Spine tumor surgery

What is it?

Spine tumor surgery addresses a wide range of neoplasms that can affect the spinal column, spinal cord, and surrounding structures. These tumors vary in their histological characteristics, which significantly influence their behavior, treatment approach, and prognosis.

Histological Classification of Spinal Tumors

  1. Primary Spinal Tumors: These originate in the spine and can be benign or malignant. Histologically, they may include:
    • Osteoid Osteomas and Osteoblastomas: Benign bone tumors that often cause pain and respond well to surgical removal.
    • Chordomas: Malignant tumors arising from notochordal remnants, commonly occurring in the sacrum and requiring aggressive surgical resection.
    • Ependymomas and Astrocytomas: Glial tumors arising within the spinal cord; ependymomas are generally more benign and resectable compared to astrocytomas.
  2. Metastatic Spinal Tumors: These cancers have spread to the spine from other body parts. Common primary sources include breast, prostate, lung, and renal cell carcinomas.

Procedure

Surgical approaches and techniques in spine tumor surgeries are diverse and complex, tailored to address the specific type and location of the tumor, as well as the overall health and condition of the patient. Here’s an overview:

  1. Surgical Planning and Preoperative Assessment:
  • Imaging Studies: MRI, CT scans, and sometimes PET scans are crucial for mapping the tumor’s location, size, extent, and its relationship to critical structures like the spinal cord and nerve roots.
  • Biopsy: A biopsy may be conducted before major surgery to determine the tumor’s histological type, which guides the treatment plan.
  1. Approaches Based on Tumor Location:
  • Anterior Approach (Front): Used for tumors located at the front of the spine. It provides direct access to vertebral bodies and discs in the cervical and thoracic regions. In the lumbar spine, this approach may involve a retroperitoneal (behind the abdominal cavity) path.
  • Posterior Approach (Back): Common for tumors on the backside of the spine or within the spinal canal. It’s often used for decompression procedures and for stabilizing the spine post-tumor resection.
  • Lateral Approach (Side): Employed for tumors on the side of the spine, this approach can minimize the disruption to major structures and is helpful in thoracic and lumbar spine surgeries.
  1. Tumor Resection Techniques:
  • Intramedullary Tumors: Located within the spinal cord, these require delicate microsurgical techniques to minimize damage to the spinal tissue.
  • Extramedullary Tumors: Situated outside the spinal cord but within the spinal canal, these are often more accessible and can be removed with fewer risks to the spinal cord.
  • Vertebral Body Tumors: May require vertebrectomy (removal of a vertebral body) followed by reconstruction using bone grafts and spinal instrumentation.
  1. Decompression and Stabilization:
  • Laminectomy: Removal of the lamina to access the spinal canal and relieve pressure on the spinal cord or nerves.
  • Foraminotomy: Enlarging the nerve root exit spaces to relieve nerve compression.
  • Spinal Fusion: Post-resection, the stability of the spine is often restored through fusion techniques using bone grafts and hardware like rods and screws.
  1. Minimally Invasive and Advanced Techniques:
  • Minimally Invasive Surgery (MIS): For select tumors, MIS techniques involve smaller incisions, less muscle disruption, and typically result in faster recovery. Endoscopic surgeries fall into this category.
  • Intraoperative Navigation and Imaging: Real-time imaging and navigation systems enhance surgical precision, especially in complex cases or reoperations.
  • Neuromonitoring: Continuous monitoring of spinal cord and nerve function during surgery to prevent neurological damage.
  1. Special Considerations for Metastatic Tumors:
  • En Bloc Resection: In some cases of solitary metastases, removing the entire tumor in one piece may be attempted for a better oncological outcome.
  • Palliative Surgery: In cases of widespread metastatic disease, the focus may be on relieving pain, stabilizing the spine, or addressing neurological symptoms rather than complete tumor removal.

 

Challenges in Spine Tumor Surgery

    • Varied Histological Behavior: The diverse histological behavior of spinal tumors presents unique challenges in surgical management, necessitating tailored strategies for each tumor type.
    • Neurological Preservation: The critical challenge remains to achieve maximal safe resection while preserving spinal cord and nerve function, which is critical due to the proximity of these tumors to critical neurological structures.