Spine Tumors: Surgery

Pictured: Mark Bilsky More than 1,500 people come to Memorial Sloan Kettering’s Spine Tumor Center every year for diagnosis and treatment from leaders in the field such as neurosurgeon Mark Bilsky.

About 10 percent of spine tumor patients at Memorial Sloan Kettering are treated with surgery. Spine surgery is an intricate procedure in which surgeons remove as much tumor as possible while avoiding injury to the spinal cord and other major nerves. This approach is recommended if your tumor compresses the spinal cord and is not sensitive to conventional radiation therapy, or if you have spinal instability that cannot be repaired with minimally invasive procedures.

Surgery is often curative for patients with primary intradural spine tumors that are slow growing. Other types of spine tumors, such as astrocytomas, are often treated with radiation therapy after surgery to eliminate any isolated cancer cells that were not removed. Research suggests that this combination can significantly improve survival and mobility for many patients compared with radiation alone.

Surgeons at Memorial Sloan Kettering are among the most experienced and have worked to make spine surgery a much safer, more effective option for many patients. Our surgical team performs more than 175 spine surgeries each year, using highly precise techniques to remove as much of your tumor as possible without causing injury to nerves and other structures. Our team also uses a variety of procedures to monitor nerve and spinal cord function and to prevent complications such as bleeding.

Advanced Surgical Techniques

Until recently, surgery to remove metastatic spine tumors was performed with an incision in the abdomen, making it difficult to remove the tumor safely. Our neurosurgeons have extensive experience in using an approach called posterolateral resection, in which spine tumors are removed and the spine is reinforced through an incision in the middle of the back. This method reduces the risk of complications and shortens recovery time, allowing patients to return to radiation therapy or other treatments sooner.

Another surgical technique, called an en bloc resection, is used to remove the tumor in a single piece. En bloc resection is often used to completely eliminate primary tumors such as giant cell tumors, low-grade chondrosarcomas, and chordomas that are located in the bones of the spine or next to the spine.

Surgery for Metastatic Spine Tumors

If you have a metastatic spine tumor (a tumor in the spine that began elsewhere in your body), some surgical procedures can help stabilize your spine, reduce pain, prevent paralysis, and increase mobility. These procedures are not curative, but can provide local control of the cancer while allowing you to return to other treatments such as chemotherapy or radiation therapy. Commonly used palliative surgical techniques include spinal cord decompression and spinal instrumentation.

Spinal Cord Decompression

This technique, also called posterolateral laminectomy, involves removing the bony roof of the spinal canal (lamina) to relieve pressure on the spinal cord and nerve roots. Decompression also creates enough space so that high-dose radiation can be given without risking spinal cord injury.

Spinal Instrumentation

Pedicle screws and rods are surgically attached to the spine to redistribute stress on the bones and keep them aligned. This technique is usually used when a patient has significant spinal cord compression, a collapsed vertebra, or a burst fracture that cannot be repaired with kyphoplasty. When possible, our surgeons use specially designed screws to attach the rods in a less invasive technique than with open surgery.

Improving the Safety of Spine Surgery

Our spine tumor team works together to ensure the highest level of safety during your surgery. Our team routinely uses the following advanced, minimally invasive techniques to monitor your progress during surgery and to prevent complications such as injury to the spinal cord and blood loss.

Intraoperative Neurophysiologic Monitoring (IONM)

Our neurologists work side by side with surgeons in the operating room to identify any changes in neurologic function that may arise during surgery. Using special devices, the doctors stimulate nerves that are involved in movement and other key functions in the body, and then measure and record their reactions. This technique helps the surgeon to avoid damaging nerves during the procedure.


Spinal Angiography & Embolization

Removing a tumor with an abnormally large number of blood vessels can increase the risk of blood loss during surgery. In spinal angiography, blood vessels are identified by injecting a contrast dye into the tumor area before taking an x-ray. Then, during embolization, an interventional radiologist injects small beads into these blood vessels to prevent them from bleeding.