For metastatic tumours (most common): posterior decompression and stabilisation with pedicle screws and rods, sometimes combined with vertebral body resection and cage reconstruction. For primary tumours: en bloc resection (complete removal with a margin) may be attempted for certain tumour types — requiring complex, staged anterior and posterior approaches. Vertebroplasty or kyphoplasty may be used for painful vertebral metastases without neurological compression. Minimally invasive techniques (separation surgery) may be used when radiotherapy will treat the tumour. Operations range from one to eight hours depending on complexity.
Surgery is recommended for spinal cord compression from tumour causing neurological deficit or at high risk of neurological deterioration, mechanical instability of the spine from bone destruction, intractable pain not controlled by other means, and curative resection of primary spinal tumours.
Radiotherapy (conventional, stereotactic radiosurgery), chemotherapy, hormonal therapy, immunotherapy, bisphosphonates/denosumab for bone metastases, pain management, bracing, and observation. Many spinal metastases are managed without surgery.
Full staging. MRI of the entire spine (multiple levels may be affected). CT for surgical planning. Assessment of oncological prognosis (Tokuhashi, Tomita scores). MDT discussion. Preoperative embolisation for vascular tumours (renal, thyroid metastases).
For decompression and stabilisation: prevention or reversal of neurological deficit, pain relief, and restoration of spinal stability. For curative resection: complete tumour removal with the chance of cure for suitable primary tumours. Quality of life improvement is the primary goal for metastatic disease.
Blood lossCommon
Spinal tumour surgery can involve significant blood loss, particularly for vascular tumours.
Post-operative painExpected
From extensive surgical dissection.
Medical complicationsCommon
Many patients have advanced cancer with poor physiological reserve.
Neurological deteriorationUncommon
Worsening weakness or paralysis. Risk depends on tumour location and surgical complexity.
Wound infectionUncommon
Higher risk in immunocompromised patients and those receiving chemotherapy/radiotherapy.
Implant failureUncommon
Screws may pull out of tumour-weakened bone.
CSF leakUncommon
Dural tear, particularly with intradural tumours.
Disease progressionCommon
Cancer may continue to progress despite surgery.
DVT/PECommon
High risk in cancer patients.
General anaesthesia with neuromonitoring. Significant blood loss potential — transfusion capability essential. Prone or lateral positioning. May be a prolonged procedure.
Hospital stay varies from two days (vertebroplasty) to two weeks (complex resection). Mobilisation as soon as possible. Bracing may be used for three months. Physiotherapy for mobility and function. Oncological treatment (radiotherapy, chemotherapy) may follow. Recovery depends on the patient's overall condition and the extent of surgery.
Oncology surveillance with regular imaging. Spinal X-rays to monitor instrumentation. Neurological monitoring. MDT review.
Will surgery cure my cancer?
For metastatic disease, surgery is almost always palliative — aimed at preserving function and quality of life, not cure. For primary spinal tumours, en bloc resection offers the chance of cure for suitable cases.
Why is the decision so complex?
The decision to operate on spinal tumours balances neurological benefit against surgical risk, estimated survival, the tumour's sensitivity to radiotherapy, the patient's overall condition, and their wishes. MDT discussion ensures the best decision for each individual.