intradural: When a tumor lies inside the dural lining. 

  • Intradural-extramedullary: When tumor lies inside the dural lining but outside the spinal cord tissue e.g Nerve sheath tumors, Meningiomas.

  • Intradural-intramedullary: Tumors are located within the dura and spinal cord parenchyma e.g Ependymomas and Astrocytomas.

2. Extradural: Tumors are located outside the dural lining e.g. metastasis or primary bone tumors.

Metastatic spine tumors comprise the most common group of spine tumors and they commonly spread from breast, prostate, lung, and kidney cancer.

What is Spinal Tumor Surgery?

Surgery is done to remove tumors in the spinal region. The most common tumor encounter is metastasis and it causes vertebral bone damage or spinal cord or nerve compression. The aim of surgery in such cases is to decompress the spinal cord adequately so that neurology recovers and to provide strength to the spine column by inserting pedicle screws and rods. At the same time specimen can be sent for histopathological and immunohistochemistry markers study, which help in identifying the primary source of the tumor and to start the chemotherapy or radiotherapy accordingly. 

Possible Surgical Procedures Of Spinal Tumors:

Depending on the type and location of the spinal tumor, possible surgical procedures to remove part of, or the entire tumor include:

  • Metastatic Spine Tumour Surgery: A metastatic spine tumor — which can begin anywhere in the body and then spread to the spine, which is removed using surgical procedures such as:

    • Spinal Decompression: Spinal decompression is a surgical procedure that involves the removal of a part of the tumor (resection), or the entire tumor (excise) to decompress or relieve the pressure of the tumor on the spinal cord and nerve roots. The procedure also creates enough space for high-dose radiation treatment without causing injury to the spinal cord. The procedure reduces pain in the neck and shoulder and restores neurological functions.

    • Spinal instrumentation or spinal implants: Specially designed screws and rods are attached to the spine to restore spinal stability and alignment. This technique is used depending on the severity of the spinal cord compression.

    • Kyphoplasty and Vertebroplasty: When a spinal tumor causes spinal compression or fracture, a spinal decompression procedure is performed along with kyphoplasty or vertebroplasty procedures. Both are minimally invasive procedures that are performed to restore spinal stability. Kyphoplasty uses a balloon to create space between the bones and a mixture of cement is injected to stabilize the spine. Vertebroplasty uses radio-frequency ablation to remove the tumor and space is then filled with a mixture of bone cement. 

  • En bloc Resection: The entire larger primary tumors located in the spine or next to the spine are removed in a single piece. Usually treatment of choice for primary malignant bone tumor.

  • Spinal Embolization: In case the spinal tumor has a high number of blood cells, the blood flow to the tumor is blocked using imaging techniques prior to surgery to prevent loss of blood. This causes the tumor to shrink. Firstly, a diagnostic technique called spinal angiography is performed to get an accurate picture of the blood vessels in the spine by injecting a contrast dye and blood vessels are identified using an X-ray.

  • Radiosurgery (CyberKnife): Spinal tumors are treated using targeted radiation and the tumor disappears with time.

Advantages of the procedure:

  • Removes tumors.

  • Relief from neck/back pain and swelling.

  • The neurological function can be restored or preserved.

  • Improves mobility and muscle strength.

Factors on which surgery for spinal tumors depends.

Surgery for the spinal tumor is recommended based on a variety of factors such as:

  • Type, size, and stage of the tumor.

  • To remove a benign or malignant tumor.

  • To reduce the size of the tumor.

  • To relieve persistent neck or back pain.

  • To correct problems like difficulty in maintaining balance, difficulty walking, dysfunction of the bowel or bladder, etc.

  • To correct the neurologic deficits including compression of the spinal cord or nerve.

  • To stabilize the spine.

  • To treat spinal fractures.

  • To improve spinal functioning and quality of life.

Recovery:

After surgical removal of the tumor, most patients are given rehabilitation therapy to speed up the recovery and get back to everyday activities. In case the tumor is cancerous or malignant, additional treatment such as radiation or chemotherapy is also given as part of the continued care.

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