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Spinal Tumors

For patients with spinal tumors, a multidisciplinary team approach is crucial for optimal assessment and treatment. The process typically involves the following steps:

  • First, we review imaging tests such as MRI, CT scans, and PET scans which have been performed to detect and evaluate the tumor’s location, size, and extent. A biopsy may also be done to determine the tumor type, usually through a minimally invasive procedure.
  • Next, a multidisciplinary tumor board consisting of specialists from various fields such as neurosurgery, orthopedic surgery, medical oncology, radiation oncology, radiology, and palliative care convenes to review the case. This team comprehensively evaluates the imaging, biopsy results, and the patient’s overall condition to develop an individualized treatment plan.
  • If surgery is recommended, state-of-the-art techniques are employed by highly skilled neurosurgeons. These may include minimally invasive approaches, intraoperative navigation, and augmented reality to precisely locate and remove the tumor while preserving healthy tissue. We have experience using advanced surgical implants like carbon-fiber reinforced polyetheretherketone (CFR-PEEK) for spinal reconstruction. These implants aid in the postoperative monitoring of the tumor resection site since they are virtually invisible on X-ray.
  • During surgery, techniques like intraoperative neuromonitoring, endovascular embolization, and real-time imaging guidance are utilized to maximize safety and effectiveness. The extent of tumor resection depends on factors like tumor type and location, with the goal of decompressing the spinal cord and restoring stability, as well as reducing the tumor volume to the lowest possible degree. Many times, a complete resection can be carried out by performing an en bloc removal, thus, preventing spread of the tumor during surgery.
  • After surgery, you may receive additional treatments like chemotherapy, radiation therapy, or immunotherapy, based on the multidisciplinary team’s recommendations. Rehabilitation, pain management, and palliative care are also integrated into the treatment plan as well to promote a quick and holistic recovery.

Minimally Invasive Spine (MIS) Surgery:

The structures of the spinal column, including the bones, discs, and nerves are located deep within the body. Soft tissue and muscle must be navigated to reach the area of interest in the spine. Traditional open spine surgery involves cutting and retracting the soft tissue and muscle to reach the spine. This technique requires a larger incision as well as greater dissection of the muscles and associated ligaments. The traditional open approach results in greater blood loss, increased risk of infection, increased post-operative pain, and loss of muscle mass. Minimally invasive spine (MIS) surgery offers patients an alternative approach, utilizing techniques with smaller incisions and less tissue disruption to accomplish the same goal as traditional open spine surgery. The Intent Medical Group providers can perform all techniques in traditional open and minimally invasive spine surgery, allowing the surgical team to tailor any treatment plan to a patient’s specific needs and expectations. 

Description of MIS Surgery:

Specific information regarding the surgery varies based upon the type of minimally invasive surgery and the pathology being treated. With that said, there are common principles and technologies applied across most minimally invasive techniques that allow for smaller incisions and less tissue disruption. 

Fluoroscopy – Because of the small incisions and decreased tissue exposure with minimally invasive techniques, real-time imaging using x-rays (fluoroscopy) are necessary to confirm accurate retractor and instrument placement.

Intraoperative 2D/3D Navigation – 2D fluoroscopy and 3D imaging can be obtained intra-operatively. These images provide computerized navigation to improve the accuracy and safety of minimally invasive spinal surgery, especially in the placement of surgical instrumentation.

Tubular Retractor and Instruments – Tubular retractors establish a working corridor within the soft tissue and muscle to the spine. The retractor is placed within natural muscle planes to gently move the muscle to the side as opposed to cutting the muscle in traditional open spine surgery. Custom-designed instruments to drill, remove bone, dissect, place instrumentation, and suture are used to accomplish the same goals as traditional open surgery through this smaller corridor. Following completion of the surgery, the retractor is removed, allowing the muscles to return to their natural position.

Operative Microscope – A specialized operative microscope is used to illuminate the surgical field and enhance visualization for the surgeon and the operating room team. Frequently, the microscope is used in conjunction with the tubular retractor.

Types of MIS Surgery: 

  • Tubular posterior cervical foraminotomy
  • Tubular lumbar microdiscectomy
  • Tubular lumbar laminectomy and decompression
  • Percutaneous vertebroplasty/kyphoplasty
  • Percutaneous thoracic and lumbar pedicle instrumentation and fusion
  • Tubular and mini-open transforaminal lumbar interbody fusion (TLIF)
  • Lateral lumbar interbody fusion (LLIF)
  • Anterior lumbar interbody fusion (ALIF)

Benefits of MIS Surgery:

Compared to traditional spine surgery, minimally invasive techniques are associated with smaller incisions and less soft tissue disruption. These benefits translate to decreased rate of infection, decreased blood loss, less post-operative pain, and better preservation of the spinal muscle mass. Patients frequently require less pain medication compared to those who had an open procedure. The recovery following minimally invasive spine surgery is shorter, with many patients having shorter hospital stays including some patients going home the same day of surgery. 

Risks and Complications of MIS Surgery:

All surgical procedures have associated risks. The types of complications are similar between open traditional spine surgery and minimally invasive spine surgery although the incidence may differ. These complications include, but are not limited to, blood loss, infection, spinal fluid leak, nerve and spinal cord damage, pain, lack of improvement, need for future surgery, blood clots, pneumonia, and issues related to general anesthesia. Most minimally invasive spine surgeries are still performed under general anesthesia. Although possible, the overall chance of these complications occurring is relatively low. While minimally invasive spine surgery is safe and effective, there is still stress on the human body after undergoing any type of procedure. As such, non-surgical options will always be considered as first-line treatments.

Expectations after MIS Surgery:

Despite the benefits of minimally invasive surgery, the post-operative recovery is a gradual process, requiring strength and determination. The recovery timeline varies depending on the type of surgery performed and the patients themselves. The surgical team will do their best to educate the patient and their families regarding reasonable expectations and goals following the surgery, with the understanding that even the smallest of minimally invasive cases still need several weeks or months to make a full recovery. Regardless of the procedure performed, the surgical team is dedicated to your wellbeing and clinical improvement.

Candidates for MIS Surgery:

Many patients who are candidates for traditional open spine surgery can also be managed with minimally invasive spine surgery. Conditions such as a herniated cervical disc, a herniated lumbar disc, lumbar spinal stenosis, vertebral compression fractures, lumbar spondylolisthesis, and even certain types of spinal deformity can often be managed with minimally invasive techniques. However, not all patients or disease processes can be managed with a minimally invasive approach. Multiple conversations and discussions between the patient and surgical team are necessary to determine the optimal treatment plan. Even if a person is not a candidate for surgery, the Intent Medical Group team remain committed to the healthcare needs of all patients.