Spine Surgery: Tumors of the Spine
Guest: Dr. Bruce Frankel – Neurosurgery, MUSC
Host: Dr. Linda Austin – Psychiatrist, MUSC
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Bruce Frankel, who is Associate Professor of Neurosurgery here at the Medical University of South Carolina. Dr. Frankel, you’re doing some very interesting work in the treatment of tumors of the spine. To start off, is this cancer that begins in the spine, or cancer that starts somewhere else, like breast, and spreads to the spine?
Dr. Bruce Frankel: The most common cancers, unfortunately, are ones that spread from tumors that arise elsewhere. Only very rarely do we see primary tumors arising within the spine or the spinal cord itself.
Dr. Linda Austin: Now, I would think that those most be very painful cancer sites and really keep patients from having quality of life. Is that not correct?
Dr. Bruce Frankel: It really is. The first presentation, and often one that’s ignored until worse symptoms arise, is pain, and pain that keeps them up at night.
Dr. Linda Austin: Can they metastasize to any part of the spine, or is there one section or another that’s more common?
Dr. Bruce Frankel: Probably directly proportional to the bony mass, so the thoracic and lumbar spine would be more common than the cervical spine.
Dr. Linda Austin: I see. And how do you treat these?
Dr. Bruce Frankel: There are a variety of treatments available. Traditionally, these tumors were just radiated. But over the last ten years, literature has shown that there is an important role for surgical management, in addition to adjuvant therapy such as chemo and radiation.
Dr. Linda Austin: So, walk me through that. Let’s imagine you have a woman, or a man, come to you and they’ve been diagnosed with lung cancer, or breast cancer, and, early in the course, it has shown up as a primary lesion somewhere else, secondary tumor, then, of the spine. What do you do as a neurosurgeon?
Dr. Bruce Frankel: As a neurosurgeon, my role is to prevent neurological catastrophes, as well as to prevent pain and stabilize the spine, if need be. The first thing I’ll find out is how much pain the patient is in: are they functional? If it’s just pain, can that pain be treated using an injection of cement, for example, or some other therapy, such as radiation therapy, so that one can avoid surgery? If, in addition to the pain, there’s a neurological deficit, or the spine is fractured and unstable, it’s important to stabilize the spine, decompress, or take the tumor off the neural elements and then stabilize the spine, so that they can remain functional and have a good quality of life.
Dr. Linda Austin: And, just to clarify, clearly, you’re not really getting at the heart of the cancer itself, because that has to be treated with chemotherapy, and there are other sites. But because the spine is such a vulnerable point, both from the person’s pain level and their function, it must be very important to get in and treat this.
Dr. Bruce Frankel: It is. And I think you hit on a very important roll, that it isn’t going to cure their cancer. But what we try to do is improve their quality of life by reducing pain, and improve the length of time the patient can be mobile and not lose strength in their legs, for example, which can have a negative impact on their longevity.
Dr. Lind Austin: Absolutely. So, the procedure, then, of injecting with cement, from start to finish, how long does that take?
Dr. Bruce Frankel: For simple fractures of the spine that don’t involve neurological deficits, weakness, or dysfunction of the bowel or bladder, the spine can be stabilized in 15 minutes with a small injection of cement, which has been shown to markedly reduce pain. And I’d like to think of that as a pain-reducing procedure, more so than a treatment for that particular cancer.
Dr. Linda Austin: Is the patient awake during the procedure?
Dr. Bruce Frankel: They can be awake. We have a discussion with them before that. Some prefer to be asleep, since it involves minimal discomfort. Others prefer, or their disease state may warrant, that they’re awake for the procedure.
Dr. Linda Austin: I see. And then, do they spend the night at the hospital after that?
Dr. Bruce Frankel: They have the option, depending on how they’re doing, to spend the night. Many prefer to go home that same day.
Dr. Linda Austin: I understand this can really offer very dramatic relief of pain. Is that right?
Dr. Bruce Frankel: It can. And one of the important ways to think about that is, if you use radiation, maybe radiation should be thought of as a silver bullet; it can be used once, but if the tumor grows through it, or there’s a recurrence, radiation can’t be used in that area, or areas nearby. So we like to have the option of using other modalities in addition to, maybe, postpone the radiation, and some of the risks it has as well.
Dr. Linda Austin: Dr. Frankel, thank you so much for talking with us today.
Dr. Bruce Frankel: You’re welcome. Thank you.
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