Indications For Surgery In Spinal Tumors:
- Diagnosis [?]
- “Severe” Unbearable, Uncontrolled “Rest Pain”
- Progressive-Significant Neural Compression [Cord-Conus-Cauda]
- Postoperative Instabilities and Deformities [Viz: Growing Spines]
Types of Bony Spinal Tumors
A. Benign Tumors
With No Risk of Spread / Recurrence [Aneurysmal Bone Cyst-Osteochondroma - Osteoid Osteoma]
L3 : OSTEOID OSTEOMA IN 18 year old : Surgical EXCISION
No adjuvant (Chemotherapy or Radiotherapy) needed Generally
B. Locally Aggressive Tumors With Potential For Recurrence And/Or Malignant Conversion-Spread
[Giantcelltumors -Solitary Plasmacytomas]
Sx: Meticulous Resection-Reconstruction With Back Up Therapy [Chemotherapy/Radiotherapy]
C. Highly Malignant Tumors With Spread Or Local Invasion
[Multiple Myeloma Osteosarcomas]
Highly Malignant Tumors With Spread Or Local Invasion [Multiple Myeloma-Osteosarcomas]
Sx: Palliative Surgery For Immedeate Stabilty And Cord Decompression To Reduce Tumor Load And Improve Quality Of Life [Back Up Ct/Rt]
Though The Need For Surgery In This Group Has Reduced Over The Years
D. Metastasis
[Renal-Gi-Breast-Lung-Prostae]
- Metastatic spine tumours – not rare !
- Impairs – pt s function and ADL
- Choice and decision making in treatment protocols of spine mets is the key !!
- ‘Local control of disease’ and alleviation of “pain and paralysis” leading to improved ADL is the hallmark of surgical intervention!!
- Surgery is extensive and morbid , hence general condition and life expectancy are significant indices for decision making !!
- Adequate choice of procedure – is the key in any intervention !!
- Efficacy of adjuvant therapy in the primary pathology alters surgical decision making !!
- A Multi Disciplinary Approach is always warranted !!
- Factors Determining The eventual Plan of treatment
- Pathology and extent of disease
- Sensitivity to adjuvant therapy
- Pt s general condition
- Expected survival
- Co morbidities
- Age
- Availability of resources
Carcinoma LUNG WITH SPINAL METS
