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Depending
on the type of tumor, where it’s
located, and the patient’s
medical condition, treatments may
include chemotherapy, radiation
therapy and/or surgical
removal of the tumor. However,
surgical removal is not always possible
if the tumor is located in an area
of the spine that is difficult to
reach. Sometimes, embolization is
necessary as in the cases of aneurismal
bone cysts, kidney cancer and multiple
myeloma. This is a procedure that
limits blood flow to the tumor.
Other times, a combination of treatments
is used to ensure that cancer does
not spread to other areas of the
body. Keep in mind, there is no
evidence to show that any of these
therapies improve the prognosis
or change survival rates.
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Whether
benign or malignant, a spinal tumor
is a very serious medical condition.
However, if diagnosed early, patients
with spinal tumors have a better
chance of a full recovery. Patients
who are experiencing any of the
symptoms listed in this article
should seek medical help right away.
Spinal
Tumors: Surgery and Recovery
Surgery
Some spinal tumors,
benign or malignant, require surgical
intervention before or after non-operative
treatments. When pain is unresponsive
to non-operative treatment, neurologic
deficit progresses, a specimen is needed,
neural elements (e.g. nerves) are compressed,
vertebral destruction exists, or when
spinal stabilization is necessary - surgery
is considered. The
primary goals in surgery are to reduce
pain caused by the spinal tumor, restore
or preserve neurologic function, and provide
spinal stability. The spinal tumor may
be approached surgically from the front
(anterior) or back (posterior) of the
body. Surgery
may include tumor resection (partial removal)
or excision (complete removal). When the
tumor is removed (partially or completed)
pain and neurologic problems may clear
up.
Spinal instrumentation
and Fusion are procedures used to reconstruct
and stabilize the spine. These procedures
join and solidify the level (or levels)
where a spinal element (e.g. vertebral
body) has been damaged or removed. Instrumentation
uses medically designed hardware such
as rods, bars, wires, and screws. These
devices hold the spine straight during
fusion. Fusion is the adhesive process
joining bony spinal elements.The
number of days spent the patient will
spend in the hospital after surgery is
partially dependent on the procedure(s)
performed. Thereafter, the patient's care
is monitored by periodical office visits
and re-evaluation by the treating physician.
Recovery
The patient's
care is monitored by periodical office
visits and re-evaluation by the treating
physician. This is important because some
tumors, benign or malignant, may reoccur.
Treatment may include radiation and/or
chemotherapy. The side effects from radiation
can be severe including reddened or painful
skin at the treatment site, nausea, vomiting,
loss of appetite, and fatigue. Chemotherapy
can cause similar side effects. However,
many of these side effects can be treated
with drugs.
Usually when the
treatment period has ended, the symptoms
clear up. Analgesics are given to control
post-operative pain and cancer pain. Cancer
pain may be difficult to control (e.g.
'break through pain'). A pain management
specialist may provide assistance if conventional
drugs (e.g. pill, skin patch) do not provide
relief.
Any surgery, radiation
treatment, or chemotherapy can drain the
patient nutritionally. Therefore, a proper
diet is important to regain strength,
lost weight, and a measure of health.
A professional nutritionist can provide
guidance. Depending
on the extent of the surgery and the patient's
medical status, a course of physical therapy
may be prescribed. Through exercise and
modalities the patient can build strength,
endurance, and flexibility.
Spinal
Tumors: Diagnosis and Non-Surgical Treatment
Diagnosis
The patient's medical status is evaluated
with particular attention given to back
pain and neurologic deficit. Although
back pain is often the primary symptom,
some patients present with paraparesis
(slight paralysis), spinal deformity (e.g.
scoliosis, kyphosis), and malaise. Plain
radiographs (x-rays) may demonstrate the
presence of a spinal tumor. A CT Scan
and/or MRI can provide further tumor detail
including neural elements (e.g. spinal
canal).
An
angiogram demonstrates the vascularity
of the tumor (e.g. blood supply). Further,
a biopsy of the tumor is necessary to
establish the diagnosis (e.g. tumor type,
benign or malignant).
Staging
classifies neoplasms (abnormal tissue)
according to the extent of the tumor including
bony and soft tissue involvement, and
spinal canal intrusion. A whole body Technetium-99
bone scan is required and may include
a chest x-ray, and CT scan of the lungs
and abdomen. The
above findings and results from laboratory
tests (e.g. complete blood count, urinalysis)
are compared to the patient's symptoms
to confirm the diagnosis.
Treatment
A coordinated
multidisciplinary approach is used to
treat spinal tumors. The expertise of
a neuroradiologist, pathologist, angiographer,
oncologist, and spinal surgeon may be
combined during the patient's treatment.
The type of tumor, neurologic deficit,
spinal deformity (e.g. scoliosis), bony
involvement, prior treatment, patient's
medical status, pain, and life expectancy
are considered prior to treatment.
Aggressive tumors
may require surgical resection (partial
removal) or excision (complete removal).
Others require non-surgical treatment
that may include bracing, radiation, chemotherapy,
or embolization. Some tumors require both
surgery and non-operative treatment. Analgesics
are given for pain.
If pain is difficult
to manage, a pain management specialist
may be consulted. Steroids may be prescribed
to reduce edema (swelling) that can occur
around tumors. Bracing may be used to
control pain and provide spinal stability.
Radiation and/or chemotherapy may shrink
tumors. The dose and frequency of radiotherapy
(e.g. radiation) is carefully calculated
to destroy cancer cells while preserving
healthy cells. Chemotherapy drugs can
be administered orally or intravenously.
Surgery may be
indicated when:
