Surgery aimed at relieving nerve compression and preserving spinal stability in benign, malignant, or metastatic tumors arising from the spinal cord, spinal cord coverings, or vertebral bone.
Indication
- Intramedullary (within the spinal cord) and intradural-extramedullary (arising from the spinal cord coverings) tumors (ependymoma, schwannoma, meningioma)
- Primary tumors arising from the vertebral bone
- Spinal metastases from lung, breast, prostate, or kidney cancer
- Spinal cord or nerve root compression due to tumor (weakness, sensory loss, sphincter dysfunction)
- Spinal instability or pathological fracture due to tumor
- Treatment-resistant, intractable spinal pain
Preparation
- Whole-spine MRI (with contrast), and CT and PET-CT imaging when needed
- Multidisciplinary tumor board evaluation (neurosurgery, oncology, radiation oncology)
- Anesthesia consultation, blood tests, and arrangement of blood reserves
- Adjustment of blood-thinning medications with physician approval
- Smoking cessation and optimization of nutritional status
How it's performed
- The patient is placed in the prone or lateral position; blood pressure, heart rhythm, and oxygen levels are monitored
- General anesthesia is administered; neuromonitoring (motor and sensory nerve tracking) is used when needed
- The lesion location is precisely confirmed with neuronavigation, fluoroscopy, or intraoperative CT
- Using the surgical microscope and microsurgical techniques, the tumor is separated from surrounding tissues and removed
- If spinal stability is compromised, stabilization is achieved with pedicle screws, cages, or bone grafts
- After surgery, dural and skin layers are carefully closed to prevent CSF leak
Post-procedure
- 24-48 hours of monitoring in intensive care; neurological examination is repeated regularly
- An early postoperative MRI and X-ray are obtained
- Hospital stay averages 5-14 days; this varies according to tumor type and overall condition
- Radiotherapy, chemotherapy, or targeted therapy may be planned based on the pathology result
- Physical therapy and rehabilitation program; regular MRI and clinical follow-up
Risks
- Spinal cord or nerve root injury (temporary/permanent weakness, sensory loss, sphincter dysfunction)
- Cerebrospinal fluid leak and meningitis
- Bleeding, hematoma, and need for transfusion
- Wound infection, deep infection, and instrumentation-related complications
- Inability to remove the entire tumor and recurrence (residual/relapse)
FAQ
Is a spinal tumor always cancer?
No. Many spinal tumors, such as schwannomas and meningiomas, are benign and usually do not require additional treatment after surgery. In malignant or metastatic tumors, radiotherapy and systemic therapy are planned alongside surgery.
Will I be able to walk after surgery?
The outcome depends on the tumor's location, size, the preoperative neurological status, and the duration of spinal cord compression. Functional recovery is more likely with early diagnosis and intervention. No definite success rate can be guaranteed.
Are the screws and cages removed from the body?
The titanium implants placed are usually permanent; they are not removed unless they cause a problem. They do not interfere with MRI scans or airport detectors.
How much benefit does surgery provide for metastatic tumors?
In metastatic spinal tumors, the goal of surgery is not to eradicate the tumor entirely but to reduce pain, relieve nerve compression, and preserve spinal stability. Maintaining quality of life and independent mobility are important gains.
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