Spinal Tumor Surgery Risks and Success Rates: What to Expect

What are the issues related to spinal tumors? What are the risks associated with surgery?

Around the end of April this year, I suddenly experienced lower back pain.
However, after resting for a few days, the pain subsided, so I didn't pay much attention to it.
In July, while bending over, I heard a popping sound and thought I had strained my back, so I went to an orthopedic clinic for an X-ray.
At that time, the orthopedic doctor mentioned that one of my lumbar vertebrae appeared to be flatter than usual and advised me to be cautious, but he did not recommend further examination at a larger hospital.
A few days later, I was no longer in pain, but I did notice that my lower back was more easily fatigued.

In November, after sneezing, my back pain returned, so I went directly to a major hospital (a medical center in Taipei) to see a doctor.
The doctor ordered an MRI, which revealed that there was a growth on my spine causing a compression fracture.
A biopsy has been performed, and I am currently awaiting the results.
This is the MRI image: (image hosting link) https://imgur.com/a/aYln1wH.
The doctor said that regardless of the biopsy results, I would need to undergo a major surgery lasting 7-8 hours.

I want to ask if this means my situation is hopeless? I understand that all surgeries carry risks, and the doctor mentioned that the success rate is over 90%.
What I don't quite understand is how medical professionals define surgical success and failure.
What conditions are considered successful, and what conditions are deemed failures, especially in spinal surgery? Also, is there a chance that my attending physician might let a resident perform the surgery? If the definition of failure means ending up in a wheelchair, does that mean failure equates to being wheelchair-bound for life? I'm really feeling overwhelmed; I'm only 23 years old...

MING, 20~29 year old female. Ask Date: 2020/12/17

Dr. Chen Yongxue reply Orthopedics

Hello, I would like to understand how surgical success and failure are defined in medicine.
Success is defined as complete tumor removal, no nerve damage, no infection, and secure implantation.
Also, could my attending physician be negligent and let a student perform the surgery? Surgery requires assistance; it is not possible to perform spinal surgery alone.
For other concerns, it is best to discuss directly with your attending physician.
Thank you.

Reply Date: 2020/12/17

More Info

Understanding spinal tumor surgery, particularly for conditions like giant cell tumors, involves recognizing both the risks and the definitions of surgical success and failure. Your situation is understandably distressing, especially given your age and the potential implications of the surgery.
Defining Surgical Success and Failure
In the medical field, the definitions of surgical success and failure can vary based on the specific context of the surgery. Generally, a successful surgery is defined by several criteria:
1. Complete Tumor Removal: The primary goal in surgeries for spinal tumors is often to remove the tumor completely. If the tumor is entirely excised, this is typically considered a successful outcome.

2. Preservation of Neurological Function: A successful surgery should not result in damage to the spinal cord or surrounding nerves. If the patient retains normal neurological function post-surgery, this is a strong indicator of success.

3. Absence of Complications: Successful outcomes also include the absence of significant complications such as infections, excessive bleeding, or the need for additional surgeries.

4. Improvement in Symptoms: Post-operative improvement in symptoms, such as pain relief and restoration of mobility, is also a key factor in determining success.

Conversely, surgical failure may be defined by:
1. Incomplete Tumor Removal: If any part of the tumor remains, especially if it leads to recurrence, this can be considered a failure.

2. Neurological Damage: Any loss of function, such as paralysis or loss of bowel and bladder control, can indicate a failed outcome.

3. Severe Complications: Significant complications that arise during or after the surgery can also define a failure.

4. Persistent or Worsening Symptoms: If the surgery does not alleviate symptoms or leads to new problems, it may be deemed unsuccessful.

Risks of Spinal Tumor Surgery
Surgical intervention for spinal tumors, especially those located in critical areas like the lumbar spine, carries inherent risks. These include:
- Infection: As with any surgery, there is a risk of infection at the surgical site.

- Bleeding: Spinal surgeries can involve significant blood loss, and in some cases, may require transfusions.

- Neurological Damage: There is a risk of nerve damage during surgery, which can lead to complications such as paralysis or loss of sensation.

- Recurrence of Tumor: Some tumors, like giant cell tumors, have a high rate of recurrence, which may necessitate further treatment.

- Complications from Anesthesia: As with any major surgery, there are risks associated with anesthesia, particularly in patients with underlying health conditions.

Surgical Team and Expertise
Your concern about the surgical team is valid. Spinal surgeries are complex and typically require a skilled team. The lead surgeon is usually an experienced orthopedic or neurosurgeon specializing in spinal procedures. It is common for surgical teams to include residents or fellows, but they operate under the supervision of the attending physician. If you have concerns about the experience of the surgical team, it is important to communicate these with your primary surgeon.

Preoperative and Postoperative Considerations
Before surgery, discussions about the potential use of medications like denosumab or bisphosphonates may be beneficial. These treatments can help manage tumor growth and may reduce surgical risks. Postoperatively, rehabilitation and physical therapy are crucial for recovery, and the timeline for returning to normal activities can vary significantly based on individual circumstances.

Conclusion
While the prospect of surgery can be daunting, understanding the definitions of success and failure, the risks involved, and the importance of a skilled surgical team can help alleviate some anxiety. It is crucial to maintain open communication with your healthcare providers, ask questions, and express any concerns you may have. Seeking a second opinion from a specialized center with a robust spinal tumor team may also provide additional reassurance and clarity regarding your treatment options. Remember, you are not alone in this journey, and there are resources available to support you through your treatment and recovery.

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