Treatment

Ideally, the goal of vertebral tumor treatment is to completely get rid of the tumor. But, this might be complicated by the risk of permanent damage to the spinal cord or surrounding nerves. Doctors also must consider your age, overall health, the type of tumor, and whether it is primary or has spread or metastasized to your spine from elsewhere in your body.

Treatment options for most vertebral tumors include:

• Monitoring. Some tumors may be discovered before they cause symptoms — often when you're being evaluated for another condition. If small tumors are noncancerous and aren't growing or pressing on surrounding tissues, watching them carefully may be all that's needed.

  This is especially true in older adults for whom surgery or radiation therapy may pose special risks. During observation, your doctor will likely recommend periodic CT or MRI scans at an appropriate interval to monitor the tumor.

• Surgery. This is often the treatment of choice for tumors that can be removed with an acceptable risk of spinal cord or nerve injury.

  Newer techniques and instruments allow neurosurgeons to reach tumors that were once considered inaccessible. Sometimes, surgeons may use a high-powered microscope in microsurgery to make it easier to distinguish a tumor from healthy tissue.

  Doctors can also monitor the function of the spinal cord and other important nerves during surgery, thus minimizing the chance of their being injured. In some instances, an ultrasound might be used during surgery to break up tumors and remove the fragments.

  But even with advances in surgical techniques and technology, not all tumors can be totally removed. Sometimes, surgery might be followed by radiation therapy, chemotherapy or both.

  Recovery from spinal surgery may take weeks or longer, depending on the procedure or complications, such as bleeding and damage to nerve tissue.

• Radiation therapy. This may be used following an operation to eliminate the remnants of tumors that can't be completely removed, treat inoperable tumors or treat those tumors where surgery is too risky.

  It may also be the first line therapy for some vertebral tumors. Radiation therapy may also be used to relieve pain when surgery is too risky.

  Medications may help ease some of the side effects of radiation, such as nausea and vomiting.

  Sometimes, your radiation therapy regimen may be adjusted to help prevent damage to surrounding tissue from the radiation and improve the treatment's effectiveness. Modifications may range from simply changing the dosage of radiation to using sophisticated techniques such as 3-D conformal radiation therapy.

  A specialized type of radiation therapy called proton beam therapy also may be used to treat some vertebral tumors such as chordomas, chondrosarcomas and some childhood cancers when spinal radiation is required. Proton beam therapy can better target radioactive protons at the tumor site without damaging the surrounding tissue as in traditional radiation therapy.

• Stereotactic radiosurgery (SRS). This treatment, which isn't actually surgery, delivers a high dose of precisely targeted radiation. In SRS, doctors use computers to focus radiation beams on tumors with pinpoint accuracy and from multiple angles.

  There are different types of technology used in radiosurgery to stereotactically deliver radiation to treat vertebral tumors.

  SRS has certain limits on the size and specific type of the tumors that can be treated. But when appropriate, it's been proved quite effective. Growing research supports its use for the treatment of spinal tumors.

  However, there are risks — such as an increased risk of vertebral fractures. Further study is needed to determine the best technique, radiation dose and schedule for SRS in the treatment of vertebral tumors.

• Chemotherapy. A standard treatment for many types of cancer, chemotherapy uses medications to destroy cancer cells or stop them from growing. Your doctor can determine whether chemotherapy might be beneficial for you, either alone or in combination with other therapies.

  Side effects may include fatigue, nausea, vomiting, increased risk of infection and hair loss.

• Other drugs. Because surgery and radiation therapy as well as tumors themselves can cause inflammation inside the spinal cord, doctors sometimes prescribe corticosteroids to reduce the swelling, either following surgery or during radiation treatments.

  Although corticosteroids reduce inflammation, they are usually used only for short periods to avoid serious side effects such as muscle weakness, osteoporosis, high blood pressure, diabetes and an increased susceptibility to infection.