Metastatic Tumor Resection
Why is this surgery done?
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.
How is metastatic tumor resection done?
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.
What are my risks? What are common complications?
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:
- Infection, sometimes leading to additional surgery, increased pain or injury
- Blood loss, sometimes requiring blood products
- Damage to the spinal cord or spinal nerves, which can be temporary or permanent and can result in pain, numbness, weakness or paralysis
- Damage to the covering of the spinal cord or a nerve (dura), which can cause a spinal fluid leak and may require a drainage procedure or another operation
- In surgeries where a fusion is recommended, failure of your bone to fuse, which can lead to additional surgery, increased pain or injury
- Acceleration of the normal aging changes in the bones adjacent or next to the fusion
- Problems with the bone screws or rods, which can lead to additional surgery, increased pain or injury
- Blood clots
What do I need to know before surgery?
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.
- If you take any blood thinners—for example Coumadin (warfarin), aspirin, Plavix, Xeralto, Eliquis, Brilinta or Ticlid—make sure your surgeon is aware of this medication as soon as possible. You will be given specific instructions regarding any need to discontinue or modify your current use of any blood-thinning medication. If necessary, your surgeon will get clearance from your cardiologist or other physician to ensure that this medication change is safe and appropriate for you based on your heart history, including prior heart attack, stent placement or open-heart surgery.
- Stop taking aspirin-based products one week before surgery. Also, stop taking nonsteroidal anti- inflammatory drugs, such as ibuprofen, Naprosyn, Naproxen, Advil and Motrin, at least one week before surgery.
- Please do not eat or drink anything after midnight the day of your surgery. This includes water, coffee, chewing gum and hard candies. You may brush your teeth with toothpaste the morning of surgery.
- Some daily medications may be taken the day of surgery with a sip of water. Medications that are appropriate to take the morning of surgery will be discussed with you by the hospital staff or your surgeon’s staff.
General discharge instructions
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.
- Your incision can be open to air when you leave the hospital. It is important that someone look at your incision each day to look for problems.
- It is important to keep the incision clean and dry. You may shower when you are home, but we do not recommend tub bathing, hot tubs or swimming until seen back by your surgical team.
- Sutures or staples are usually removed two weeks after surgery, but this can vary. Your surgical team will help coordinate removal of staples or sutures.
- General anesthesia, inactivity after surgery and pain-relieving prescription narcotics may cause constipation after surgery. It may be helpful to take a stool softener and/or laxative after surgery. These medications, which include Colace, Miralax and Senokot, may be purchased over the counter at your local pharmacy.
- Do not drive for at least the first four weeks after surgery. We recommend you drive only when you are no longer taking pain medications and when you can comfortably turn your body far enough to drive safely using the car’s mirrors.
- Do not lift anything heavier than 10 pounds until you see your surgeon at the follow-up appointment 4 – 6 weeks after your surgery.
- Do not do things that require repetitive bending, twisting or lifting. Such activities include laundry, sweeping, vacuuming, shoveling and yard work. When you are moving, remember to use good body mechanics, which includes using your legs instead of your back when lifting.
- Do not smoke. It is not healthy for your back or your body’s healing abilities.
- If a fusion was performed, please avoid nonsteroidal anti-inflammatory drugs such as Celebrex, Motrin, ibuprofen, Advil and Aleve. These medications may hinder the bone growth needed for the fusion occurring after your surgery.
Call your surgeon if you experience any of these symptoms:
- Signs or symptoms of infection, including redness, wound drainage, worsening pain or a fever of more than 101 degrees
- New or worsening leg weakness, pain, numbness or tingling as compared to before surgery
- Difficulty with bowel or bladder function
- Calf or leg swelling, tenderness or redness
What should I expect while recovering?
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.
Possible physical therapy exercises
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.