Whether it is the rare primary chordoma or the relatively common metastasis from another site, a tumor of the spine poses significant clinical challenges for spine surgeons. Optimal treatment requires ongoing experience with the latest treatments and technology, and a team approach that helps ensure patients have a clear understanding of their full range of treatment options.
For example, tumors and their treatments can cause osteolysis and vertebral body fractures that lead to pain, progressive deformity and functional limitations. "Once disease is metastatic, our goal is to prevent paralysis and improve pain," says Serena S. Hu, M.D.
As part of the Spine Center at UCSF Medical Center — which includes Sigurd Berven, M.D., Shane Burch, M.D., Vedat Deviren, M.D., and Bobby Tay, M.D. — Hu has conducted research that helps clinicians better understand how certain patterns of spinal involvement by a tumor indicate a greater risk of fractures and paralysis and, therefore, justify more invasive treatment.
She notes that experience in vertebroplasty and kyphoplasty can help surgeons shore up the spine, relieve pain and prevent bony collapse. Moreover, the availability of equipment such as an operating room CT scanner enables experienced surgeons to immediately redress any intraoperative complications.
Experience also matters when performing en bloc resections, procedures where the surgeon completely removes solitary metastases and primary tumors in single pieces to prevent the spread of tumor cells in the spinal area. "Research has shown that leaving no margin of residual tumor improves survival; with an intralesional resection, recurrences are more likely," says Berven, who has taught courses on the technique. The UCSF Spine Center is one of the only centers in California that perform these types of resections.
Another key success factor is collaboration. At regular interdisciplinary spine tumor conferences, UCSF spine surgeons, neurosurgeons, oncologists, radiation oncologists, radiologists and pathologists discuss a full array of treatment options, including adjunct chemotherapy and radiation therapy for complex cases.
The group draws upon information that members bring back from their participation in the Spine Oncology Study Group, an international, biannual meeting that sets treatment guidelines based on current, outcomes-based research. "So many studies [of spine tumors] are necessarily smaller studies — it can take years to get enough data together," says Burch. "The Spine Oncology Study Group is a way to combine thinking and expand impact for these rare diseases — and to bring treatments to our patients faster."
An active research program, like the one at the UCSF Spine Center, can also benefit patients. Recently, for example, Burch encountered a patient with tumors that had spread through his sacrum and pelvis. "Essentially, he had been told to go home and die," says Burch.
Drawing on research in this area, Burch used MRI and CT scans to model the bones that needed to be surgically removed, and created titanium replacement parts in an attempt to reconstruct the patient so he could walk again.
Another example from Burch's work is his demonstration that light-based technology can activate a chemotherapeutic agent to precisely target and kill bone lesions without harming the bone. (Traditional radiation therapy can damage the spine and its surrounding structures.) He notes that with nearly 100,000 cancer cases per year in the United States metastasizing to the spine, photodynamic therapy — proven for other cancer treatments — has enormous promise.
To contact Dr. Sigurd Berven, Dr. Shane Burch, Dr. Vedat Deviren, Dr. Serena Hu and Dr. Bobby Tay, call (866) 81-SPINE [(866) 817-7463].
Stem Cells and Tissue Regeneration
With a major stem cell research grant, Ophir Klein, M.D., Ph.D, is exploring the molecular processes that regulate the behavior of dental stem cells in mice, with the goal of promoting tooth regeneration and treating craniofacial abnormalities in humans.