Spinal Tumors

Surgical treatment for spinal tumors navigates a complex, evolving frontier, uniting modern technology and medical expertise for innovative therapies. Spinal tumors, whether benign or malignant, pose significant challenges in their diagnosis and management.

In this context, surgical interventions often become the key to providing patients with not only symptomatic relief, but also improved quality of life prospects. In this regard, the detailed exploration of surgical methods, advanced technologies and advances in the treatment of spinal tumors brings to the fore a vital insight into this branch of neurological surgery.

 

CONTENT:

1. Types of Spinal Tumors
2. Indications for Surgical Treatment of Spinal Tumors
3. Common Surgical Procedures
4. Advanced Technologies and Minimally Invasive Approaches
5. Potential Complications and Postoperative Management

 

Types of Spinal Tumors

In the complex world of spinal tumors, the diversity of these conditions requires a thorough understanding before considering surgical options. These tumors can be classified into various categories, each with distinct characteristics and implications for their management.

• Meningiomas

Meningiomas are a category of tumors that develop from the membranes that cover the brain and spinal cord. They can vary in size and degree of malignancy, and the surgical approach depends on their location and extent.

• Neuronomas

Neurinomas, also known as schwannomas, are tumors that develop around nerves and can affect the spinal cord. The surgical approach focuses on preserving the nerves and minimizing the risks to their functionality.

• Cancer Metastases

Metastatic spinal tumors come from cancer that has spread from other areas of the body. They can affect the vertebrae and spinal cord, often requiring an integrated approach, including surgery to relieve pressure and adjuvant therapies to manage the primary cancer.

• Glioblastomas

Glioblastomas are aggressive brain tumors that, in some cases, can spread to the spinal cord. Surgery may be needed to remove or shrink the tumor mass, although treatment often also includes radiation therapy and chemotherapy.

Each type of spinal tumor presents unique challenges, and the treatment plan must be tailored to the specifics of each case. Before approaching surgical treatment, a detailed assessment of the type of tumor, its stage and the impact on the patient is essential to ensure an effective and personalized approach.

Indications for Surgical Treatment of Spinal Tumors

The decision to resort to surgical treatment for a spinal tumor is a complex process, influenced by a number of factors that must be carefully evaluated. These essential factors determine the nature and extent of surgery, adapting to the specific needs of each patient.

1. Tumor size

The size of the tumor is an important criterion in determining the need for surgery. Large tumors can exert significant pressure on adjacent structures, causing symptoms and affecting quality of life. In these cases, the surgical approach may be essential to reduce the tumor mass and restore the normal function of the spine.

2. Tumor location

The location of the tumor is another determining factor in the decision to opt for surgical treatment. Tumors located near the spinal cord or nerves can create severe complications, which is why surgery may be considered to minimize risks and preserve nerve functionality.

3. Degree of Malignancy

The degree of malignancy of the tumor is crucial in defining the treatment strategy. Malignant tumors, which have an increased potential for spread and recurrence, may require a more aggressive surgical approach, often associated with complementary therapies such as radiotherapy or chemotherapy.

4. Symptoms Presented by the Patient

The symptoms experienced by the patient play a central role in making the decision for surgical treatment. Persistent pain, weakness, difficulty moving, or changes in pelvic organ function may indicate the need for surgery to relieve or prevent progression of symptoms and improve the patient’s quality of life.

By carefully evaluating these factors, the medical team can create a personalized treatment plan, adapted to the specifics of each case. The decision to choose surgical treatment for a spinal tumor reflects a balance between effectively removing the tumor and minimizing the impact on spinal and nervous system functionality.

 

Common Surgical Procedures

1. Tumor Resection:

Tumor resection is one of the fundamental surgical interventions in the treatment of benign spinal tumors. This procedure aims at the complete excision of the tumor mass, thus eliminating any risk of recurrence and restoring the integrity of the affected tissues. Usually performed for tumors with benign features, tumor resection aims to preserve the health of the spine and the functionality of the spinal cord.

2. Spinal Cord Decompression:

Tumors that grow near the spinal cord can put pressure on it, causing symptoms such as pain, weakness, or difficulty moving. The spinal cord decompression procedure involves removing or reducing the pressure exerted by the tumor on the nerve structures. This intervention not only relieves symptoms, but also prevents further damage to the spinal cord, thus contributing to improving the patient’s quality of life.

3. Stabilization and Reconstruction:

In situations where the tumors are malignant or affect the bony structures of the spine, surgical procedures for stabilization and reconstruction become the imperative of treatment. These interventions have the role of strengthening the spine, preventing instability and subsequent deformations. Reconstruction also focuses on restoring the integrity of the affected bones and neighboring structures, thus maintaining the stability of the spine and its functionality.

Advanced Technologies and Minimally Invasive Approaches

A significant evolution in the field of spinal tumor surgery has been represented by advanced technologies and minimally invasive approaches. Advanced imaging such as magnetic resonance imaging (MRI) and computed tomography (CT) provides surgeons with detailed information for precise intervention planning.

Minimally invasive approaches such as laser surgery and endoscopic techniques have the advantage of reducing tissue trauma and postoperative recovery time. These methods allow, in many cases, to perform the surgical intervention with smaller incisions, without compromising the quality of the treatment.

 

Potential Complications and Postoperative Management

Regardless of the nature of the surgery, the treatment of spinal tumors comes with risks and potential complications that require a careful and anticipatory approach. These complications include:

• Bleeding

Excessive bleeding during or after surgery can be a serious complication, requiring immediate management to prevent further complications.

• Infections

Postoperative infections are a risk given the opening of tissues and exposure to potentially contaminating environments. Correct administration of antibiotics and close monitoring are essential in preventing and treating infections.

• Nerve Damage

Surgery near nerves may cause damage. They can cause temporary or permanent loss of nerve functionality, affecting the patient’s quality of life.

• Affecting the Functionality of the Spinal Cord

Especially with spinal cord-adjacent tumors, there’s a risk of post-surgery functional impact. Moreover, careful control of this aspect is crucial to avoid severe complications.

• Postoperative Management

After surgery, postoperative management plays a vital role in ensuring an optimal recovery for the patient. It involves:

1. Physiotherapy

The personalized physiotherapy program helps to restore muscle strength, mobility and functionality. Exercises are tailored to minimize the risk of complications and support spinal recovery.

2. Occupational Therapy

Occupational therapy focuses on restoring independence and the ability to perform daily activities. This improves the patient’s quality of life and contributes to reintegration into society.

3. Adjuvant Therapy

In some cases, adjuvant therapies such as radiotherapy or chemotherapy may be necessary to complete the treatment and prevent relapses.

However, medical teams aim to optimize patient recovery and support a return to an active, healthy life through meticulous complication management and thorough postoperative care.

A spinal tumor is a mass of abnormal tissue that develops in the spine, either in the spinal cord (spinal cord tumors) or in the vertebrae (vertebral tumor or extradural tumor). The cells that make up the tumor are abnormal cells, which grow outside the usual mechanisms of cell growth control. Spinal tumors can cause pain, neurological problems and sometimes paralysis.

A spinal tumor can be life-threatening and can cause permanent disability. Treatment of spinal tumors may include surgery, radiation therapy, chemotherapy and other medications, most often combinations of these. Evidence indicates surgical resection of spinal cord tumors as the gold standard in the treatment of these conditions, chemotherapy and radiation being used for tumors with a high degree of infiltration into neighboring tissues or for recurrent tumors.

They can be malignant tumors (cancerous) or benign tumors (non-cancerous) that can develop in the spinal cord or surrounding areas. A malignant spinal tumor contains cancer cells, grows rapidly, invades nearby healthy tissues and can be life-threatening.

A benign tumor does not contain cancer cells, rarely invades nearby tissues or spreads to other parts of the body and usually does not grow again after it is removed. However, even if some such tumors are not cancerous, they can compress the spinal cord or nerve roots and cause symptoms. Some common benign spinal tumors are osteoma, osteoblastoma, hemangioma, neurofibroma, and osteochondroma. Fortunately, spinal tumors are relatively rare.

 

CONTENT:

1. Causes of Spinal Tumors
2. Symptoms of Spinal Tumors
3. Treatment of Spinal Tumors

 

Causes

The exact cause of spinal tumors is unknown. It is suspected that certain defective genes are involved, but it is not known whether such genetic defects are inherited or simply develop over time. These could be caused by environmental factors, such as exposure to certain chemicals.

However, in some cases, spinal tumors are linked to known inherited syndromes, such as neurofibromatosis 2 and von Hippel-Lindau disease.

 

Symptoms

Because spinal tumors can affect the spinal cord or nerve roots, blood vessels, or vertebrae, the symptoms are different and occur especially as the tumors grow. Possible signs and symptoms include:

• Pain at the site of the tumor due to its growth
• Back pain, which often radiates to other parts of the body
• Lack of sensitivity to pain, heat or cold
• Fecal or urinary incontinence
• The weight of walking, which sometimes leads to falls
• Back pain that gets worse at night
• Loss of sensitivity or muscle weakness, especially in the arms or legs
• Muscle weakness, which can be moderate or severe, in different parts of the body.
• Back pain is an early symptom of spinal tumors. The pain can spread to the hips, legs, soles or arms and can worsen over time – even with treatment.

 

Spinal tumors have varying degrees of evolution, depending on the type of tumor.

Vertebral tumors can weaken bone structure, predisposing the spine to fractures due to minor trauma.

 

Treatment

The goal of treatment is to reduce or prevent nerve damage caused by pressure on the spinal cord. The faster the symptoms develop, the faster treatment is needed to prevent permanent damage.

Ideally, the goal of treatment is to completely remove the tumor, but this goal can be complicated by the risk of permanent damage to the spinal cord and surrounding nerves. Physicians must also take into account age and general health. Corticosteroids (dexamethasone) can be given to reduce inflammation and swelling around the spinal cord.

Emergency surgery may be needed to improve spinal cord compression. Some tumors can be completely removed. In other cases, only part of the tumor can be removed to relieve pressure on the spinal cord. Chemotherapy has not been shown to be effective against most primary tumors, but may be recommended in some cases, depending on the type of tumor.

The type of non-surgical treatment depends on many factors, including the type of tumor (benign or malignant), the stage of the disease, the goal of treatment (eg, pain reduction, healing), the patient’s life expectancy, and general health.

Surgery
It may be recommended to remove the tumor if it is limited to only a portion of the spine. During surgery, there may be a risk of damage to nearby nerves or the spinal cord. Surgical resection can be combined with radiation or chemotherapy to remove residual cancer cells.

Surgery to treat a spinal tumor may be warranted when a specific biopsy is needed, if the tumor causes compression of the spinal cord or nerves, if the neurological deficit progresses, the pain does not respond to non-surgical treatment, we are talking about the destruction of the vertebrae or develops spinal instability.

But even with the latest technological advances in surgery, not all tumors can be completely removed. When the tumor cannot be completely removed, surgery may be followed by radiation or chemotherapy. Recovery after surgery on the spine can take weeks or even longer, depending on the procedure. There may be a temporary loss of sensation or other complications, including bleeding and nerve tissue damage.

Radiotherapy
It is done either after surgery for spinal cancer or alternatively to treat spinal cancer that is not operable.

Chemotherapy
One or more anti-cancer drugs are given to kill the tumors. Some of the commonly used drugs are methotrexate, doxorubicin, cyclophosphamide, carboplatin, ifosfamide. These drugs are given either orally, injected intravenously or intramuscularly, or injected directly into the affected area (including injection into the cerebrospinal fluid if the tumor affects the spinal cord or spinal nerves).

Palliative therapy
Pain therapy is also called palliative treatment – the goal is to relieve pain, reduce symptoms and prevent complications. These are treatments that do not cure the disease, but rather improve the patient’s quality of life. Treatment may include anti-inflammatory drugs and various forms of treatment for pain, including morphine. Physical therapy may be prescribed to help a patient regain flexibility and muscle strength. In addition, your doctor may recommend nutritional support.