Spinal Tumor Breakthrough
Published: May 27, 2006
BACKGROUND: When tumors grow in the bone of the spinal column, there are not many surgical treatments that can remove them without causing serious damage to the spinal cord. As the tumors grow, they press up against the spinal cord. This pressure can cause a variety of symptoms like excruciating pain and numbness and tingling in extremities. If left untreated, patients can become paralyzed. Because of the proximity to sensitive anatomy including the spinal cord, pharynx, nerves, and major blood vessels, surgeons often refuse to operate for fear of causing irreversible nerve damage, paralysis and even death. As a result, patients with these kinds of tumors are often left without hope.
A NEW APPROACH: Christopher Ames, M.D., is co-director of the University of California, San Francisco Spine Center. He focuses on complex spinal reconstructive surgery for tumor removal. Dr. Ames developed the transpedicular approach to previously unresectable cervical and cervical thoracic tumors. This new method allows him to complete remove spinal tumors without any spinal cord manipulation. Called a lateral paramedian transpedicular approach, the technique uses advances in spinal instrumentation and reconstructive strategies to provide a direct approach to the removal of cervical spinal tumors with minimal, or no, neural manipulation.
THE PROCEDURE: For this surgery, Dr. Ames first removes and then reconstructs portions of the cervical spine so he can get to the tumors. Once the bone is removed, he has a direct line of sight to the tumor. He’s able to completely remove it without moving or manipulating the spinal cord. After the tumor is removed, surgeons immediately rebuild the spine with artificial pedicle screws, a reconstruction technique also developed by Dr. Ames. The patient is kept in a cervical collar for at least three months after the surgery. The technique is particularly useful in cases in which the tumor is located in the middle of the spinal canal and attached to the lining of the spine. These types of tumors include meningiomas, neurofibromas and exophytic astrocytomas. The University of California, San Francisco is currently the only medical institution in the United States where patients can undergo this surgery.
RISKS: The major risks of this technique include injury to the vertebral artery from mobilization and retraction as well as to the spinal cord and cervical nerve root from extensive dissection, manipulation, and retraction. Dr. Ames published a description of the procedure in the October 2005 issue of Neurosurgery. Surgeons at the University of California San, Francisco have performed the procedure on more than 15 patients with no serious complications.
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