Surgery for a spine tumor depends on the nature and location of the tumor.
Resection: When possible, the tumor is resected (removed) to relieve pressure and
pain. This is delicate surgery, as tumors can be adjacent to important
spine structures. At Weill Cornell, we emphasize intraoperative monitoring
and stimulation of the spinal cord to maximize the safety of the resection.
Spine Stabilization: For metastatic spine tumors, we offer our patients state-of-the-art spinal
stabilization to preserve mechanical and neurologic function and improve
quality of life. We emphasize minimally invasive techniques, such as retropleural
thoracotomies, short segment fusions, and the use of cages to enhance fusion.
In a vertebroplasty, the surgeon advances a needle through the skin on
a patient’s back under x-ray guidance to confirm that it has entered
the fractured vertebra (left). The surgeon then injects bone cement into
the fractured vertebra (right), where it quickly hardens to provide stability
to the bone and relief of pain.
Vertebroplasty and Kyphoplasty: Advanced procedures such as kyphoplasty and vertebroplasty allow neurosurgeons
to reconstruct compressed vertebral bone, restore alignment, or remove
pressure on a nerve. Vertebroplasty and kyphoplasty are image-guided procedures
performed in an X-ray suite or in an operating room with X-ray equipment.
For a vertebroplasty, the patient is prone (face down) and the procedure
is done either under general anesthesia or under sedation (in which the
patient is awake). One or two needles are advanced under x-ray guidance
into the fractured vertebra through the skin in the back. After the x-ray
confirms good needle placement, the surgeon injects bone cement into the
fractured vertebra. The cement hardens in a few minutes, providing immediate
stability to the bone and relief of pain.
To perform a kyphoplasty, a surgeon first guides a catheter into the vertebra,
then inserts and inflates a small balloon. The balloon creates a cavity
as it inflates; the balloon is then deflated and withdrawn from the vertebra.
In the next step, the surgeon inserts a needle into the catheter to deliver
bone cement into the cavity. The cement hardens in place, providing immediate
stability to the bone.
Kyphoplasty, also referred to as “balloon vertebroplasty,”
is similar to vertebroplasty, but (as its name suggests) uses a balloon.
The balloon is guided through the needle into the vertebra and inflated
in order to correct the abnormal wedging of the broken vertebra. Once
the bones are in the correct position, the balloon is deflated and removed,
and the large cavity created is filled with bone cement. The cement hardens
in place, providing immediate stability to the bone.
A variant of this procedure, called “structural kyphoplasty,”
involves the placement of a stack of wafers instead of a balloon in an
attempt to restore normal wedging. The stack of wafers is held in place
with the subsequent injection of cement. Correcting the abnormal wedging
may help restore the spine to a more normal alignment.
Stereotactic Radiosurgery (SRS): Neurological surgeons can use stereotactic radiosurgery (highly targeted
radiation beams from multiple angles) to treat spinal tumors. This technique
is a highly effective and minimally invasive treatment. Side effects are
usually moderate and limited and the procedure carries a very low risk
of infection or other complications that can occur after open surgery.
This is a rapidly developing technique — requiring the most highly
trained surgeons utilizing the most sophisticated equipment — such
as the Gamma Knife, CyberKnife, proton beams, and linear accelerators
— and is usually only available in major medical centers (see
Doctors Who Treat Spinal Tumors).
The expert spine surgeons at the Weill Cornell Brain and Spine Center are
fortunate to be part of the NewYork-Presbyterian Hospital team. The 2013-14
"America's Best Hospitals" ranking in
US News and World Report placed NewYork-Presbyterian as the #1 hospital in New York, and our Neurology
and Neurosurgery program ranks as the #1 program in New York (and #3 nationwide).
Together, the NewYork-Presbyterian/Weill Cornell Medical Center team is
the best choice for your spine.
Request an Appointment