Carlos Bagley, M.D. Answers Questions On: Spinal Cord Tumors

It depends on the patient’s clinical circumstances. More often than not, a spinal cord tumor is a cervical or thoracic lesion, but not always. Factors include the patient’s clinical condition at presentation, the location of the tumor, and the risk versus the reward of the surgical resection. There are some very intricate areas that are particularly high risk.

With the appropriate skills, tools, and team, those lesions can be very safely removed. But the circumstances have to be appropriate for that. We look at all the tools we have – radiosurgery, traditional radiation therapy, surgery, as well as observation – and determine with the patient what’s the best decision for him or her. That’s key, that the patient be involved in the decision.

Depending on whether it’s a primary spinal cord tumor or a spinal column tumor (a tumor in the bone), the approaches vary tremendously. For example, with a spinal cord tumor, we typically don’t have to think about reconstructing the spine once we’ve removed it. It’s more about how we can access the tumor and what’s going to be the safest corridor to get there. Usually that’s directly through the back.

For a spinal column tumor, on the other hand, where the bone is involved and in many cases can be destroyed, we have to think of not only how we’re going to remove the tumor but also how we’re going to reconstruct the bone. The key is thinking first of the removal and then of the reconstruction and not the other way around. Some of the challenges I’ve seen others run into have resulted from their thinking first about how to reconstruct versus first how to get the tumor out. Removing the maximum amount of the tumor in a safe fashion is really the primary objective. We have enough tools now that, with a broad enough surgical skill set, we can pretty much reconstruct and put any area of the spinal column back together.

With one tumor in particular called chordoma – a primary tumor of the bone that’s relatively rare but can be very devastating to the patient because it has a high propensity for reoccurrence – we’ve been able to develop new laboratory models to study new treatments and also look at new treatment paradigms. In initial results, we have been able to show significant promise in decreasing the risk of reoccurrence of those tumors and increasing the local control rate.

Any time you can improve the care and treatment of something that’s potentially devastating to our patients because of its impact on their lives, it’s always very exciting for doctors and patients.