In general, extensive surgical procedures (open surgery) are often avoided in patients with metastatic spinal tumors. Patients with metastatic cancer are susceptible to systemic complications, and studies have not proven that survival is extended reliably with aggressive treatment of spinal metastases.1
As a general rule, open surgical procedures for the treatment of metastatic spine tumors are primarily performed on patients who meet the following criteria:
- A life expectancy of more than 6 months
- Only one tumor
- Neurological deficits (such as weakness, loss of muscle control) and/or significant spinal instability
For purposes of this article, open surgery is characterized as a spine surgery with an incision larger than a 1/2 inch long (and may be several inches long).
Patients with slow-growing metastatic spinal tumors, such as those resulting from breast or thyroid primary cancers, and those with only one spinal tumor are potential candidates for removal with a curative goal.
It is likely that stabilization of the vertebra is necessary after removal of the tumor, which can be done at the same time (as part of the same surgery) as the tumor removal.
Spinal Stabilization Surgery
The goal of treatment is to stabilize the spine and to reduce any deformity that may have developed. Surgeons will choose the best stabilization method based upon tumor type, extent of bone destruction, general patient condition, and anticipated cancer treatments. There are various surgical approaches as well as stabilization methods available. While the goal of surgery is fusion, treatments for the cancer, like chemo therapy, may interfere with the bone healing required to create a fusion. Stability in cases where fusion does not occur relies on solid mechanical fixation from implants such as titanium screws, plates, rods and cages.
In This Article:
Spinal Decompression Surgery
Operative methods to relieve pressure placed on the spinal cord are classified as follows:
- Corpectomy - removal of the body of a vertebra and the discs
- Laminectomy - removal of a small part of the bony arches of the spinal canal called the lamina
- Costotransversectomy - removal of a part of a rib along with the transverse process of a vertebra
The most suitable method of decompression is selected based on a number of considerations, including the anatomical location of the tumor and general condition of the patient.
In general, surgical treatment is customized to the patient's overall health condition, the type and stage of cancer, as well as the location, size and type of spinal tumor(s). Open surgery is relatively rare but can be helpful in certain cases.