Minimally Invasive Surgery for Spine Tumors : Vertebral Fracture Treatments , Vertebroplasty and Kyphoplasty (Vertebral Augmentation)

Minimally Invasive Spine Tumor Surgery

Tumor is abnormal mass of rapidly growing cells without any physiological function. That means it does not perform any function for the body but derives its nutrition from the body.  It can occur anywhere in the body. The cause is unknown. Those tumors that are found in and around the spinal cord are known as spinal tumors. They may be primary tumors whose cells of origin is the spinal tissue, or they may be secondary tumors which have spread (metastasize) via blood stream from some other focus in the body.
 

The Spinal cord is covered by a layer of protective tissue called as meninges. The entire spinal cord is encased within the vertebral column.
 

The Spinal tumor are of three types depending on their location:

• Intramedullary – within the substance of the spinal cord.
• Intradural-Extramedullary- within the layers (meninges) covering the spinal cord
• Extradural- between the meninges an the vertebral body. Most of the spinal tumors are extradural.  

Tumors are also classified as benign and malignant. Tumors that are confined to a particular area in the body are known as benign tumors. Those tumors that spread rapidly to various parts of the body are known as malignant tumor. A tumor can initially start as a benign one and can convert to a malignant one in a few cases. The benign tumors are easier to treat as they are localized in their extent and their complete removal is possible. Whereas incase of metastatic or malignant tumor, the earlier they are detected, the better the chances of their removal. But in the malignant tumor the chances of recurrence are also there as they are rapidly growing tumors.
 

What are the Symptoms of Spinal Tumor?

Tumor may cause generalized symptoms in the body (like persistent low energy levels, unexplainable weight loss, lump formation, enlargement of lymph nodes, malaise, irregularities of menstruation in females etc) as well as symptoms pertaining to the affected organ in the body. In case of spinal tumor the patient may present with any of the following:

• Back pain, often radiating to other parts of the body and worse at night
  
• Loss of sensation or muscle weakness, especially in the legs
• Difficulty walking, sometimes leading to falls
• Decreased sensitivity to pain, heat and cold
• Loss of bowel or bladder function
• Paralysis may occur in varying degrees and in different parts of the body, depending on which nerves are compressed.
• Scoliosis or other spinal deformity resulting from a large, but non cancerous tumor
• Erosion and Destruction of vertebral body

Minimally Invasive Surgery for Spine Tumors

Surgery is considered minimally invasive when it involves small incisions (e.g. ½ inch) and minimal tissue disruption. Most minimally invasive procedures are done on an outpatient basis, meaning that the patient can go home the same day, and have relatively short recovery times.

Vertebral Fracture Treatments
Vertebroplasty and Kyphoplasty, also referred to as vertebral augmentation, are typically reliable procedures designed to provide pain relief for patients who have a vertebral fracture associated with a spinal tumor.

Vertebroplasty
This procedure involves inserting a needle through a small incision in the back so that a medical-grade bone cement can be inserted into a fractured vertebra to fill in the empty spaces and act as an internal cast to stabilize the bone. The treatment is designed to reduce pain, prevent further collapse of the vertebra, and restore the patient's mobility.

Kyphoplasty (Vertebral Augmentation)
Kyphoplasty also involves injecting bone cement into a vertebra, and involves the additional step of first inserting a balloon into the bone and inflating the balloon to create a cavity. This treatment is designed to stop the pain caused by a spinal fracture, and to stabilize the bone via an internal cast.

Transarterial Chemoembolization
This procedure involves a small incision in the thigh for access to the femoral artery. A catheter guided by a wire is directed through the vascular system to the tumor with the aid of imaging. Once the tumor is located, a chemotherapeutic agent is injected directly into the tumor to shrink or destroy the tumor to remove pressure on individual nerve roots or the spinal cord.

Recovery

Recovery after tumor surgery is a relatively slow process as the patient is weakened by the tumor and all the medications, chemotherapy and radiotherapy, he has been subjected to. Regular follow ups are required to detect any recurrence of tumor. Positive mindset combined with a strong support system can work wonders for the patient’s recovery. The patient should take nutritious diet to replenish his body reserves. 

Tumor or cancer as it is referred to in common man’s language, is a much feared disease. Many of those who are affected feel their world go crumbling around them with the mere mention of such a diagnosis. They go through a variety of emotional phases from denial to acceptance to defeat against the killer. Not only the patient but also the caretaker or the family member is totally drained out while attending to the patient. The picture may seem very dismal, but tumor patients still have a hope to live a normal life, provided the condition is detected early and the remedial measures are begun in time. We provide these patients with a world class diagnostic setup to detect tumors as early as possible and also advanced surgical techniques to treat them. We provide a multidisciplinary approach towards handling of such patients as they require medical, surgical, emotional and psychological support. We make the stay of the patient as well as that of the caretaker as comfortable as possible and try our best to allay their fears and anxieties. All this is offered at our hospitals at very affordable costs.

Advanced Minimally Invasive Lumbar Spine Fusion Surgery in India at Low Cost

If the spinal arthritis has progressed to spinal instability, the patient may require a combination of lumbar decompression (laminectomy) and lumbar fusion to stabilize the spine and alleviate chronic back pain. Lumbar fusion, also called spinal fusion. Fusion may also involve supplemental hardware, such as plates, cages, and screws to hold the spine in place. Once the union between the vertebrae has solidified, the hardware is no longer needed, but few patients are eager to undergo another surgery for their removal.

Lumbar fusion can be performed using the traditional open technique or minimally invasive methods. In traditional open spinal fusion surgery, the surgeon must make a large incision and cut through thick spinal muscles. 

Spinal fusion procedures involve removing the disc from between the vertebrae (in the disc space) and then filling the gap with a metal, plastic, or bone spacer. These spacers, also called cages, contain bone graft material that facilitates bone healing and fusion. After the spacer is implanted, the surgeon may use metal screws, plates, and rods to further stabilize the spine.

About 80 percent of all fusion surgeries involve one or two levels of vertebrae of the spine. Patients undergoing this type of fusion are very likely to be able to return to their normal activities after the surgery.

The experienced physicians at Midwest Orthopaedics at Rush Minimally Invasive Spine Institute may recommend spinal fusion to alleviate symptoms for many back conditions, including:

• Tumor
• Spinal stenosis
• Spondylolisthesis
• Fracture
• Scoliosis
• Degenerative Back Disease

Lumbar fusion can be performed from the front (anterior approach), from the back (posterior approach) or from the side (lateral approach). The surgeons at Midwest Orthopaedic at Rush Minimally Invasive Spine Institute choose which approach is most appropriate based upon many factors, including the need for bone spur removal, the degree of instability, the medical condition, and body habitus of the patient. Usually the decision as to which approach makes the most sense involves a discussion of the pros and cons of each approach in a particular situation. The following are spinal fusion approaches that may be considered:

• Anterior Lumbar Interbody Fusion (ALIF) with Instrumentation
• Posterior Lumbar Interbody Fusion (PLIF)
• Transforaminal Lumbar Interbody Fusion (TLIF)
• Lateral Fusion Interbody Fusion (XLIF, DLIF)

Anterior Lumbar Interbody Fusion (ALIF) with Instrumentation: ALIF is used in the treatment of a disc problem that causes pain and instability in the lower back (lumbar spine). In ALIF, the procedure is performed from the front allowing to access the spine without moving nerves and disturbing the back muscles.

Posterior Lumbar Interbody Fusion (PLIF): In PLIF, the surgeon approaches from the back by making one or two 2.5 cm incisions that provide access to the spine once the lamina (bone) is removed and nerves are retracted. In addition to spinal stenosis, PLIF is common in treating patients with:

• Spondylolisthesis
• Degenerative Disc Disease
• Recurring Herniated Disc

Transforaminal Lumbar Interbody Fusion (TLIF): In TLIF,  use the posterior (back) approach or the lateral (side) approach. The surgery is performed on one side only and the bone graft is inserted into the disc space laterally. The facet joints may be trimmed or removed to give nerve roots room. This approach requires less movement of nerves and opening of back muscles. The incision is 2 cm in length. In addition to spinal stenosis, TLIF is common in treating patients with:

• Spondylolisthesis
• Degenerative Disc Disease
• Recurring Herniated Disc

Lateral Interbody Fusion (XLIF/DLIF): These procedures, which  helped to develop, are being used to treat patients with spinal instability caused by degenerative discs, loss of height of disc space that causes pinching of a spinal nerve, change in normal curvature to the spine (scoliosis), and slippage of one vertebra over another. These procedures make use of the side (lateral) approach avoiding the spinal muscles and may take about one to one and a half hours to complete.

The symptoms of spinal cancer may occur very slowly. Other times, they occur quickly, even over a matter of hours or days

The symptoms of spinal cancer depend on several factors, including the tumor type, size, location and extent, as well as age, health history and more. Some common spinal cancer symptoms include pain, numbness, weakness and difficulty with urination.

The symptoms of spinal cancer may occur very slowly. Other times, they occur quickly, even over a matter of hours or days. Metastatic spinal tumors, which have spread to the spine from another location in the body, often progress quickly.

Common spinal cancer symptoms

The most noticeable sign of spinal cancer is pain. Pain can come from the tumor's presence in the spinal column, pushing on sensitive nerve endings or causing spinal instability. When the spine is not lined up properly, other physically notable symptoms may result (e.g., changes in posture, Kyphosis or hunchback).

When the tumor presses on the spinal cord, symptoms may begin with numbness or tingling in the arms or legs. Next, there may be clumsiness, not knowing where the feet are, and difficulty with buttons or keys. As the disease progresses, spinal cancer symptoms may grow to include weakness, inability to move the legs and eventually paralysis.

Some common signs of spinal tumors may include the following:

§  Pain (back and/or neck pain, arm and/or leg pain)

§  Muscle weakness or numbness in the arms or legs

§  Difficulty walking

§  General loss of sensation

§  Difficulty with urination (incontinence)

§  Change in bowel habits (retention)

§  Paralysis to varying degrees

§  Spinal deformities

§  Pain or difficulty with standing

  Minimally Invasive Spinal Tumor Removal Surgery in India

Some Spinal Tumors, benign or malignant, require surgical intervention before or after non-operative treatments. When pain is unresponsive to non-operative treatment, neurologic deficit progresses, a specimen is needed, neural elements (e.g. nerves) are compressed, vertebral destruction exists, or when spinal stabilization is necessary - surgery is considered. The primary goals in surgery are to reduce pain caused by the spinal tumor, restore or preserve neurologic function, and provide spinal stability. The spinal tumor may be approached surgically from the front (anterior) or back (posterior) of the body.

Surgery may include tumor resection (partial removal) or excision (complete removal). When the tumor is removed (partially or completed) pain and neurologic problems may clear up. Spinal instrumentation and Fusion are procedures used to reconstruct and stabilize the spine. These procedures join and solidify the level (or levels) where a spinal element (e.g. vertebral body) has been damaged or removed.

Why surgery for Spine Tumor Removal?

• When the tumor is removed (partially or completely) pain and neurologic problems may clear up.
• To restore and preserve neurological function and provide spinal stability.
• Spinal Tumor surgery is generally indicated in case there is a localized tumor which can be removed with minimum damage to nerve and spinal cord,
• There is persistent neurological deficit and pain which is unresponsive to non operative treatment
• Surgery may include resection (partial removal) or excision (complete removal) of tumor.
  
  
  

Types of Spinal Tumors : Spinal Tumor Removal Surgery in India

It's not clear why most spinal tumors develop. Experts suspect that defective genes play a role, although it's usually not known whether such genetic defects are inherited, occur spontaneously or are caused by something in the environment, such as exposure to certain chemicals. In some cases, however, spinal tumors are linked to known inherited syndromes, such as neurofibromatosis 2 and von Hippel-Lindau disease.

The parts of your spine that are likely to be affected by a spinal tumor include the:

• Vertebrae. Your spine is made up of small bones (vertebrae) stacked on top of one another that enclose and protect the spinal cord and its nerve roots.
• Spinal cord. Your spinal cord is a double-layered, long column of nerve fibers that carries messages to and from your brain. Wrapped around the entire spinal cord are three protective membranes (meninges).

Types of spinal tumors

Spinal tumors are classified according to their location in the spine.

• Extradural (vertebral) tumors. Most tumors that affect the vertebrae have spread (metastasized) to the spine from another site in the body — often the prostate, breast, lung or kidney. Although the original (primary) cancer is usually diagnosed before back problems develop, back pain may be the first symptom of disease in people with metastatic spinal tumors.
  Cancerous tumors that begin in the bones of the spine are far less common. Among these are osteosarcomas (osteogenic sarcomas) and Ewing's sarcoma, a particularly aggressive tumor that affects young adults. Multiple myeloma is a cancerous disease of the bone marrow — the spongy inner part of the bone that makes blood cells. Noncancerous tumors, such as osteoid osteomas, osteoblastomas and hemangiomas, also can develop in the bones of the spine.
• Intradural-extramedullary tumors. These tumors develop in the spinal cord's arachnoid membrane (meningiomas) and in the nerve roots that extend out from the spinal cord (schwannomas and neurofibromas). These tumors may be cancerous or noncancerous.
• Intramedullary tumors. These tumors begin in the supporting cells within the spinal cord. Most are either astrocytomas or ependymomas. Intramedullary tumors can be either noncancerous or cancerous. In rare cases, tumors from other parts of the body can metastasize to the spinal cord itself.
  
  Minimally Invasive Spinal Tumor Removal Surgery
  
  in India
  Some Spinal Tumors, benign or malignant, require surgical intervention before or after non-operative treatments. When pain is unresponsive to non-operative treatment, neurologic deficit progresses, a specimen is needed, neural elements (e.g. nerves) are compressed, vertebral destruction exists, or when spinal stabilization is necessary - surgery is considered. The primary goals in surgery are to reduce pain caused by the spinal tumor, restore or preserve neurologic function, and provide spinal stability. The spinal tumor may be approached surgically from the front (anterior) or back (posterior) of the body.
  Surgery may include tumor resection (partial removal) or excision (complete removal). When the tumor is removed (partially or completed) pain and neurologic problems may clear up. Spinal instrumentation and Fusion are procedures used to reconstruct and stabilize the spine. These procedures join and solidify the level (or levels) where a spinal element (e.g. vertebral body) has been damaged or removed.
  Why surgery for Spine Tumor Removal?
• 
  

  o    When the tumor is removed (partially or completely) pain and neurologic problems may clear up.

  o    To restore and preserve neurological function and provide spinal stability.

  o    Spinal Tumor surgery is generally indicated in case there is a localized tumor which can be removed with minimum damage to nerve and spinal cord,

  o    There is persistent neurological deficit and pain which is unresponsive to non operative treatment

  o    Surgery may include resection (partial removal) or excision (complete removal) of tumor.
  
  

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Spinal Tumor Removal Surgery :Why should you choose to get Indian hospitals offer the best spinal surgery treatment in India

A spinal tumor is a cancerous (malignant) or noncancerous (benign) growth that develops within or near your spinal cord or within the bones of your spine. Although back pain is the most common symptom of a spinal tumor, it's also an extremely common problem in people who don't have spinal tumors. In fact, most back pain isn't caused by a tumor.

A spinal tumor or a growth of any kind can affect nerves in the area of the tumor, leading to pain, neurological problems and sometimes paralysis. Whether cancerous or not, a spinal tumor can threaten life and cause permanent disability.

Treatment for a spinal tumor may include surgery, radiation therapy, chemotherapy or other medications.

Frequently Asked Questions About Spine Tumors

Q. What is the central nervous system?

A. The brain and the spinal cord form the central nervous system. It controls walking, talking, breathing and digesting food. It is also involved with our senses – seeing, hearing, touching, tasting and smelling – as well as our emotions, thoughts and memory.

Q. What are spine tumors?

A. Spine tumors are abnormal growths of tissue found in and around the spine. Tumors in the spine may be primary (begin in the spine) or secondary (metastatic – move to the spine from other locations). The most common cancers that move to the spine are breast, lung, renal and prostate.

Q. What are metastatic spine tumors?

Metastatic is a term that describes cancer that has spread from its primary site to other places in the body. Metastatic spine tumors are abnormal growths of tissue that are found in and around the spine, but that began in another location in the body. The skeletal system is the third most common site of metastases.

Most often cancer that moves to the spine is not fatal, although it can cause pain and compress nerves. Nerves that are compressed can cause weakness or paralysis of the arms or legs. Treatment of spine tumors is focused on maintaining quality of life.  

Q. Where are spine tumors located?

A. The majority of spine tumors are located in the center of the back. But they also occur in the lower back or neck region.  The location of the tumor determines the symptoms experienced.

Q. What are the symptoms of spine tumors?

A. Some patients have no symptoms. The most common symptom, however, is pain. Patients may experience persistent back or neck pain. Other complaints may include numbness, tingling or weakness in the arms or legs, problems walking and maintaining balance or problems with bowel and bladder function. 

Q. How is a spine tumor diagnosed?

A. The most common test is a magnetic resonance imaging (MRI) of the spine, which will show the soft tissues and nerves of the spinal column. Plain X-rays will show vertebral fractures, common when the tumor invades the spinal bones. A computerized tomography (CT) scan shows the bones more clearly and can help to determine the extent of the bony disease. Other tests include CT scans of the chest, abdomen and pelvis or a positron emission tomography (PET) scan to determine where else the cancer may be.

Q. What are the treatments for spine tumors?

A. The type of treatment that is best for you depends on the type of your tumor, the location of the tumor and how much tumor is in the spine. Your options may include:

• No medical treatment
• Managing your pain
• Surgery
• Radiation and/or chemotherapy
• Vertebroplasty (injecting bone cement into spine bones to make them strong)

Q. When is surgery necessary?

A. The role of surgery for metastatic spine tumors is to improve or maintain quality of life. There are a number of reasons why surgery would be a good treatment option for spine tumors:

• Surgical cure, if tumor can be removed
• Control of tumor growth by surgical removal, sometimes accompanied by radiation and/or chemotherapy
• Alleviation of symptoms by reducing pressure on nerves and stabilizing spine to prevent deformities, collapse or paralysis

The goal is usually to reduce the severity of symptoms, including:

• Reduction of pain
• Restoration of spine stability to improve mobility
• Preservation of neurological function
• Alteration or change in prognosis

Q. How do I know if I am a candidate for surgery?

A. The following are factors that determine if you are a candidate for surgery:

• Medically stable
• Expected survival of three months or more
• Extent of systemic disease

Q. What are the surgical options?

A. The type of surgery your doctor recommends will depend on the type of tumor, its location and the symptoms you are experiencing. If you have weakness, numbness or paralysis of arms and legs or a change in bladder or bowel function, an open surgical procedure may be necessary. 

• Closed procedure (vertebroplasty) – Using a needle, the surgeon injects special cement into the vertebral body damaged by the tumor.
• Open procedures – These procedures may be done with a surgical incision on the front or back
  o Decompression:  to remove bone that has the tumor and to increase the space around the spinal cord and nerves
  o Stabilization:  application of screws, rods or cement to stabilize the spinal column
  o Combination: both of the above procedures; may be staged one or more days apart

Q. How long is the recovery period after surgery?

A. Your length of stay in the hospital will vary by the extent and type of surgery. A typical hospital stay after spinal tumor surgery is 5 to 10 days, although each person will respond differently and recover differently. 

Following surgery, you may need help with activities of daily living. This is referred to as rehabilitation. Rehabilitation may be done in an inpatient setting, which means you are admitted to a rehab unit or hospital. It can also be done as an outpatient, which means you could receive therapy in your home or be transported to a rehab facility during the week.

Q. What are the othertreatment options?

A. The non-surgical treatment options for spinal tumors are observation, radiation therapy and chemotherapy.

• Observation – Tumors that cause mild or no symptoms and do not appear to be progressing may be observed and monitored with regular MRIs.
• Radiation therapy – If you are a candidate to receive radiation therapy to the spine, you will be evaluated by a radiation oncologist who specializes in radiation treatments. Radiation therapy, if indicated, may be delayed to allow time for healing after surgery.  This will be determined by your doctors.
• Chemotherapy – Usually, chemotherapy for spinal tumors is not indicated. If you require chemotherapy for systemic cancer, you will be referred back to your original oncologist to make determinations regarding chemotherapy.
  
  
  
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Nonsurgical Vertebroplasty Is Effective Treatment for Spinal Fractures

Vertebroplasty is a pain treatment for vertebral compression fractures that fail to respond to conventional medical therapy, such as minimal or no pain relief with analgesics or narcotic doses that are intolerable. Vertebroplasty, a nonsurgical treatment performed by interventional radiologists using imaging guidance, stabilizes the collapsed vertebra with the injection of medical-grade bone cement into the spine. This reduces pain, and can prevent further collapse of the vertebra, thereby preventing the height loss and spine curvature commonly seen as a result of osteoporosis. Vertebroplasty dramatically improves back pain within hours of the procedure, provides long-term pain relief and has a low complication rate, as demonstrated in multiple studies.

Vertebroplasty also known as Percutaneous Vertebroplasty is a spinal procedure in which bone cement is injected through a small hole in the skin (percutaneously) into a fractured vertebra with the goal of relieving the pain of osteoporotic compression fractures and providing strength to the bone. Vertebroplasty is used for patients with vertebral compression fractures due to osteoporosis, metastatic tumors, or benign tumors such as vertebral heamangiomas. It also provides vertebral stabilization when the lesion threatens the stability of the spine. Vertebroplasty can increase patient mobility, decrease narcotic needs, and prevent further vertebral collapse. 

If the vertebra isn't shored up, it can heal in a compressed or flattened wedge shape. Once this occurs, the compression fracture cannot be treated effectively. It is very important for someone with persistent spinal pain lasting more than three months to consult an interventional radiologist, and people who require constant pain relief with narcotics should seek help immediately.

Vertebroplasty is an outpatient procedure using X-ray imaging and conscious sedation. The interventional radiologist inserts a needle through a nick in the skin in the back, directing it under fluoroscopy (continuous, moving X-ray imaging) into the fractured vertebra. The physician then injects the medical-grade bone cement into the vertebra. Vertebroplasty takes from one to two hours to perform depending on how many bones are treated. The cement hardens within 15 minutes and stabilizes the fracture, like an internal cast.

Vertebroplasty is considered for patients with painful compression fractures in the spine, often caused by osteoporosis. Because the treatment often results in a dramatic decrease in pain, the advantages are numerous.

Decreased Pain : A compression fracture causes sharp and debilitating pain. Those suffering from these fractures are often prescribed bed rest and pain medication. Vertebroplasty reduces and in some cases eliminates the need for pain medication, and it also restores mobility in many patients.

Prevention of further vertebral collapse. The cement fills spaces in bones made porous by osteoporosis, strengthening the bone so that it is less likely to fracture again.

Recovery :

The patient recovery is quick as it is a minimally invasive surgery with very little blood loss and damage to surrounding tissues. The patients are kept under observation for 1-2 hrs after which they are discharged. They return to normal day to day activities within a week.

About Osteoporosis

Osteoporosis is characterized by low bone mass and structural deterioration of the bone resulting in an increased susceptibility to fractures. Osteoporosis is a condition where the bone density decreases with advancing age, due to deficiency of calcium and vitamin D. Osteoporosis makes the bones of the body weak and susceptible to fractures, especially of the spine. Approximately 85% fractures in old age are caused by osteoporosis and remaining 15% are caused by bone weakness caused by other conditions such as spread of cancer to the bones. Percutaneous Vertebroplasty is indicated for painful osteoporotic or neoplastic vertebral compression fractures refractory to medical therapy.

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