Our Approach & Expertise

	Our Spine Team (From left) Eric Lis, Neuroradiology; Lucy Garcia, RN; Mark Bilsky, Neurosurgery; and George Krol, Neuroradiology

Our multidisciplinary approach to the treatment of spine tumors allows neurosurgeons, orthopaedic surgeons, radiation oncologists, medical physicists, neuroradiologists, physiatrists, neuro-oncologists, physical therapists, occupational therapists, and nurses to work together as they devise an individualized treatment plan for each patient.

When a patient comes to our clinic, he or she can see multiple members of the treatment team all on the same day. This approach also allows our team of specialists to consult as a group with the patient in order to determine the treatment plan and evaluate progress.

In addition, our team meets weekly at the Spine Tumor Board. During these meetings, each patient's case is reviewed, and treatment plans are devised and discussed in order to determine the best therapy possible.

Individualized Treatment

Advanced diagnostics combined with surgery, radiation therapy, and/or other treatments, followed by rehabilitation are used to ensure that patients receive the most sophisticated and effective care possible.

The majority of spine tumors have spread, or metastasized, from another location in the body to the spine. Treatments for these tumors are devised to help with mobility, relieve pain, control local tumor growth, and improve quality of life.¹ Because most patients receive more than one type of therapy, our doctors collaborate from the very beginning on all aspects of care.

When devising a treatment plan, our surgeons and radiation oncologists follow a conservative "treatment decision framework," which was developed to help the treatment team determine whether surgery or radiation therapy will be most effective in improving neurologic and functional ability, stabilizing the spine, relieving pain, and controlling local tumors. By using this framework as a guide, our team's goal is to find the best treatment for each individual patient.²

	Radiation oncologists Yoshiya Yamada and Brett Cox

After the tumor's exact location is determined by our neuroradiology team, treatment decisions can be made. Radiation therapy and surgery are the most common treatments for spine tumors.

Radiation Therapy

Memorial Sloan-Kettering's radiation oncologists use image-guided radiation therapy (IGRT) to deliver stereotactic radiosurgery in the treatment of both metastatic and primary spine tumors. IGRT is one of the most advanced and precise external radiation treatment techniques. It uses radiation beams of varying intensity that can be "sculpted" to precisely match specific tumor shapes and sizes, helping increase the surrounding radiation dose delivered to the tumor while reducing the dose to normal, healthy tissues and, possibly, minimizing the side effects of treatment.

Our experts have treated well over 300 patients with spine tumors using IMRT, and have found tumor control to be greater than 90 percent.^{3 4 5 6}

	Neurosurgeon Mark Bilsky

Surgery

To treat spine tumors, radiation is often effective, but some patients will need surgery in order to relieve pain, or to preserve strength and the ability to walk. Our spine surgeons operate on about 140 patients a year and have developed techniques to make surgery safer and more effective for cancer patients.

In addition to treating metastatic spine tumors, we operate on many types of primary spine tumors, and have expertise in chordomas, which are found most often in the lower part of the spine known as the sacrum (also called the tailbone).^{7 8} We also see a large number of intradural tumors that begin in the membranes surrounding the spinal fluid, spinal cord, and nerve roots (an area called the spinal dura). For example, our surgeons operate on intradural extramedullary tumors (those that begin inside the spinal dura but outside the spinal cord), as well as intradural intramedullary tumors (those that occur inside the spinal cord).

We also treat tumors that grow next to the spine in the network of intersecting nerves called the nerve plexus, which supplies nerves to the arms (brachial plexus) or legs (lumbosacral plexus). Two types of tumors that develop in this region are called neurofibromas and ganglioneuromas. Removing these tumors often requires a multidisciplinary team of surgeons who specialize in spine, thoracic, and abdominal surgeries. Many of these tumors can be treated with minimally invasive techniques (also known as laparoscopy).

	Rehabilitation specialists Michael Stubblefield and Christian Custodio (from left)

Rehabilitation Medicine

Both during and after treatment, our rehabilitation specialists work with patients to relieve muscle, bone, and nerve pain, and restore function and quality of life to patients with cancer-associated spine and spinal cord injuries. Exercises and other therapies are prescribed following treatment to help strengthen affected muscles, as well as to stretch and loosen other supporting tissues of the body known as soft tissues, such as muscle, fat, fibrous tissue, and blood vessels.⁹

Our physiatrists use an electrodiagnostic method called electromyography (EMG) to help evaluate nerve and muscle disorders related to spine tumors. The information can be useful in predicting nerve recovery or in directing further therapy.

We also have clinical and research interests in the use of botulinum (Botox) toxins for management of back pain following spinal surgery or radiation therapy.¹⁰

Physical and Occupational Therapy

Our staff of skilled physical and occupational therapists are expert in the use of therapeutic exercise, neuromuscular training, and patient/caregiver education. This approach is designed to improve patients' quality of life by helping them reach maximum functional potential.

Our Support Services We understand that life can be different after a diagnosis of cancer more

Memorial Sloan-Kettering offers a broad range of psychosocial support programs designed to help patients and family members cope with the spectrum of issues related to life during and after treatment. For more information about the support services we offer patients with spine tumors, their families, and caregivers, visit the Support Services section of our Web site.