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• Acute pain control with medications and pain management

Fig. 1.22 (a–d) An elderly man with a dural-based intradural extramedullary tumor (meningioma) received laminoplasty (C6 and C7) and tumor resection treatment. Cord decompression and total tumor resection were achieved. No complications were present at time of discharge. (Source: Spinal meningiomas. In: Sheehan J, Gerszten P, eds. Controversies in Stereotactic Radiosurgery: Best Evidence Recommendations. 1st ed. Thieme; 2014).

Fig. 1.23 (a, b) Computed tomography (CT) scan through C3 revealed cervical extradural tumor (chordoma) in a child. Magnetic resonance imaging (MRI) demonstrates cervical cord compression. (Source: Extradural tumors. In: Dickman C, Fehlings M, Gokaslan Z, eds. Spinal Cord and Spinal Column Tumors. 1st ed. Thieme; 2006).

• If asymptomatic or mildly symptomatic with neck pain/radiculopathy with small focus of tumor:

– Radiation treatment (radiation oncology consultation)

◦ Some metastatic tumors are radioresistant

– Chemotherapy (medical oncology consultation)

◦ Some metastatic tumors are radioresistant

– Kyphoplasty (to treat pain)

– Surgical instrumentation and fusion (if there is concern for deformity, instability, or cord compression)

• If symptomatic with cord compression and myelopathy with large tumor burden:

– Urgent surgical decompression and fusion over multiple segments with tumor resection if deemed suitable candidate for surgery; may be followed by radiation treatment after resection if considered necessary by the radiation oncologist

◦ The oncologist will need to determine overall prognosis, Karnofsky performance score, and extent of visceral disease

◦ If poor surgical candidate with poor life expectancy, medical management is recommended

◦ Surgery may be done anteriorly, posteriorly, or combined two-stage approach for added stabilization

– Preoperative embolization may be indicated for select vascular tumors to the spine such as renal cell cancer, thyroid cancer, breast cancer, etc. in order to decrease vascularity intraoperatively