Interdisciplinarity, Follow-up and Rehabilitation

Chapter 13 - Management of Spinal Tumours

Treatment of intramedullary and intradural–extramedullary tumours is a surgical domain with superior long-term results. Radiotherapy must be considered in malignant tumours.

Patients with spinal metastasis (all compartments) and primary spinal bone tumours have to be included in an interdisciplinary decision-finding process.

As a general rule, extradural spinal tumours can be treated with radiation or have to be irradiated after primary decompression and stabilisation (photons or protons [e.g. chordomas]). Oncological treatment of primary cancer is mandatory.

The follow-up of metastatic spinal tumour diseases relates to the follow-up algorithm of the primary cancer.

Benign intradural pathologies show recurrence in a low percentage. Therefore MRI control has to be performed initially on a yearly basis, with extended intervals in the long-term follow-up.

In terms of recurrent tumour manifestations, all potential treatment options should be discussed in an interdisciplinary setting.

Neurological deficits from benign intradural lesions (i.e. meningiomas) often improve after surgery, without need for special rehabilitation programmes.

Patients with malignant diseases and reduced life expectancy benefit from a short (one-month) rehabilitation programme to adapt to their new functional status.

Patients with better oncological prognosis benefit from a short intensive rehabilitation programme, followed by physical therapy and occupational therapy, potentially lifelong.

Revision Questions

  1. On which algorithm does the follow-up of spinal metastasis depend?
  2. Which diagnostic method is the first choice in the follow-up of intradural tumours?
  3. What proportion of patients improve directly post surgery after resection of spinal intramedullary tumours?

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Last update: 18 September 2017