Spinal Tumour Surgery

A tumour affecting the spine can threaten both the structure of the spine and the spinal cord and nerves it protects. Spinal tumours fall into two broad groups: primary tumours, which arise in the spine itself, and metastatic tumours, which have spread to the spine from a cancer elsewhere in the body. Metastatic tumours are by far the more common. Surgery is one part of a wider plan, and the right approach depends heavily on the type of tumour and the patient’s overall condition.

What it is

Spinal tumour surgery addresses growths affecting the vertebrae, the spinal cord, or surrounding tissues. It has three broad aims, used in combination as required:

• Decompression — removing tumour that is pressing on the spinal cord or nerves to relieve pressure and protect function
• Stabilisation — holding the spine securely with screws and rods where the tumour or its removal has made the spine unstable
• Reconstruction — rebuilding bone that has been destroyed or surgically removed

Which of these are needed, and how extensively, depends on the tumour type, its location, the patient’s general health, and the goals of treatment.

Who is a candidate? (Indications)

Surgery is considered, as part of a wider plan, for patients with:

• Compression of the spinal cord or nerves causing pain, weakness, numbness, or loss of function
• Instability of the spine caused by tumour destroying bone
• A tumour requiring tissue diagnosis where less invasive sampling is not sufficient
• Certain primary tumours where removal is part of the treatment plan
• Severe pain from a tumour not controlled by other means

The decision is made together with the wider cancer team, balancing the potential benefit against the patient’s overall condition and prognosis.

How it is performed

Surgery is planned in detail with the multidisciplinary team and detailed imaging. In broad terms:

1. Imaging defines the tumour, its relationship to the cord and nerves, and the stability of the spine.
2. The spine is approached so the surgeon can reach the tumour and the structures at risk.
3. Tumour pressing on the cord or nerves is removed to decompress them, where indicated.
4. The spine is stabilised with screws and rods where it has been weakened.
5. Where bone has been destroyed or removed, the spine is reconstructed to restore support.

Nerve and spinal-cord monitoring is used to help protect neurological function, and navigation may assist with accurate implant placement and reconstruction in altered anatomy.

Benefits and risks

The benefits of surgery can include relief of pressure on the spinal cord and nerves, preservation or improvement of function, a stable spine, and better pain control. Against these must be weighed the risks of major surgery: injury to the cord or nerves, bleeding, infection, problems with implants or reconstruction, wound-healing difficulties, and the possibility of further surgery. Prior radiotherapy or systemic treatment, and the patient’s overall condition, can affect both the risks and what surgery can realistically achieve. These are discussed openly and individually.

Alternatives

Surgery is rarely the only treatment. Depending on the tumour, alternatives and complements include radiotherapy, systemic cancer treatments, less invasive procedures to obtain a diagnosis or relieve pain, bracing, and supportive care focused on comfort and function. For many patients, the best plan combines several of these, coordinated by the multidisciplinary team.

Dr. Garg’s approach & experience

Dr. Garg is Principal Director & Head, Orthopaedics & Spine at Max Hospital, Delhi, and a former Professor at AIIMS New Delhi, with more than 325 peer-reviewed publications. His work in complex spinal reconstruction and in navigated spine surgery is relevant to the demanding stabilisation and reconstruction that spinal tumour surgery can require. Treatment of spinal tumours is multidisciplinary, with surgery coordinated alongside oncology, radiation oncology, radiology, and pathology.

When to seek a specialist opinion

A specialist assessment is appropriate for persistent, unexplained back pain — particularly pain that is worse at night or at rest, or that occurs in someone with a known cancer. Urgent review is warranted for back pain accompanied by leg or arm weakness, numbness, difficulty walking, or any change in bladder or bowel control, as these may indicate pressure on the spinal cord.