Spinal Malignancy
What is spinal malignancy?
Primary (meaning originating in) vertebral column tumors grow from
the bone or disc and are generally rare and slow-growing The most
common tumor is osteosarcoma, which arises from the bone-forming
cells and most often seen in young people between 10 and 25 years
of age.
Multiple myeloma is another primary bone cancer. Myeloma starts
when normal immune cells grow out of control and produce tumors,
especially in bone marrow (plasmacytomas). If these tumors grow
in many sites, they are then called multiple myeloma. If the tumors
grow in the spine, they may press on the spinal cord or the nerve
roots leading out of the spinal column, causing pain and/or dysfunction.
What causes spinal malignancy?
The most common cause of spinal tumors is metastasis from cancer
in another part of the body. In women, spinal cord tumors generally
begin from breast or lung cancer. In men, spinal tumors generally
come from prostate or lung cancer.
Can spinal malignancy be prevented?
Life styles that reduce the chance for breast, prostate and lung
cancer are the best means of preventing spinal tumors. Routine screening,
detection, and treatment of those cancers can help prevent the spread
to the spine.
What are treatment options for spinal malignancy?
Based on a complete evaluation, the physician plans the most appropriate
treatment. Since most spinal tumors arise from cancer in other organs,
the goals are to control pain, reserve function, and provide structural
stability.
Decompression
This refers to any surgical technique which aims to free the space
for the nerves in the spinal canal or foramena. A spinal decompression
can be performed in the cervical spine (neck), the thoracic spine,
and in the lumbar spine. A decompression involves removing tissue
which is constricting or compressing nerve structures. In some cases
the spine becomes unstable and a spinal fusion is performed at the
time of surgery.
A number of different surgical methods are commonly used to achieve
a decompression, including: laminectomy, laminotomy, laminoplasty,
foramenotomy, anterior discectomy. The ideal technique to use will
depend largely upon the level of the spine that must be decompressed,
the elements which are causing the compression (bone, disc, ligaments
or other), the stability of the spine, and the surgeon's experience.
Spinal Fusion
Fusion is a surgically created solid bone bridge between two or
more adjacent (usually freely mobile) bones. In the spine, this
procedure is used to create a stability between vertebrae. In order
to achieve a fusion, bone must grow across the desired area in a
gradual and solid fashion. A number of techniques can increase the
chance of this to occur. The basic principle is to place bone tissue
(bone graft) into the area of desired fusion, ensure sufficient
immobility across that area (brace, cast, spinal instrumentation)
and then wait for the fusion to take place (6-9 months or more).
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John
J. Regan, M.D.