Minimally Invasive Surgery in Treating Patients With Spinal Tumors

• Estimated blood loss (EBL); in milliliters (ml) [ Time Frame: Day 0 ] [ Designated as safety issue: No ]
  Will be comparing means with the Wilcoxon test.
• Length of operation (OR time) [ Time Frame: Day 0 ] [ Designated as safety issue: No ]
  Will be comparing means with the Wilcoxon test.
• Complication rate [ Time Frame: Day 0 ] [ Designated as safety issue: No ]
• Neurological preservation [ Time Frame: Post operation day 90 ] [ Designated as safety issue: No ]

• Estimated blood loss (EBL); in milliliters (ml) [ Time Frame: Day 0 ] [ Designated as safety issue: No ]
• Length of operation (OR time) [ Time Frame: Day 0 ] [ Designated as safety issue: No ]

• Length of stay [ Time Frame: Less than 7 days ] [ Designated as safety issue: No ]
• Pain symptoms [ Time Frame: Pre-operation, post-op day 3, discharge, post-op days 7, 28, 60, and 90 ] [ Designated as safety issue: No ]
• Assessment of neurologic function using the ASIA (American Spinal Injury Association) Impairment Scale [ Time Frame: Pre-operation, post-op day 3, discharge, post-op days 7, 28, 60, and 90 ] [ Designated as safety issue: No ]
  This is an assessment of sensory and motor functions based upon the ASIA Impairment Scale
• Evaluation of arthrodesis [ Time Frame: Post-op day 1, 28, and 90 ] [ Designated as safety issue: No ]
  Plain x-ray films and CT scans are used to determine the success of arthrodesis (spinal fusion in this case) which is the artificial induction of joint ossification between two bones via surgery. This is done to relieve intractable pain in a joint which cannot be managed by pain medication.

• Length of stay [ Time Frame: Less than 7 days ] [ Designated as safety issue: No ]
• Pain symptoms [ Time Frame: Pre-operation, post-op day 3, discharge, post-op days 7, 28, 60, and 90 ] [ Designated as safety issue: No ]
• Assessment of neurologic function using the ASIA (American Spinal Injury Association) Impairment Scale [ Time Frame: Pre-operation, post-op day 3, discharge, post-op days 7, 28, 60, and 90 ] [ Designated as safety issue: No ]
  This is an assessment of sensory and motor functions based upon the ASIA Impairment Scale
• Evaluation of arthrodesis [ Time Frame: Post-op day 1, 28, and 90 ] [ Designated as safety issue: No ]
  Plain x-ray films and CT scans are used to determine the success of arthrodesis (spinal fusion in this case) which is the artifical induction of joint ossification between two bones via surgery. This is done to relieve intractable pain in a joint which cannot be managed by pain medication.

This clinical trial studies minimally invasive surgery in treating patients with spinal tumors. Posterior spinal tumor resection and anterior and posterior spinal tumor resection are less invasive types of surgery for spinal tumors and may have fewer side effects and improve recovery

PRIMARY OBJECTIVES:

I. Length of operation (operating room [OR] time). II. Estimated blood loss (EBL). III. Complication rate. IV. Neurological preservation.

SECONDARY OBJECTIVES:

I. Motor strength and sensory level (neurological outcome). II. Bladder and bowel function. III. Post-operative pain. IV. Hospital length of stay (recovery time). V. Arthrodesis.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients undergo posterior spinal tumor resection on day 0.

ARM II: Patients undergo anterior and posterior spinal tumor resection on day 0.

After completion of study treatment, patients are followed up for 6 months.

• Adult Spinal Cord Neoplasm
• Recurrent Adult Spinal Cord Neoplasm
• Spinal Bone Metastases
• Spinal Cord Metastases

• Procedure: therapeutic conventional surgery
  Undergo posterior spinal tumor resection
• Procedure: therapeutic conventional surgery
  Undergo anterior and posterior spinal tumor resection
• Procedure: quality-of-life assessment
  Ancillary studies
  Other Name: quality of life assessment

• Experimental: Arm I (posterior spinal tumor resection)
  Patients undergo posterior spinal tumor resection on day 0.
  Interventions:

  • Procedure: therapeutic conventional surgery
  • Procedure: quality-of-life assessment
• Experimental: Arm II (anterior and posterior spinal tumor resection)
  Patients undergo anterior and posterior tumor resection on day 0.
  Interventions:

  • Procedure: therapeutic conventional surgery
  • Procedure: quality-of-life assessment

Inclusion Criteria:

• Patients must have a diagnosis of primary, secondary or metastatic spine tumor and be undergoing any posterior spinal fusion with or without anterior fusion anywhere from occiput to sacrum
• Greater than 3 month life expectancy
• Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control or abstinence) prior to study entry and for six months following duration of study participation; should a woman become pregnant or suspect that she is pregnant while participating on the trial, she should inform her treating physician immediately
• All subjects must have the ability to understand and the willingness to sign a written informed consent

Exclusion Criteria:

• Patients who are not surgical candidates for spine tumor removal, determined by the surgical team
• Patients who have undergone previous spine surgery for tumor removal will be excluded
• Patients with renal cell carcinoma. As there is an emphasis on blood loss and length of surgery, the critical variable for homogeneity is the vascularity of the tumor; hypervascular spine tumors are regarded by surgeons as amongst the most challenging of cases; by far the three most common hypervascular metastatic tumors are those arising from renal cell carcinoma, thyroid carcinoma and melanoma; these pathologies are usually regarded as a distinct subset for this reason in the majority of studies; because we rarely encounter the later two pathologies in our practice, we chose to include only the former; however, to further homogenize our study population we will exclude all three of the known hypervascular metastatic spine tumors
• Subjects, who in the opinion of the investigator, may not be able to comply with the safety monitoring requirements of the study