Intradural Tumor Resection

Intradural spinal tumors are lesions that can occur in the neck region (cervical), mid-back (thoracic) or low-back (lumbar-sacral). An intradural tumor is inside the dura, which is the membrane that surrounds the spinal cord and spinal nerve roots. An intradural tumor can involve this covering, the spinal cord itself or the spinal nerve roots. Intradural tumors can be benign (non-cancerous) or malignant (cancerous). Intradural spinal tumors can cause pain, numbness or loss of function (weakness or paralysis) due to involvement of or pressure on the spinal cord or spinal nerves.

Surgery is recommended to prevent further loss of function, improve symptoms and a diagnosis. Surgery can usually cure benign tumors. Surgery cannot cure malignant tumors, but can help preserve function.

The surgical approach for an intradural tumor is usually posterior (an incision on the back of your neck or your back), but occasionally will be from the front or side. Sometimes surgery will involve a combination of these approaches. Your surgeon will explain to you why one approach may be better than another depending on the location of the intradural tumor.

After making the incision, your surgeon will need to remove bone and ligament in order to to gain access to the spinal canal, the bony channel with the dura, spinal cord and spinal nerves. The number of levels depends on the location and size of the tumor. Depending on how much bone is removed, your surgeon may recommend a fusion (screws and rods anchored to the spinal bones) to preserve stability in your spine. 

After exposing the dura, your surgeon will use a high-powered microscope to make the work around your spinal cord and spinal nerves safer. The membrane is opened. Then, using very fine instruments, the tumor is separated and removed from the dura, spinal cord and/or nerve roots. Sometimes, a tumor cannot be fully removed as it may cause more harm and loss of function to remove the entire tumor than to leave a small amount behind. The tumor removed is sent to a pathologist, who will examine the tumor and give a diagnosis.

After tumor removal, your surgeon will close the dura with suture. If a fusion is planned, your surgeon may use a combination of your own bone, cadaver bone, bone matrix, stem cells and bone morphogenetic protein (BMP) to help your spine fuse.

The incision is closed with sutures or staples. Sometimes after surgery for an intradural tumor, a patient may stay intubated (breathing tube helping your lungs) and need to stay in the intensive care unit. This depends on the approach to the tumor, the tumor location and many factors in surgery.

One of the most-often-experienced problems after intradural tumor resection is an inability to regain normal neurological function. If you have spinal cord damage resulting in weakness, numbness or tingling in your arms or legs, the primary purpose of surgery is to prevent further loss of function and damage to the spinal cord. There is no guarantee that your pain will be relieved following surgery. You may experience some improvement of your symptoms, but you may already have permanent damage that surgery cannot correct.

While complications from surgery are uncommon, some can be serious and may include:

Before your surgery, preoperative testing will need to be completed. To ensure medical clearance for surgery, testing such as blood work and EKG are completed. Usually the surgical facility will contact you and schedule an appointment for a detailed evaluation and examination. Additional clearance may be needed from a cardiologist, pulmonologist or another specialized physician.

This important checklist will help ensure that you are prepared and ready for your surgery. Please read it and ask your surgeon to answer any questions you have.

Often after an intradural tumor resection, patients are discharged from the hospital to an inpatient rehabilitation facility or a skilled nursing facility for continued recovery and care. Whether you leave the hospital for another facility or are discharged home, it is important to follow these instructions.

Call your surgeon if you experience any of these symptoms:

The recovery process from an intradural tumor resection operation can often be lengthy. Depending on the degree of the loss of function prior to surgery, many months of rehabilitation may be necessary. Additionally, other treatments such as radiation or chemotherapy may be needed depending on what kind of tumor has been removed. When these treatments are needed, it can add time to your overall recovery. It is important that you follow the recommendations and restrictions of your surgical team to ensure a good outcome.

Managing your surgical pain can be difficult. Pain from surgery will change in intensity as you heal. This is normal and expected. Your back pain should slowly improve as the healing process occurs and your fusion becomes more solid. This healing may take several months. During this time, your surgeon will work with your primary care physician or other pain management specialist on pain management techniques and regimens.

After leaving the hospital, physical therapy is recommended for some patients, even those who do not need a rehabilitation stay. Your surgeon may recommend physical therapy at one of your early postoperative appointments, depending on your progress. The most important part of your recovery is walking, which increases blood flow to the spine and assists in the healing process. Try walking on a structured basis, slowly at first and progressing on a regular basis.