Spine Tumour Treatment in Dubai, Surgical & Oncological Management by Op. Dr. Fatih Kırar

Tumour Classification, Benign vs Malignant

• Benign: meningioma, schwannoma, low-grade ependymoma, slow growth; surgical removal may be curative
• Malignant: high-grade astrocytoma, chordoma, metastases, combined surgical and oncological management

Tumour Location, The Most Important Anatomical Classification

• Extradural: vertebral metastases, lymphoma, bone tumours, compress cord from outside dura
• Intradural-extramedullary: meningioma, schwannoma, typically benign, excellent resection outcomes
• Intramedullary: ependymoma, astrocytoma, technically most demanding; continuous IONM required

Primary vs Metastatic Spinal Tumours

Primary tumours arise from spinal structures, bone, meninges, nerve sheaths, or cord parenchyma.

Metastatic tumours spread from lung, breast, prostate, kidney, and thyroid, the most common presentation to a spine tumour specialist in Dubai (30–70% of cancer patients). Thoracic spine is the most common metastatic site.

Common Spinal Tumours Treated at DRFK

• Meningioma, schwannoma, ependymoma
• Astrocytoma, majority of intramedullary astrocytomas are low-grade (WHO Grade I–II); spinal GBM is extremely rare
• Chordoma, vertebral metastases, spinal lymphoma
• Haemangioma, usually incidental; treat when symptomatic
• Multiple myeloma, vertebral destruction and pathological fracture

Early Stage, Back Pain Without Neurological Change

• Constant pain not positional; worst at night
• Progressive pain without clear cause
• Back pain with known cancer, urgent imaging
• Thoracic pain, lower threshold for MRI

Middle Stage, Nerve Root and Early Cord Involvement

• Dermatomal limb pain
• Numbness and tingling
• Progressive weakness
• Fine motor difficulty

Advanced Stage, Spinal Cord Compression (Neurological Emergency)

Malignant spinal cord compression is a neurological emergency. Call 999 immediately or attend the nearest emergency department. Do not call a clinic first.

• Progressive bilateral leg weakness
• Gait instability and falls
• Bladder or bowel dysfunction
• Dense sensory level on trunk
• Complete paralysis if untreated

When Is Spine Tumour Surgery Indicated?

• Cord compression with neurological deficit
• Vertebral instability or fracture risk
• Diagnosis required beyond CT-guided biopsy
• Benign resectable tumour (meningioma, schwannoma)
• RT failure with progressing compression
• Solitary metastasis with controlled systemic disease

When observation is appropriate

• Small asymptomatic benign intradural tumours, serial MRI 6–12 months
• Incidental haemangioma without instability or neurology

When radiotherapy is primary treatment

• Radiosensitive metastases (lymphoma, myeloma, breast, prostate) without major instability
• Stereotactic radiosurgery (SRS) for small defined metastases

When chemotherapy is indicated

• Systemic malignancy with spinal involvement
• Chemosensitive tumours (lymphoma, myeloma, germ cell)

Spinal Tumour Surgery Techniques at DRFK

• Cord decompression, neurological preservation in malignant compression
• Extradural resection / vertebrectomy when indicated
• Intradural-extramedullary microsurgical resection with IONM
• Intramedullary resection, myelotomy under microscope and IONM
• Spinal stabilisation, instrumentation, cage, vertebroplasty/kyphoplasty
• Embolisation: performed by interventional radiology specialist at the appropriate centre prior to surgical resection at DRFK for highly vascular tumours

Immediate Post-Operative Phase (Days 1–7)

Continuous neurological monitoring, post-operative MRI within 48 hours, structured analgesia, mobilisation within 24–48 hours when safe.

Nerve Recovery Timeline

• Motor: 50–70% meaningful recovery with incomplete deficit after timely decompression
• Sensory often faster than motor
• Bladder/bowel: partial recovery if recently compromised
• Earlier decompression → better recovery

Rehabilitation After Spinal Tumour Surgery

Physiotherapy with Dr. Amina Zafar from first week of discharge, rehabilitation is not optional; it translates surgical success into function.

Oncological Follow-Up and Recurrence Monitoring

• MRI at 3 months post-surgery
• Annual surveillance for benign tumours
• Coordinated oncology follow-up for malignant disease
• Radiotherapy typically 3–6 weeks post-surgery when indicated