Surgery for spinal cord compression

Your doctor might suggest you have surgery to treat cancer affecting your spine. There are different types of operations you might have. These are to:

• remove cancer
• relieve pressure
• make your spine more stable

Spinal surgery might sound like a frightening procedure, but it is quite safe. Doctors who carry out these surgeries are very skilled specialists. You can share any concerns with your doctors and cancer nurse specialist. They will be able to tell you what will happen during the operation.

Spinal surgery is not suitable for everyone. It can be a big operation so you need to be well enough. Speak to your doctor about what other treatments you may be able to have if you can’t have spinal surgery.

Who does your surgery?

A specialist team of doctors does your surgery. They are either called neurosurgeons or orthopaedic spine surgeons. Neurosurgeons specialise in treating the brain and spine. Orthopaedic spine surgeons specialise in treating the bones and the spine.

When you have it

Your surgeon might offer you surgery for one or more of the following reasons:

• to relieve pressure on your spinal cord because you have spinal cord compression
• to make your spine more stable
• to prevent you from developing spinal cord compression
• because you have a cancer type that doesn't usually respond well to radiotherapy
• because you still have uncontrolled pain 

You have surgery as soon as possible if you have spinal cord compression.

Spine stability

You might hear your doctors describe your spine as stable or unstable. The stability of your spine can affect what treatment you have. 

A healthy, stable spine provides your body with support and structure, and it protects your spinal cord. It means you can move around freely and control your movement. Cancer in the spine can affect how stable your spine is.

To find out how stable your spine is, the doctors assess your pain and other factors such as:

• where the cancer is in your spine
• what the tumour looks like on the scan
• whether the bones (vertebrae) are in the correct position (aligned) and your spine curves as it should
• whether any vertebrae have collapsed

The spine, spinal cord and vertebrae

To understand the different types of spinal surgery, it can help to know more about the anatomy of the spine and bones (vertebrae).

Your spine is divided into 4 parts or regions:

• the cervical spine - this is the neck area
• the thoracic spine - this is the area in the upper and middle back
• the lumbar spine - this is the lower back area
• the sacral spine - this is the base of the spine

It is made of small bones known as vertebrae. These sit on top of each other to make the spinal column. There are soft cushions of tissue (discs) between each vertebrae. 

The vertebrae protect the spinal cord. The spinal cord is a long bundle of nerves that stretches from the brain to the lower part of the back. The nerves send messages from the brain to control movement and feeling in different parts of our body. Cerebral spinal fluid (CSF), fat and tissue also help protect the spinal cord inside the spinal column.

Vertebrae

All vertebrae are made up of:

• a vertebrae body at the front 
• a vertebrae arch at the back

There is a hole (spinal canal) between the vertebrae body and the vertebrae arch. The spinal cord runs through this in the upper part of the spine. In the lower part of the spine (the lumbar spine), the spinal cord becomes branches of nerves. This is called the cauda equina. It also runs through the spinal canal. 

Each vertebrae arch has a part called the lamina. The lamina forms the back part, or roof, of the spinal canal.

Types of spinal surgery

There are different types of surgery. You might have:

• a vertebrectomy – the surgeon removes a vertebrae
• a laminectomy – the surgeon removes part of a vertebrae (the lamina) to relieve pressure on the spinal cord

You might hear your doctor call a laminectomy 'decompression surgery'.

There are different ways to stabilise your spine. You might have one of these procedures during surgery to remove your cancer. Or you might have it on its own, to help with your symptoms. You might have one, or several of the following procedures:

• vertebroplasty or kyphoplasty – the surgeon injects cement into the vertebrae to stabilise the spine and help symptoms
• using a piece of bone (bone graft) to replace a vertebrae
• metal rods or screws to make your spine stable

Surgery to remove a vertebrae (vertebrectomy)

During a vertebrectomy, the surgeon removes a vertebrae from the spinal column. They also usually remove the discs on either side. This can relieve pressure on the spinal cord. 

To fill the empty space and support the rest of your spine, the surgeon replaces the vertebrae. They might use:

• bone from another part or your body (a bone graft)
• a cage and metal plate 

You have the operation under general anaesthetic, which means you are asleep. You might need to stay in hospital for 2 or 3 nights, depending on your situation. 

Surgery to remove part of the vertebrae (laminectomy)

During a laminectomy, the surgeon removes a section of bone from the vertebrae arch. This is called the lamina. They then remove as much cancer as they can. This relieves pressure on the spinal cord. The surgeon might also call this decompression surgery.

The surgeon might put small screws in the vertebrae to replace the lamina. Or they might use larger screws and rods to make your spine stable.

You have this operation under general anaesthetic which means you are asleep. 

Making your spine stable

Your surgeon will need to stabilise your spine after surgery. Or you might need surgery to stabilise your spine because one of your vertebrae is damaged or has collapsed. There are different ways they can do this. You might have a combination of these:

Bone graft

You might have a bone graft as part of your surgery. The bone graft fills the space and supports your spine when the surgeon removes a vertebrae. The surgeon might use a piece of bone from another part of your body. Or use bone from someone else (a donor).

They use a metal plate and screws to hold the vertebrae and bone graft in place.

Metal rods and screws

The surgeon places screws through part of the vertebrae arch. They attach these to metal rods which are joined together in the back of the spine. This makes a brace which holds the vertebrae in place.

This is called a pedicle screw fixation.

Vertebroplasty and kyphoplasty

There are two ways of injecting special medical cement into your spine. They are:

• vertebroplasty
• kyphoplasty

You might have this treatment if painkillers aren’t controlling your pain. Or if the bones of the spine have collapsed.

In vertebroplasty, the surgeon injects bone cement into damaged vertebrae. The treatment eases pain and helps to support the spine.

Balloon kyphoplasty is similar to vertebroplasty. Surgeons use it to treat breaks (fractures) in vertebrae.

For kyphoplasty, the surgeon puts little balloons into the spine. They slowly inflate them so that the spine goes back to as near its normal height as possible. Then they inject special cement into the space created by the balloon. This is to strengthen the bone.

How your surgeon does the operation

You have a general anaesthetic, which means you'll be unconscious during the operation. How long it takes varies. Some operations can be quite quick, and others can take many hours. It depends on how complicated the surgery is. 

Open surgery

Your surgeon makes a cut (incision) on your back running vertically along your spine. The length and position of the cut will depend on:

• where the cancer is in your spine
• how many verterbrae are affected

Sometimes the surgeon may decide it is safer to remove the cancer in your spine from the front of your body.  For example, the surgeon might make an incision:

• in your neck or chest if the cancer is in your upper spine
• in your tummy (abdomen) if the cancer is in your lower spine

Minimally invasive or keyhole surgery

Keyhole surgery is also called minimally invasive surgery.  It means having an operation without needing a major cut in your back. This type of surgery is only suitable in certain situations.

The surgeon makes smaller cuts in your back. They can insert screws through these cuts to stabilise the spine. They might still need to make another small cut in the middle of your back. This is to remove some of the cancer and decompress the spine. 

After your surgery

After the operation you will have a dressing over the area on your back. There will be stitches or staples in your wound or wounds. These stay in for about 5 to 10 days after surgery.

You may have one or two tubes (drains) coming from your wound. The nurse will remove the drains after a day or 2.

You will probably have some pain straight after the surgery. This should improve in the weeks following your operation. Your nurses will monitor your pain closely and give you regular pain relief.

Your surgeon and physiotherapist will tell you when you can start moving around. They will encourage you to get out of bed as soon as possible. The physiotherapist will help you stand and walk if you are able. They might give you some exercises to help you get stronger and move around.

How long you stay in hospital will depend on your situation. You might be able to go home after a few days if your pain is well controlled and you can manage at home. Your health care team will talk to you about your home situation. They will start planning your discharge as soon as possible.

Problems after surgery

Your surgeon will talk to you about the possible risks and side effects. It is common to forget questions you may have. It can be helpful to write down your questions and take these when you meet your surgeon.

Side effects following spinal surgery can include:

• pain
• bleeding
• infection
• blood clots in your lungs or legs
• damage to the nerves in your spinal cord
• leaking of the fluid surrounding the spinal cord

There is a risk that the surgery might not help your symptoms. You might continue to have problems or pain after the operation. Your surgeon will talk to you about this before your operation. They will tell you how likely it is that you will have some benefit from the operation. And they will also talk to you about the risks of surgery. 

Coping

It can be difficult to decide whether to have surgery. You need to think about how surgery could affect your quality of life. This includes the possible side effects as well as spending time in hospital. It's important to understand what the treatment can achieve.

There might be a counsellor or specialist nurse at the hospital who you can chat to. You may also want to talk things over with a close relative or friend. After you have had time to think about the options, you and your doctor make the final decision together. It can be helpful to talk over difficult decisions with someone who is outside your circle of family and friends.

You can use Cancer Chat. This is our free online discussion forum for people affected by cancer. It is a safe space to talk to other people in similar situations, and find information and support.

If you have a question about cancer, you can contact our team of specialist cancer information nurses. Call free on 0808 800 4040, 9am to 5pm, Monday to Friday. To talk in your preferred language, ask for our interpreting service. Or you can send us a question online.