Stereotactic Spine Radiosurgery

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What is stereotactic spine radiosurgery?
spine, back, xray

Stereotactic spine radiosurgery is a type of radiation therapy. It is a treatment for tumors of the spine. It can treat benign (non-cancerous) and malignant  (cancerous) tumors. The procedure uses radiation to kill cancer cells and shrink tumors. Stereotactic spine radiosurgery is very effective in treating back pain from tumors that compress nerves. It is generally an outpatient procedure with no recovery time and minor side effects. 

Stereotactic radiosurgery is an effective alternative to neurosurgery for some patients. It is less invasive than neurosurgery and requires less hospitalization and recovery time. However, radiation kills your normal cells as well as cancer cells. Your doctor and care team will use specialized equipment and techniques to target your tumor and minimize damage to healthy cells.

Stereotactic spine radiosurgery is only one method of treating spine tumors. It is only available in a few specialized centers in the country. Discuss all the treatment options with your doctor to understand which options are right for you.

Other procedures that may be performed

Your doctor may perform other procedures to treat spine tumors. These include:

  • Biological therapy or immunotherapy boosts or stimulates your body’s immune system to help fight cancer.

  • Conventional radiation therapy

  • Chemotherapy treats cancer with medications that slow or stop the growth of cancer cells

  • Open surgery to remove part of the spine tumor to relieve pressure on the spinal cord

  • Stabilizing the spine using screws or cement (vertebroplasty and kyphoplasty)

Why is stereotactic spine radiosurgery performed?

Your doctor may recommend stereotactic spine radiosurgery to treat benign (noncancerous) or malignant (cancerous) tumors of the spine. Spinal tumors can damage the spinal bones (vertebrae) and lead to compression of the spinal cord or nerves. This can cause severe pain and nerve problems, even paralysis.  

Stereotactic spine radiosurgery can also:

  • enhance conventional radiation treatment

  • provide another option when other treatments have not worked

  • treat or control a recurring spinal tumor

  • treat or control the remaining portion of a tumor after surgery

Who performs stereotactic spine radiosurgery?

A specialized team performs stereotactic spine radiosurgery. Teams may include the following specialists:

  • Medical physicists are scientists who specialize in the safety and effectiveness of radiation treatments and imaging procedures.

  • Neurologists specialize in caring for people with diseases and conditions of the brain and nervous system, including the spinal cord, nerves, muscles, and related blood vessels.

  • Neuroradiologists specialize in diagnosing and treating diseases of the nervous system using radiological imaging.

  • Neurosurgeons and pediatric neurosurgeons specialize in the surgical treatment of diseases of the brain, spinal cord, and nerves.

  • Radiation oncologists specialize in treating cancer with radiation.

How is stereotactic spine radiosurgery performed?

Your stereotactic spine radiosurgery will be performed in a hospital radiology department or an outpatient radiology setting. You may have one or more treatments depending on your condition. The procedure generally includes the following steps:

  1. Your team will make a individualized immobilization device for you. This device will help you to hold very still during treatments so only the tumor receives radiation.

  2. You will lie in the device to have imaging exams, such as CT or MRI. Your team will use the images to plan your treatment. Images pinpoint the exact location of the tumor and normal tissues.

  3. You will return about a week later for the actual treatment.

  4. You will dress in a patient gown. You will remove jewelry, wigs, glasses, or any other item that interferes with the treatment.

  5. Your team may start an intravenous (IV) line to give you fluids and a mild sedative if needed.

  6. Your team will position you in your immobilization device.

  7. Your team will leave the treatment room, but they will observe you by video. You will be able to talk with your team over an intercom.

  8. The stereotactic spine radiosurgery machine will deliver a precise amount of radiation. You may need to be in the device for an hour or more during treatment. You will not feel anything during this process. Some people even fall asleep during treatment.

  9. Your team will remove the device and IV line after treatment.

  10. Your care team will make sure that your vital signs, such as blood pressure and pulse, are stable. They will give you medication for nausea or head pain as needed. Most people who receive stereotactic radiosurgery go home the same day. Some patients stay in the hospital for a night for further observation.

Will I feel pain?

Your comfort and relaxation is important to you and your care team. Stereotactic spine radiosurgery itself is painless. Children and people who are claustrophobic or have trouble staying still in the immobilization device may have sedative medications to stay comfortable during the procedure.

What are the risks and potential complications of stereotactic spine radiosurgery?

Complications of a stereotactic spine radiosurgery are usually mild and go away quickly. This is because the precisely targeted radiation causes little to no damage to healthy tissues. Serious complications are rare, but any medical procedure involves risks and potential complications. 

Short-term side effects include: 

Complications that can occur months to years after treatment include:

  • Development of a new cancer (rare)

  • Fracture of a bone in the spine (vertebral fracture)

  • Holes between organs or tissues (fistula)

  • Nerve damage

  • Paralysis

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and: 

  • Avoiding pregnancy as directed by your doctor. Notify your doctor immediately if there is any chance of pregnancy.

  • Following activity, dietary and lifestyle restrictions and recommendations before and after your treatment

  • Notifying your doctor immediately of any concerns

  • Taking your medications exactly as directed

Telling all members of your care team if you have any allergies

How do I prepare for stereotactic spine radiosurgery?

You are an important member of your own healthcare team. The steps you take before your treatment can improve your comfort and outcome. You can prepare for stereotactic spine radiosurgery by:

  • Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Notifying your doctor if you are nursing or if there is any chance of pregnancy

  • Notifying your doctor and care team if you have any type of implant, such as a stent, artificial heart valve, surgical clip, or pacemaker

  • Stopping smoking. Smoking reduces blood flow to the tissues, which can worsen the side effects of radiation.

  • Taking or stopping medications exactly as directed

Questions to ask your doctor

Preparing for stereotactic spine radiosurgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before your procedure and between appointments.

It is also a good idea to bring a list of questions to your appointments. Questions can include:

  • Why do I need stereotactic spine radiosurgery? Are there any other options for treating my condition?

  • How many treatments will I need?

  • How long will each treatment take? When can I go home?

  • What restrictions will I have? When can I return to work and other activities?

  • What medication plan should I follow before and after my treatment?

  • How will you treat my pain or discomfort, such as nausea?

  • What other tests or treatments might I need?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular hours.

What can I expect after stereotactic spine radiosurgery?

Knowing what to expect after stereotactic spine radiosurgery can help you get back to your everyday life as soon as possible.

How will I feel after stereotactic spine radiosurgery?

People often feel fine right after stereotactic spine radiosurgery. You may be a little tired that day, but most people can return to normal activities by the next day. Side effects, such as fatigue and skin irritation, may develop shortly. They are generally mild and temporary. 

Rarely, side effects or complications may occur months to years after treatment. Many people have no complications or side effects at all. 

Your doctor will give you medications to help ease your side effects. Call your doctor if you have trouble controlling side effects.

When can I go home?

You will likely go home the same day as stereotactic spine radiosurgery. You will still be drowsy if you had sedation and will need a ride home. You should not drive for about 24 hours, and someone should stay with you during that time.

When should I call my doctor?

It is important to keep your follow-up appointments after stereotactic spine radiosurgery. You will need to have MRI scans to monitor the tumor and may need another treatment, depending on your condition.

Contact your doctor if you have any concerns between appointments. Call your doctor right away if you have side effects or symptoms that are difficult to control or are getting worse.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Oct 27
  1. The Role of Stereotactic Radiosurgery in Metastasis to the Spine. National Center for Biotechnology Information, U.S. National Library of Medicine. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291699/
  2. Stereotactic Radiosurgery Program. UCLA Health. http://neurosurgery.ucla.edu/body.cfm?id=952
  3. Neurosurgeon Mark Bilsky on Stereotactic Radiosurgery for Spine Tumors. Memorial Sloan-Kettering Cancer Center. http://www.mskcc.org/blog/neurosurgeon-mark-bilsky-stereotactic-radiosurgery-spine-tumors
  4. Stereotactic Radiosurgery in the Management of Spinal Lesions: An Introduction. AANS Neurosurgeon. http://www.aansneurosurgeon.org/200311/6/957
  5. Stereotactic radiosurgery for spinal cancer. Cancer Treatment Centers of America. http://www.cancercenter.com/spinal-cancer/srs/
  6. Stereotactic Spinal Radiosurgery. Cleveland Clinic. http://my.clevelandclinic.org/neurological_institute/brain-tumor-neuro-oncology/treatment-services/s...
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