Surgery for a spinal cord tumour is a microsurgical operation in which the bony covering of the spinal canal is opened to reach a mass growing inside the cord itself, attached to its coverings, or compressing it from the surrounding vertebrae. The aims are to relieve pressure on nervous tissue and to obtain a confirmed tissue diagnosis on which the rest of treatment is built. Operation is usually considered when back or neck pain does not settle with rest and is worse at night, when numbness and weakness are progressing in the limbs, when balance and walking deteriorate, or when bladder and bowel control change. Neurological deterioration over hours or days is an emergency that must not be delayed. The plan is made by a multidisciplinary team of neurosurgeon or spine surgeon, oncologist, neuroradiologist and rehabilitation therapists, after contrast MRI of the whole spine and a documented neurological examination. Intra-operative neurophysiological monitoring of spinal cord function may be used to warn the surgeon immediately if a safety limit is approached. Candidacy is decided by clinical examination and review of the images, not by reading a general description. The limits must be clear before consent. Surgery protects the function that remains far more than it restores function lost long ago, and it cannot guarantee that walking or bladder control will return. Complete removal is not possible in every case, particularly when the tumour is interwoven with spinal cord fibres, so decompression and biopsy may be the deliberate goal. In malignant or metastatic tumours the operation is one part of a plan that includes radiotherapy and drug therapy rather than a substitute for them, and some small, slow, symptom-free tumours are followed with imaging instead of being operated on. The procedure is carried out under general anaesthesia, followed by supervised early mobilisation and a rehabilitation programme whose progress is measured in weeks rather than days, with follow-up imaging at intervals the team sets.
Procedure steps
- 1
Localisation and baseline neurological assessment
Contrast MRI of the whole spine is reviewed to establish the level of the tumour and its relationship to the cord and nerve roots, and the neurological examination is documented in detail, including power, sensation, reflexes and bladder function, so any later change can be measured against it.
- 2
Anaesthesia and intra-operative neuromonitoring
General anaesthesia is given and chosen so that nerve signals can still be monitored, the patient is positioned to keep the spine aligned and to protect joints and peripheral nerves, and electrodes for monitoring motor and sensory pathways are connected.
- 3
Bony exposure and opening of the coverings
A limited part of the posterior vertebral elements is opened, only as much as safe access requires, preserving as much mechanical stability as possible. The coverings around the spinal cord are then opened under microscopic magnification with meticulous control of pressure and bleeding.
- 4
Microsurgical removal
The tumour is separated from nervous tissue layer by layer with fine instruments, within the limits that monitoring signals allow: if further removal threatens an essential motor pathway, the surgeon stops at a safe point and settles for decompression, and samples are sent for pathology.
- 5
Closure, stabilisation when needed, and recovery
The coverings are closed tightly to prevent a cerebrospinal fluid leak, instrumented fixation with screws and rods may be added if the tumour or the exposure has weakened vertebral stability, and the patient is monitored in an appropriate unit with hourly checks of limb movement, sensation and bladder function.
Before the procedure
Tell your doctor about all your medicines, especially blood thinners, steroids and diabetes treatment, and stop none of them on your own; follow the team's instructions. Report previous back surgery, osteoporosis, and any skin, urinary or dental infection before the date. Complete contrast MRI of the whole spine and any other requested tests, and bring the reports on the day of admission. Ask about the plan to prevent venous thrombosis, when physiotherapy will start, and how you should lie in bed. Prepare your home in advance: a bed that is easy to get out of, clear walkways, a safe bathroom, and someone to help during the first two weeks. Stop smoking as far as you can, since it delays healing and wound union, and follow the fasting time before anaesthesia.
After the procedure
Mobilise early, but only as your physiotherapist directs, and avoid twisting, bending and lifting for the period your surgeon specifies. Keep the wound clean and dry, attend dressing and suture-removal appointments, and take painkillers as prescribed rather than by your own judgement. Record daily the strength and sensation in your limbs and your bladder control; this record tells more about your progress than any single scan. Do not skip rehabilitation sessions even if you improve quickly. **Seek emergency care immediately** if you develop **new or increasing weakness in the legs or hands**, numbness climbing upwards from the feet, **urinary retention or involuntary leakage of urine or stool**, numbness in the saddle area between the thighs, severe pain unresponsive to your painkillers, fever with a red or discharging or opening wound, clear fluid leaking from the wound with headache that worsens on sitting up, or a swollen painful calf or sudden shortness of breath.
Expected duration
Usually three to eight hours depending on the level and size of the tumour, with a typical stay of three to seven days followed by rehabilitation.
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