Moderator: Hello, everyone! Although spinal tumors only account for 6-10% of bone tumors in the whole body, the structure and function are very important because the spine is the central axis of the human body and is the pillar of the body with functions of weight bearing, shock absorption, protection and movement, etc. At the same time, the spinal canal of the spine also protects the more important central nervous system – spinal cord tissue, which controls the motor, sensory and reflex functions of the limbs and internal organs. Once the tumor invades the spine, it will bring a series of serious clinical consequences. Therefore, early diagnosis and standardized treatment of spinal tumors are very important. Our guest in the studio today is Professor Song from the orthopedic department of the hospital.
Doctor: Hello, everyone, I would like to talk to you today about issues related to the diagnosis and treatment of spinal tumors. As the host just mentioned, the incidence of spinal tumor is not high, but it is very harmful to human body. Firstly, like other malignant tumors, malignant tumors of the spine, whether primary or metastatic, can directly endanger the life of patients. Finally, because of the low incidence of spinal tumors, there are fewer doctors who specialize in spinal tumors, and general practitioners lack sufficient experience in diagnosis and treatment when they encounter these diseases. Among orthopedic surgeries, spinal surgery is the most difficult and risky; and among spinal surgeries, spinal tumors are the most difficult and risky. Therefore, once spinal tumors are detected, some patients often show extreme fear and either stumble or rush to the doctor, and even some medical professionals are at their wits’ end and cannot come up with a decent treatment plan. Therefore, I would like to explain to you some common sense issues about spinal tumors today, and welcome you to discuss them together.
Moderator: Professor Song has long been engaged in the diagnosis and treatment of various spinal injuries and diseases, and is especially good at the diagnosis, differential diagnosis and surgical treatment of difficult diseases such as spinal tumors and spinal tuberculosis. Are spinal tumors common in China?
Doctor: The incidence of spinal tumors is low, especially primary spinal tumors are even less common. However, metastatic tumors to the spine due to breast cancer, thyroid cancer, prostate cancer, lung cancer, liver cancer, etc. are still relatively common.
Moderator: What are the most common symptoms of spinal tumors?
Doctor: Spinal tumors lack characteristic clinical manifestations and are difficult to detect in the early stage, so they are easy to be misdiagnosed and missed, so they need to be given enough attention. However, in general, whether primary or metastatic tumors, they often manifest as local pain, poor mobility of hands and feet, abnormal sensation, spinal deformity, and even local mass formation. Once these symptoms appear, professional help should be sought as soon as possible.
Moderator: May I ask Director Song what can be done to screen our body for spinal tumors?
Doctor: Once you suspect a spinal tumor, you should first consult with your local spine surgeon and decide on the examination plan based on the specific situation. If metastatic tumor is suspected, in addition to MRI and CT examination, PET-CT (Positron Emission Computed Tomography) and serological examinations such as tumor markers can be considered to clarify the site and nature of the primary tumor.
For example, spinal tumor involves a central nerve, and we just mentioned the spine and lumbar spine, so many people have a confused feeling that I may have back pain, but I don’t think it is a spinal disease.
Doctor: I think it is very difficult to identify from the patient’s point of view. There are some medical practitioners online, like me who are engaged in spine surgery, who should at least consider the possibility of spinal tumors when they encounter such patients.
Moderator: We saw a question, one of the users said that there is a spinal tumor in the family, the spinal tumor has caused symptoms of paralysis, if the patient is already paralyzed, he still has the need for surgery?
Doctor: In such cases, we often give an analogy: for example, after an earthquake or a mining accident, many people are crushed inside, and it is not entirely clear whether these people are still alive or not. If there are 100 people crushed inside, if 50 have died, you save them, it is impossible to salvage back; but the other 50, if only injured, then after treatment and rehabilitation, it is entirely possible to heal. There are thousands of spinal nerve cells in the spinal canal, and if the nerve cells inside are already necrotic, then even the best surgery is ineffective; but if the nerve cells are only degenerated (injured) after the pressure, there is hope for recovery after the surgery. I once treated a patient with thoracic spinal tuberculosis who was completely paralyzed in both lower extremities before the surgery, and one year after the surgery, he did not recover any movement or sensation in both lower extremities. After another 3 months, a miracle happened: the patient could move his toes on his own! When he came to me for a review last month, he was able to walk on his own. So, don’t give up hope at any time.
Moderator: Is there any special attention to the diet of patients after spinal tumor surgery?
Doctors: After surgery, patients should fast for 6 hours to prevent pneumonia caused by inadvertent suction, after which they can eat a liquid diet, and then gradually transition to a semi-liquid or normal diet. There is no special contraindication to the diet of spinal surgery patients after recovery. The dietary principle is to be nutritious, to give high protein and high calorie diet, to replenish the vitamins needed by the body, and to improve the body’s resistance.
Moderator: One of the biggest pains brought by spinal tumor is pain. Do you think there is any way to control pain medicine during the patient’s illness?
Doctors: Some patients have very severe pain. At this time, in addition to surgery, chemotherapy, radiotherapy and endocrine therapy for spinal tumors, pain management is the main means to control pain. The application of pain medication should follow certain principles: oral administration or transdermal patches, administration by steps, including non-opioids, weak opioids, and strong opioids. Attention should also be paid to timely dosing, individualized treatment, and timely management of drug side effects. In addition, there are also complementary medications, including antidepressants, anticonvulsants, anti-anxiety, corticosteroids, traditional Chinese medicine, etc. In addition, appropriate psychotherapy is given.
Moderator: What are some domestic treatments for spinal malignancies?
Doctor: The main treatment methods include surgery, chemotherapy (anti-tumor drug therapy, including targeted drug therapy, which has developed rapidly in recent years), radiation therapy (radiotherapy for short), and endocrine therapy.
Moderator: Some patients ask what kind of care family members give to patients after spinal tumor surgery.
Doctor: The main care should be given to doctors and nurses: including monitoring the patient’s respiration, pulse, blood pressure, heart rate and other vital signs, observing the patient’s hand and foot movement and sensation; strengthening the care of various tubes and incisions, changing medication in time, keeping the wound dry and clean, and preventing infection; turning the patient regularly to prevent decubitus ulcers; encouraging the patient to cough to prevent pneumonia; also guiding the patient to do a limb functional exercise to promote the recovery of his neurological function. Families should be aware of some common sense issues, which will greatly benefit the patient’s recovery.
Moderator: Is there any statistics on the age group of spinal tumor incidence in China, or is it that all kinds of people have it regardless of age group?
Doctor: Relatively speaking, primary tumors are more common in young people, while secondary tumors that metastasize from other parts of the body are more common in older people.
Moderator: If elderly people have spinal tumors, they may be old and their families don’t mind surgical treatment, so they will think of a conservative treatment.
Doctor: The overall treatment goals of spinal tumors include: prolonging life, reducing pain, and improving quality of life. For these purposes, the treatment plan can be individualized, including chemotherapy, radiotherapy, endocrine therapy, and other aspects, including physical therapy, braking, etc.
Moderator: Spinal tumor is not a very high incidence disease, but once it occurs, it is very serious, we would like to understand what harm it can bring to people?
Doctor: The hazards of spinal tumor include pain caused by the tumor itself, compression pathological fracture, vertebral collapse, posterior convexity deformity and vertebral joint instability caused by the destruction of adjacent bone structure by tumor tissue; and compression of spinal cord tissue will lead to pain, numbness and even paralysis.
Moderator: Will spinal tumors recur again after surgery? What are the specific reasons for recurrence?
Doctor: Tumors have the possibility of recurrence. There are many reasons for recurrence, firstly, it is related to the specific pathological type of tumor, such as giant cell tumor of bone, chordoma and other invasive benign and malignant tumors, which are easy to recur, while most benign tumors are not easy to recur if treated properly; secondly, it is related to the growth site of tumor and the treatment method, some spinal tumors have vital growth sites, some are close to spinal cord, nerves or large blood vessels, so it is difficult to achieve a whole block with intact edges. Some of them are close to spinal cord, nerves or large blood vessels, so it is difficult to remove the whole block with intact edges, and the possibility of recurrence will be much higher; besides, the surgeon is inexperienced, or the technology is not up to it, so he cannot cut it clean at one time, which will cause local recurrence or even a distant metastasis. Therefore, if you have such a disease, do not rush to the doctor, you should find a professional hospital, professional doctors to help you to analyze and solve the problem.
Moderator: Let’s look at one more question from the netizens. Is it possible to perform surgery when spinal metastasis occurs in malignant tumors?
Doctor: In the past, once a metastatic tumor is found in the spine, it means that the tumor is already at an advanced stage and surgery is generally not recommended. However, in recent years, with the development of medical science and the improvement of people’s living standard, the concept and strategy of treatment for metastatic tumors at home and abroad have actually changed fundamentally. If the patient’s pain can be relieved and neurological function can be saved through surgical treatment, we think that surgical treatment is still meaningful. It is especially meaningful for tumors with relatively low malignancy and long expected survival, such as thyroid cancer, breast cancer and prostate cancer. With comprehensive treatment, these patients can have a life expectancy of several years, a decade or even decades. For patients with metastatic spinal tumors that meet the following conditions, surgery can be considered: the patient’s expected survival period is more than six months; the tumor has caused spinal cord and nerve compression and progressive neurological impairment; intractable pain medication is ineffective, insensitive to radiotherapy and chemotherapy, or the tumor recurs after chemotherapy and radiotherapy and compresses the spinal cord; the patient is in good general condition and can tolerate surgery. When these conditions are met, we can consider surgery.
Moderator: If a patient is found to have a benign spinal tumor, does he also need surgery?
Doctor: Benign tumors can also compress the spinal cord or nerve roots and cause neurological damage, or produce intractable pain, and drug treatment is ineffective; some benign tumors continue to increase in size and compress adjacent organs and tissues of the spine; some benign tumors even have distant metastases or even malignant changes at a later stage. Therefore, benign tumors of the spine should never be taken lightly.
Moderator: Spinal tumors can be life-threatening, this will definitely be the case.
Some tumors of the upper cervical spine compress the medulla oblongata and the upper cervical medulla, which can cause fatal respiratory or circulatory depression leading to death, and some tumors can invade the adjacent large blood vessels, which can cause fatal hemorrhage once the blood vessels are perforated; in addition, after the tumor compresses the spinal cord leading to paralysis, serious lung infection, respiratory failure and other complications can be life-threatening. Finally, spinal malignant tumor, like other tumors, can itself lead to death due to systemic consumption and metastasis. Therefore, the significance of early diagnosis and early treatment is very important to save or prolong the life of patients.
Host: When it comes to early diagnosis, it seems that among the items of physical examination, there is no such piece as examination of spinal tumor. If you have watched today’s program and feel that you have knowledge about this aspect and want to go for examination, what are the general methods to confirm the diagnosis?
Doctor: The earliest symptoms of spinal tumors are similar to those of common degenerative diseases of the spine, so it is recommended to do some corresponding tests first, and if you suspect that you have a spinal tumor, then you should see a more specialized doctor.
Moderator: Let’s look at a more specialized question, do you need to remove the spinal nail fixation system? Nowadays, the materials used in surgery are quite sophisticated, such as heart surgery are used titanium alloy materials.
Doctor: The internal fixation system we use is basically titanium alloy material, which is more compatible with human tissue and does not need to be removed in special cases.
The host: another question from a netizen, we have been talking about the treatment of spinal tumors, is there any help for us to take Chinese medicine treatment?
Doctor: Chinese medicine treatment is an adjuvant treatment in the process of tumor treatment. For patients who are physically weak, Chinese medicine treatment before and after surgery can enhance resistance and play the role of Chinese medicine in removing evil and suppressing tumors; using Chinese medicine treatment during radiotherapy and chemotherapy can reduce side effects and increase efficacy. Chinese medicine treatment has an important role in controlling the recurrence and metastasis of malignant tumors. However, we need to note that herbal treatment must be based on surgery and radiotherapy, and herbal treatment alone is unlikely to cure tumors.
Moderator: Another user asked, they said that spinal tumors are very similar to cervical spondylosis, lumbar disc herniation and other spinal diseases, is there any difference in some symptoms and in treatment?
Doctor: I have been engaged in spine surgery, and I have dealt a lot with conventional spine diseases, including cervical spondylosis, lumbar disc herniation, lumbar spinal stenosis, etc. The aim of treatment for these degenerative spine diseases is to improve function, maintain stability, and preserve the proper mobility of the spine as much as possible; whereas the priority of spine tumor treatment is to save or prolong life. Therefore, doctors who are involved in spinal tumors need to have the theoretical and surgical foundation of spinal surgery, as well as a solid knowledge of oncology, so that they can develop and implement a comprehensive treatment for patients in order to maximize their lives, reduce their pain, improve their function, and enhance their quality of life.
Moderator: One of the netizens suggested that spinal tumors have no symptoms before, so he was very worried, so what kind of prevention methods can be told?
Doctor: At present, there are no preventive measures specifically for spinal tumors, but we can refer to the three-level prevention model recommended by the World Health Organization. First of all, primary prevention, also known as etiological prevention, is the most active and effective preventive measure, that is, to promote a healthy lifestyle and reduce cancer-causing factors. The first is not to smoke, because smoking can lead to lung cancer, oral cancer, laryngeal cancer, esophageal cancer and so on, which is extremely harmful. The second is not to drink alcohol, excessive drinking can harm the gastrointestinal tract and liver, leading to stomach cancer and liver cancer. Third, do not eat a high-fat, high-sugar, high-calorie diet and maintain a normal weight. Don’t eat moldy and spoiled food, and eat less pickled food. Fourthly try to avoid exposure to the sun to reduce the occurrence of skin cancer. The fifth is to insist on physical exercise, maintain optimistic mood and be healthy and open-minded, which are very important for tumor prevention. The second is secondary prevention, which is to achieve early detection, early diagnosis and early treatment. Experts from the World Health Organization have put forward “ten” early signs of malignant tumors to remind public attention. For example, hard nodes or lumps, foreign body sensation in the esophagus, persistent indigestion, dry cough or blood in sputum, unexplained blood in stool, painless hematuria, irregular vaginal bleeding, untreated ulcers, unexplained weight loss or low fever, etc. are all early signs of cancer, and one should be highly alert to these symptoms for immediate examination and treatment. Lastly, tertiary prevention is to provide active medical treatment to patients with diagnosed cancer to obtain the best results. Even if a patient is at an advanced stage, we should try our best to help him alleviate his pain, improve his quality of life and prolong his survival period. In The Art of War, Sun Tzu talks about: the upper military strategy, the second one is to attack friends, the second one is to attack soldiers, and the next one is to attack the city. The method of attacking a city is the last resort. Regardless of the disease, prevention is the best policy, and surgical treatment, especially major surgery, is a last resort.
Moderator: The level of medical care you are talking about is not only a combination of Chinese and Western medicine, but also a combination of Chinese and Western culture. We just mentioned about the ten early signs with the World Health Organization, and then look at the question of a netizen, their family does not yet have a tertiary hospital, he asked about the spinal tumor diagnosis error aggression will occur, the probability of this will be how much?
Doctor: This definitely exists, and the rate of misdiagnosis or missed diagnosis is not low, but it is hard to say the probability. There are many different types of spinal tumors, and the incidence is not uniform, and the ease of diagnosis varies greatly. Here, I can only hope that spinal tumors will stay away from us, and even if we are unfortunate enough to have spinal tumors, it is best to diagnose and treat them early to get the best results.
Moderator: No matter what the situation is, don’t give up on treatment. What are the conditions that increase the risk of spinal tumors, and what is the impact on surgery if the patient also has other diseases, and which diseases and spinal tumors together will make surgery impossible?
Doctor: After all, spine surgery is a major surgery, and the patient’s age, the presence of other factors, physical condition, and the presence of underlying diseases will affect the safety of the surgery. The risk of surgery is somewhat increased in the elderly, children and the frail. For patients with chronic diseases such as hypertension, diabetes mellitus and chronic bronchitis, most patients can safely undergo surgery if the indicators can be adjusted before surgery; while for patients with serious problems such as combined immune deficiency, coagulation mechanism disorders, abnormal heart and lung function and liver and kidney function, the risk of surgery will be greatly increased and in principle, non-surgical treatment should be chosen; if the significance of surgery If surgery is of great significance, or if the patient and family members have a strong desire for surgery, medical treatment should be carried out first to adjust the function of important organs to a more ideal state as far as possible before considering surgery.
Moderator: What should the family members of spinal tumor patients pay attention to in the process of treatment and rehabilitation?
Doctor: Treatment and rehabilitation varies from person to person and from disease to disease, and cannot be generalized. Cherishing life and caring for the health of family members should be a constant theme. Family love is a treatment that cannot be replaced by any modern technology, and the love of family members is a source of happiness for spinal tumor patients during treatment and recovery.
Moderator: There are many patients who rely on the spiritual support of their families to survive their pain.
Doctor: There was a patient who had primary liver cancer, a highly malignant tumor, and the doctor told him he had only three to six months to live. After the liver cancer resection, he underwent chemotherapy; later he found that the tumor had metastasized to the lung and underwent resection of the lung tumor; later it metastasized to the scapula and underwent resection of the scapula tumor; finally, this patient’s tumor metastasized to the spine and he came to me for surgical resection of the metastatic tumor in the spine. Up to now, this patient has survived for more than five years. We call “survival with tumor” as “dancing with wolves”, which is a modern concept of tumor treatment. Even if you have a malignant tumor of high malignancy, or even multiple metastases in your body, you should not give up treatment.