ortho spine and tumors

[MilesDavisTheDoctor]

Do orthopedic spine surgeons do a good amount of tumor surgery or is that left mainly to neurosurgeons?

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[DrOrthoSpineMD]

we tend not to do intradural work. if the tumor is intradural ortho spine generally refers to nsg.
ive done numerous spine tumors/mets cases in the vertebral body or posterior elements.

 

[MilesDavisTheDoctor]

How often do you see spine tumors in your practice?

 

[longhaul3]

Anyone who practices general spine surgery or covers spine call will see a ton of mets to the bony spine. Degen spine and tumors probably make up > 95% of general spine consults/referrals in my rough estimation. Mets love to go to the spine.

Most ortho spine surgeons I know will do a bony tumor case (corpectomy, perc fix, whatever) for stabilization/decompression that comes in on call. Not sure how often they do separation surgery, but when we split spine call and anything extradural comes in on their watch, they see it. We as neuro do all the intradural stuff.

 

[MilesDavisTheDoctor]

what type of tumors what an orthopedic spine surgeon see? is it mainly just mets to the vertebrae or primary tumors in the vertebrae and spinal cord outside the dura

 

[longhaul3]

Mostly mets. Primary bone tumors of the spine are much less common but every now and then you see a sarcoma or some aggressive but benign lesion like an aneurysmal bone cyst.

The spinal cord is inside the dura so there aren't any extradural spinal cord tumors. The general classification scheme is extradural vs. intradural extramedullary (IDEM) vs. intramedullary. Intramedullary tumors are in the spinal cord itself but are by definition intradural.

 

[MilesDavisTheDoctor]

Do you like mets cases?

 

[longhaul3]

Mets are not a single kind of case. They cause all different kinds of surgical spinal disease based on their location, extent of proliferation, and pathology.

A case for a spinal met can range from an open or percutaneous biopsy that takes 10 minutes to a laminectomy for epidural decompression that takes an hour to a multilevel transthoracic corpectomy that takes 2 days. It can be done for diagnosis, palliation, separation, or more rarely for cure.

They can be frustrating because they are some of the biggest whacks we do, and often patients will still die within weeks or months despite a more favorable prognosis. Sometimes we only do the surgery to debulk the tumor so the patient can safely have radiation without impacting the cord (separation surgery). On the other hand, they can be satisfying because we can give people some of their functionality back so they can live out their days with at least a minimal quality of life.

 

[MilesDavisTheDoctor]

does ortho ever get to do any stuff in the dura? I see some fellowships talk about giving ortho spine surgeons training in intradural pathology but im not really sure what that means. It's too bad it seems like ortho doesn't do that stuff, those seem like the dankest tumors