Contemporary Techniques for the Treatment of Spinal Tumours

Harris Clark^*
*Correspondence: Harris Clark, Department of Neuroscience, Kabul University, Kabul, Afghanistan, Email:

Keywords

Primary spinal tumors • Spinal metastases • Spine tumor treatment

Introduction

The bony structure that houses the spinal cord is referred to as the spine. In addition to safeguarding this vital component of the central nervous system, the spine is also in charge of supporting the body's weight, withstanding external forces, allowing for mobility and flexibility, dissipating energy and shielding the body from impact. Sadly, the spine is also susceptible to a variety of diseases, with spinal disorders being one of the most common and costly medical conditions. The spine in particular was found to be the most common location for metastases in the skeletal system. It was also found to be a rare but challenging location for several primary tumors that can cause neurological impairments, putting a significant strain on patients and healthcare systems worldwide.

Discussion

Spinal tumors can be treated with a variety of methods, including radiation and highly invasive en bloc resection. However, there are some limitations to the application and efficacy of spine oncology therapeutic approaches. As a result, modern technologies like nanotechnology, 3D printing and digital tools started to be used more and more in spine tumor management to get around the drawbacks of traditional treatment methods. Due to the blood–spinal cord barrier, instability of antitumor agents and rapid elimination from the desired tissue, the majority of chemotherapeutic drugs encounter difficulties in reaching the target tissue and exerting their pharmacological activity. Additionally, the organism is susceptible to off-target toxicity due to its lack of selectivity. In this context, nanomaterials emerged as promising drug carriers, reducing side effects, enhancing drug distribution and bioavailability, enhancing tumor site absorption and increasing transported biomolecule therapeutic efficacy. When a tumor needs to be removed, a variety of surgical methods can be used, depending on the type of tumor, the goal of the surgery and the patient's overall health [1].

To further develop methodology accuracy and postoperative results, arising advanced innovations began being integrated into growth resections as reciprocal instruments for envisioning the careful field. In addition, since the tumor was removed, significant advancements have been made in reconstructive techniques. With the help of 3D printing technologies, the recent focus has been on addressing the unique characteristics of each patient and designing individual personalized implants. To that end, the purpose of this paper is to discuss the most recent developments in anticancer nanoformulations, personalized implants and improved surgical techniques, as well as the types of spine tumors and the most common current treatment options. A portion of these points have been the subject of past surveys in the field. This paper, on the other hand, focuses on the most recent advancements in the treatment of spine tumours. It mostly discusses studies that were published between 2018 and 2022 and offers several perspectives for the future. This review takes a comprehensive approach with the goal of providing an overview of current and emerging therapeutic strategies, laying the groundwork for subsequent research in the field and assisting in the conception of more effective solutions [2].

About 15% of all tumors in the central nervous system are spine-specific. A spinal cord tumor is a mass that grows in the spinal canal or in the spinal bones. It typically falls into one of three categories: intramedullary, extradural and intradural-extramedullary. Extradural tumors are the most prevalent of these types because they are typically metastatic and originate in vertebral bodies or other structures outside the dura. The intradural-extramedullary tumors, which originate from leptomeninges or nerve roots, are the second most common type of spine tumor. These tumors grow outside of the spinal canal, despite being inside the dura, as their name suggests. The last type of spine tumors, which invade and destroy the grey and white matter of the spinal cord and are the least common, fall into this category. The following sections provide additional information on spine tumors, which are divided into primary spinal tumors and spinal metastases according to their origin. A small percentage of all tumors in the central nervous system are primary spinal cord tumors. The heterogeneous group of benign and malignant neoplastic tumours known as intramedullary spinal cord tumors (IMSCTs) includes ependymoma, astrocytoma, glioblastoma, hemangioblastoma, ganglioglioma, germinoma and lymphoma [3].

The majority of IMSCTs are considered benign because they do not localize infiltrate spinal cord parenchyma. Nevertheless, some tumors behave malignly. Sadly, they are frequently diagnosed in later stages, particularly when there are no early neurological deficits. The tumor has already invaded the spinal canal when neurological symptoms appear, reducing the likelihood of tumor resection and leading to significant morbidity and mortality. Primary osseous spinal tumors (POSTs), a rare neoplasm that make up about 5% of all primary bone tumors, are another category of spine-located tumors. Chordomas, chondrosarcomas, Ewing sarcomas and osteosarcomas are the most common malignant POSTs. Chordomas are the most common sacral malignancy and present significant surgical and oncological challenges. The primitive notochordal remnants of the axial skeleton are the source of these slow-growing, bone-destructive tumors, which typically develop in the sacrum but can also develop in the mobile spine (such as the cervical spine and thoracolumbar spine). On the other hand, chondrosarcomas mostly affects the thoracic spine; be that as it may, it might likewise happen in different areas of the spine [4].

Chondrosarcomas originate primarily from the embryonic remainder of the cartilaginous matrix. Although it rarely affects the spine, Ewing sarcoma is one of the most common bone sarcomas affecting young people. However, due to its close proximity to neurologic and vascular structures, this mesenchymal tumor in the mobile spine presents significant local treatment challenges. Spinal osteosarcomas, the last group of POSTs, are tumors that typically occur in the posterior parts of the thoracic and sacral regions of the spine and, less frequently, the cervical region. The majority of osteosarcoma symptoms are nonspecific, making it difficult to diagnose the disease at an early stage and placing a significant strain on the patient, their caregivers and health-related budgets. The primary treatment option for spine tumors is surgical excision, which must be included in the diagnostic and therapeutic plan approved by the multidisciplinary tumor board. Tumor control, spinal cord decompression and mechanical stability restoration are the primary reasons for surgery. The goal of the procedure varies depending on the type of tumor; specifically, primary tumors are removed with the intention of curing the disease, while metastases are resected to alleviate symptoms. Multi-metastatic patients, on the other hand, typically require a decompression procedure because tumor resection surgery is out of the question.

Resection of a spine tumor can be accomplished using a variety of surgical methods, including en bloc resection of the affected tissues and minimally invasive surgery. The removal of the tumor and the long-term reconstruction of the spine and surrounding tissues must both be part of surgical resection. Percutaneous procedures like vertebroplasty and kyphoplasty can be used to inject polymethylmethacrylate into the vertebral body using X-ray or CT in certain situations, such as malignant vertebral compression fractures. A polymer injection prevents the vertebral body from further collapsing, reduces pain from micro fractures and stabilizes the vertebrae. However, due to their inability to reduce tumor size, these procedures are not suitable for treating pain or neurological deficits brought on by nerve root or spinal compression. A good alternative for expediting a patient's return home and continuation of oncological treatment, facilitating postoperative recovery, reducing the risk of complications and facilitating postoperative recovery is the use of minimally invasive surgical techniques. For improving tumor surgery capabilities, endoscopic and robot-assisted procedures have gained ground in this regard.

Due to the fact that it is nearly impossible to repeat excision procedures for primary malignant tumors of the thoracic and lumbar spine if the initial resection is incomplete, tumor resection needs to be as complete as possible. In this setting, extensive surgical excision is frequently required to guarantee the removal of all malignant tissue and stop the recurrence of the tumor. As a result, wide en bloc resection, which involves removing the tumor within a layer of healthy tissue known as the "margin" continues to be the most effective method. The margin is essential for preventing tumor growth, but it is frequently difficult to achieve due to anatomical constraints. To prevent tumor recurrence in these situations, postoperative adjuvant therapies are necessary. Because of the sacrum's structural role and the presence of the sacral nerve roots, resection of sacral lesions is thought to be particularly challenging. In addition, there is a possibility of blood loss during surgery due to the close relationship between this anatomic structure and the pelvic vasculature. Resection of a spine tumor typically involves a double anterior plus posterior step, though sometimes only a posterior approach is used. To enable peritumoral devascularisation and release of the tumor anteriorly in the retro rectal space, the anterior approach calls for sub umbilical medial laparotomy. The posterior approach, on the other hand, assumes a medial longitudinal or arched transverse incision that always includes the biopsy area and can be performed during the same surgical step or 24 to 48 hours after the anterior step [5].

Conclusion

Wide resection is necessary for local disease-free progression, but it also necessitates more extensive reconstructive surgery and may result in significant patient morbidity. When surgery is combined with radiotherapy, surgical site infections, fatigue fractures, haemorrhagic complications, pseudomeningocele, osteomyelitis, sacroiliac instability, non-union, digestive fistula, cerebrospinal fluid leakage and ureter wounds are all examples of surgical complications. A number of serious complications, including infections (such as meningitis and arachnoiditis), intracranial hypotension-related issues (such as intracranial haemorrhage and cranial nerve palsies) and neurological deficits related to the compression or incarceration of neural elements, may also result from cerebrospinal leakage. In addition, anaesthesia plans must take into account intraoperative neuromonitoring and patient comorbidities as well as the associated perioperative risks. Postoperative nausea and vomiting, as well as delayed awakening brought on by intraoperative anaesthetic factors, can be complications of patient-controlled anaesthesia. Postoperative visual loss (one of the rarest but most feared complications of spine surgery), acute or chronic pain and pressure ulcers are additional potential issues associated with prolonged spinal tumor resection.

Acknowledgement

None.

Conflict of Interest

None.

References

1. Frost, Brody A., Sandra Camarero-Espinosa and E. Johan Foster. "Materials for the spine: Anatomy, problems and solutions." Materials 12 (2019): 253.

Google Scholar, Crossref, Indexed at

2. Grijalvo, Santiago, Manuel Nieto‐Díaz, Rodrigo M. Maza and Ramón Eritja, et al. "Alginate hydrogels as scaffolds and delivery systems to repair the damaged spinal cord." Biotechnol J 14 (2019): 1900275.

Google Scholar, Crossref, Indexed at

3. Ge, Laurence, Karan Arul and Addisu Mesfin."Spinal cord injury from spinal tumors: Prevalence, management and outcomes." World Neurosurg 122 (2019): e1551-e1556.

Google Scholar, Crossref, Indexed at

4. Bollen, Laurens, Sander PD Dijkstra, Ronald HMA Bartels and Alexander de Graeff, et al. "Clinical management of spinal metastases: The Dutch national guideline." Eur J Cancer 104 (2018): 81-90.

Google Scholar, Crossref, Indexed at

5. Lador, Ran, Gilad Regev, Khalil Salame and Morsi Khashan et al. "Use of 3-dimensional printing technology in complex spine surgeries." World Neurosurg 133 (2020): e327-e341.

 Google Scholar, Crossref, Indexed at