Metastatic Tumor Resection

Metastatic spinal tumors are lesions that arise in the spine from cancer in other areas of the body. Although any type of cancer can lead to metastatic spine tumors, the most common types include lung, breast, prostate and kidney cancer. Metastatic tumors of the spine are most commonly found in the bone portion of the spine, which causes destruction of the bone and puts nerves at risk for being damaged. This can lead to pain, numbness and weakness of the arms and legs. The purpose of spinal surgery for metastatic spine tumors is to remove as much of the tumor as possible to decompress the nerves and allow them to heal. Additionally, the tumors can cause instability of the spine due to the bone destruction. In this case, surgery is needed to stabilize the spine and restore proper alignment. Surgery for metastatic spine tumors does not cure the cancer, but is important to preserve and restore nerve function.

The surgical approach for a metastatic spinal 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 neurosurgeon will explain to you why one approach may be better than another depending on the location of the tumor and other factors, such as spinal instability.

This type of surgery is done in a larger hospital with a team of physicians including your neurosurgeon, anesthesiologist, surgical assistants and a nerve monitoring technician. The nerve monitoring is important to ensure your spinal cord is not injured during the surgery. 

After making the incision, your neurosurgeon will need to remove bone and ligament to gain access to the spinal canal, the bony channel where the nerves are located. Many times, this canal is occupied by the metastatic tumor, causing compression of the nerves. The tumor is removed using careful dissection to avoid damage to the nerves. The number of levels depends on the location and size of the tumor. Depending on how much bone was destroyed by the tumor, your neurosurgeon may need to perform a fusion (screws and rods anchored to the spinal bones) in order to preserve stability in your spine. Bone screws are placed in multiple vertebrae (the bones of the spine) using sophisticated computer navigation techniques to ensure safe placement. These screws are connected to rods, which provide structural support to your spine. Following the screw and rod placements, your neurosurgeon will need to help the spinal bones fuse together by putting grafting materials on the remaining spinal bones. This may include a combination of your own bone, cadaver bone, bone matrix, stem cells and bone morphogenetic protein (BMP) to help your spine fuse together.

The incision is then closed with sutures or staples. Sometimes after surgery for a metastatic spine 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.

Oftentimes, patients may have pain, numbness or weakness caused by the nerve damage from the metastatic spinal tumor. Although the purpose of the surgery is to prevent further nerve damage, surgery is limited in reversing the nerve damage already present from the metastatic spine tumor. Thus, the pain, numbness and weakness present before the surgery may not improve afterwards.

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 a metastatic spinal 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 metastatic spinal 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 neurosurgeon 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. If your neurosurgeon has instructed you to use assistive devices (a collar, back brace, walker or cane) please use them as instructed.