Spinal tumors pose the exceptional challenge of removing the tumor without damaging the spinal nerves. That was a difficult and sometimes impossible task with standard surgery.
But minimally invasive spine surgery (MISS) has revolutionized our ability to successfully remove these tumors. MISS introduced new techniques and instruments that give a skilled neurosurgeon like Richard B. Kim, MD the ability to reach and remove tumors that were once inaccessible.
Tumors that begin in the spine, called primary spinal tumors, can be malignant (cancerous) or benign (noncancerous). These tumors often originate in the membranes covering the spinal cord and in the spinal nerves. Though not as common, they can also grow in the vertebrae.
Secondary spinal tumors are always malignant because they begin as cancer in another part of the body and then spread to the spine.
About 40% of primary spinal tumors occur inside the membranes that surround the spinal cord without affecting the nerves that make up the spinal cord. Tumors that grow inside the spinal cord represent approximately 5% of all primary tumors.
Primary tumors have names such as meningiomas, schwannomas, neurofibromas, ependymomas, and astrocytomas. These names reflect the cells and tissues that grow to form the tumor.
Some primary tumors are usually benign, and others are typically malignant. But they're not always straightforward. For example, ependymomas are considered to be cancerous. Yet some grow so slowly they don’t need immediate treatment, and others grow very rapidly.
Additionally, benign tumors can grow rapidly, press against nerves, and cause serious problems. They need to be surgically removed as quickly as malignant tumors.
Tumors that develop outside the membranes covering the spinal cord account for 55% of all spinal tumors. They’re usually metastatic tumors.
It's estimated that 30-70% of patients with cancer outside the spine end up with secondary tumors in the vertebrae. Other cancers that commonly spread to the spine include lung, breast, and prostate cancer.
Before MISS, removing a spinal tumor was a dangerous procedure that was seldom performed. Instead, patients were treated with other therapies to reduce the size of the tumor or kill cancerous cells.
With MISS, I have the ability to aggressively remove tumors, carefully separating the tumor from essential nerves and the surrounding tissues.
Minimally invasive procedures are defined by making a small incision. However, the benefit extends beyond the incision size. I can perform more precise surgery and reach tumors in difficult locations due to the advanced instruments designed to fit through tiny incisions.
A few examples of minimally invasive techniques used to treat spinal tumors include:
Tumor resection refers to cutting out part or all of the tumor.
I may perform an embolization to shrink the tumor so it's easier to remove or to control bleeding during a resection. I guide a catheter through your blood vessels to the tumor and release an embolic substance (tiny gelatin sponges or beads) that blocks the blood vessels and cuts off the tumor's blood supply.
When a spinal tumor places pressure on the nerves, I perform one of several types of minimally invasive decompression procedures. In some cases, I may combine decompression with a resection.
The goal is to create more space to relieve the pressure, which usually involves removing part or all of a vertebrae or disc. After the decompression procedure, I insert a bone graft and fixation devices to stabilize the spine.
Standard open surgery requires a long incision that cuts through all the muscles and tissues. Then the opening is pulled back to provide a good view of your spine.
MISS causes significantly less trauma compared to open surgery. The incision only needs to accommodate tools that are about the size of a pencil. In most cases, I don't cut the muscles. Instead, I guide a tubular dilator through the muscle fibers and gently stretch the muscles to create an opening.
Thanks to this gentle care, you have:
If you have a malignant tumor and need radiation therapy or chemotherapy after MISS, faster wound healing means you can start your postop treatment sooner.
If you have questions about MISS to remove a spinal tumor, call my office or book an appointment online today.