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Minimally Invasive Spine Surgery pp 503–530Cite as

Minimally Invasive Surgery for Spinal Tumors

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Abstract

Spinal tumors comprise a diverse set of pathologies, including tumors of the spinal cord, its meninges, and tumors of the bony spinal column. Tumors in each location can be divided into benign and malignant primary lesions, which most commonly arise from the cord and meninges, and metastases, which more commonly localize to the bony elements. Traditionally both spinal cord tumors and lesions of the vertebral column have been treated surgically, despite the often high morbidity associated with such procedures. In the past two decades though, more minimally invasive techniques have been developed for the treatment of spinal tumors, which decrease intraoperative morbidity, shorten postoperative recovery, and accelerate the return to systemic treatment. The goal of this chapter is to give a brief overview of spinal oncology, along with a description of the minimally invasive surgical techniques that have been developed to address these pathologies.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Zach Pennington, Camilo A. Molina & Daniel M. Sciubba

Authors
  1. Zach Pennington
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  2. Camilo A. Molina
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  3. Daniel M. Sciubba
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Corresponding author

Correspondence to Daniel M. Sciubba .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Frank M. Phillips

  2. Texas Back Institute Texas Health Presbyterian Hospital Plano Scoliosis and Spine Tumor Center, Plano, TX, USA

    Isador H. Lieberman

  3. Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA

    David W. Polly Jr.

  4. Department of Neurological Surgery, University of Miami/Jackson Memorial Hospital, Miami, FL, USA

    Michael Y. Wang

Appendices

Quiz Questions

  1. 1.

    What are the most common types of spinal neoplasms?

  2. 2.

    What are the objectives for the treatment of spinal metastases?

  3. 3.

    What tumor sizes and types can reasonably be treated with minimally invasive techniques?

  4. 4.

    Which are the relative merits of an anterior vs. posterior minimally invasive approach, such as video-assisted thoracoscopy vs. a posterior mini-open approach?

Answers

  1. 1.

    Vertebral column metastases

  2. 2.

    Palliation of patient symptoms. For patients with expected survival times exceeding 3–6 months, surgery should be offered for relief of mechanical pain localizable to metastatic disease or pain and/or neurological dysfunction secondary to neural element decompression. For patients with more limited survival, surgery – especially if done via a minimally invasive approach – is reasonable for relief of neural element compression and may be considered for those with severe tumor-related mechanical pain.

  3. 3.

    For vertebral column lesions, minimally invasive techniques are reasonably entertained where en bloc resection is not required (e.g., metastatic lesions), and the lesion is isolated to a single vertebral body. Geometric concerns mean that lesions involving more than one consecutive vertebra and those requiring en bloc resection should be approached with open approaches. For lesions of the spinal cord and meninges, minimally invasive approaches are reasonably entertained for lesions involving fewer than two levels. Ventrally located lesions and those extending more than two levels likely benefit from an open approach.

  4. 4.

    Relative merits of the minimally invasive approaches are shorter hospital lengths of stay, lower blood loss, and lower complication rates. Minimally invasive approaches also likely decrease muscle damage, postoperative pain, and rates of surgical site infection, though evidence for these outcomes is best supported in the non-oncology literature.

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Pennington, Z., Molina, C.A., Sciubba, D.M. (2019). Minimally Invasive Surgery for Spinal Tumors. In: Phillips, F., Lieberman, I., Polly Jr., D., Wang, M. (eds) Minimally Invasive Spine Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-19007-1_41

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