Dr. Jorge Torales
Neurosurgeon · Skull base and spinal endoscopy
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Spinal cord
Spinal cord surgery: tumours and lesions of the spinal cord
Microsurgical treatment of intramedullary and extramedullary pathology: spinal cord tumours, syringomyelia, spinal vascular malformations, and compressive cervical myelopathy. Continuous neurophysiological monitoring.
What is it?
Spinal cord surgery: tumours and lesions of the spinal cord
Spinal cord surgery treats lesions within the spinal cord or in close relationship to it. Intramedullary tumours (astrocytomas, ependymomas, haemangioblastomas) account for 5-10% of central nervous system tumours. Surgery requires high-definition microscopy, continuous neurophysiological monitoring, and specific expertise. The goal is maximum resection with functional preservation.
5-10%
of CNS tumours are spinal cord tumours
>90%
complete resection in ependymomas with the right technique
<5%
permanent new neurological deficit at specialist centres
Symptoms
When to consult a neurosurgeon?
Symptoms depend on the spinal cord level affected:
- Progressive localised back pain that worsens when lying down
- Radicular pain in the affected dermatome
- Progressive weakness below the level of the lesion
- Sensory disturbance (hypoaesthesia, paraesthesias, thermoalgesic dissociation)
- Spasticity and increased deep tendon reflexes
- Bladder or bowel sphincter dysfunction
- Horner syndrome in high cervical lesions
Urgent attention: Rapid onset of paraparesis or sphincter dysfunction requires urgent assessment: some cases constitute a neurosurgical emergency.
Treatments
Which techniques do we use?
Microsurgical resection of ependymomas
The most common tumour in adults. A cleavage plane with the spinal cord allows complete resection in 90% of cases with functional preservation.
Resection of spinal astrocytomas
Infiltrative tumours, more difficult to resect completely. Goal: maximum safe resection with continuous monitoring.
Resection of haemangioblastomas
Vascular tumours, sometimes associated with von Hippel-Lindau disease. En-bloc resection with spinal cord preservation.
Syringomyelia drainage
When the cause is treatable (Chiari decompression), the syrinx usually resolves. In refractory cases, syringosubarachnoid or syringoperitoneal shunting.
Decompression in cervical myelopathy
Anterior approach (ACDF, corpectomy) or posterior approach (laminectomy, laminoplasty) depending on location and cause.
Surgery for spinal vascular malformations
Dural fistulas and cavernomas. Microsurgical surgery or coordination with the endovascular team.
Our protocol
How we approach each case
The workup includes contrast-enhanced spinal MRI (axial and sagittal sequences, T1/T2, contrast) and, where indicated, selective spinal angiography. All patients are assessed with a quantitative neurological scale (McCormick, JOA) preoperatively. Surgery is performed under high-definition microscopy with continuous neurophysiological monitoring (SSEP, MEP, EMG) and, where appropriate, intraoperative ultrasonography. Typical postoperative hospital stay is 5-10 days and includes early-onset neurological rehabilitation.
Perioperative protocol
How we organise each case
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1 · Preoperative workup
Gadolinium-enhanced spinal MRI with specific sequences, motor and somatosensory evoked potentials, functional assessment using ASIA and McCormick scales.
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2 · Surgery
Microsurgery with continuous neurophysiological monitoring (MEPs, SSEPs, D-wave). Posterior, lateral, or anterior approaches according to the lesion. Ultrasonic aspirator (CUSA) and visualisation with intraoperative staining.
"From purely anatomical neurosurgery towards precision neurosurgery."
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3 · Immediate postoperative
ICU 24-48h. Early integrated rehabilitation from day one. Serial functional assessment.
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4 · Discharge and follow-up
Discharge at 5-10 days with transition to a spinal rehabilitation unit. Follow-up MRI at 3, 6, and 12 months.
Team
Neurosurgeons who treat this condition
Dr. Abel Ferrés Pijoan
Neurosurgeon · Spine, neuro-oncology, and skull base
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Dr. Pedro Roldán Ramos
Neurosurgeon · Spine, functional, and brain surgery
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Results
Prognosis and recovery
In spinal ependymomas, complete resection is achieved in 80-90% of cases with excellent long-term functional outcomes (survival >90% at 10 years). In astrocytomas, maximum safe resection prolongs survival, though recurrence is more frequent. Neurophysiological monitoring has reduced permanent new neurological deficit to below 5% at specialist centres. Postoperative recovery includes intensive neurological rehabilitation with functional follow-up for at least 12 months.
Frequently asked questions
Answers to your questions
What are intramedullary tumours?
These are tumours that grow within the spinal cord itself. The most common are astrocytomas, ependymomas, and haemangioblastomas. They account for 5-10% of central nervous system tumours and require microsurgical resection with continuous neurophysiological monitoring.
Can spinal cord surgery cause loss of movement?
The risk of neurological deficit exists and depends on tumour type, location, and the patient's preoperative neurological status. Intraoperative neurophysiological monitoring significantly reduces this risk by detecting functional changes in real time and allowing the technique to be modified accordingly.
What is syringomyelia?
It is a cystic cavity that forms within the spinal cord, filled with cerebrospinal fluid. It may result from a Chiari malformation, spinal cord trauma, or tumours. It causes selective loss of thermoalgesic sensation, weakness, and pain. Treatment focuses on the underlying cause.
How long does recovery from spinal cord surgery take?
Hospital stay is 5-10 days depending on the type of procedure. Neurological recovery may extend over several months. Intensive neurological rehabilitation from the immediate postoperative period is key to maximising functional recovery.
Are all spinal cord lesions operable?
No. Some lesions benefit more from periodic observation (small asymptomatic tumours), radiosurgery (some haemangioblastomas), or medical treatment. Each case is assessed by a multidisciplinary committee considering an individualised benefit-to-risk analysis.
References
What clinical guidelines say
"Surgery for intramedullary tumours should be performed at specialist centres with full neurophysiological monitoring (SSEP, MEP) and specific microsurgical expertise."
"Total resection is the goal in well-defined spinal ependymomas and is associated with long-term disease-free survival exceeding 90%."
Bibliography
Scientific references consulted
Studies and clinical guidelines on which we base our approach to this condition.
- Fehlings MG. et al. A Clinical Practice Guideline for the Management of Acute Spinal Cord Injury. Global Spine J. 2017. View publication
- McCormick PC. et al. Intramedullary spinal cord tumors: surgical results. J Neurosurg. 1990. View publication
- Klekamp J. Treatment of syringomyelia related to nontraumatic arachnoid pathologies of the spinal canal. Neurosurgery. 2013. View publication
- Kirshblum SC. et al. International standards for neurological classification of spinal cord injury (ASIA). J Spinal Cord Med. 2011. View publication
- Sala F. et al. Motor evoked potential monitoring improves outcome after surgery for intramedullary spinal cord tumors. Neurosurgery. 2006. View publication
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Robot-assisted surgery with ALAYA
We use the ALAYA Robotic Assistant (Cyber Surgery) for the precise placement of pedicle screws in spinal fusion surgery, both open and minimally invasive.
ALAYA guides the trajectory of the surgical instruments through a patented kinematic tracking system that requires no optical navigation cameras: it avoids the classic line-of-sight problems and takes up less space in theatre. The patient's position is monitored in real time by a bone reference clamp attached directly to the tracking device, which improves the overall accuracy of the procedure.
What do we use it for?
- Pedicle screw placement in the posterior thoracic and sacro-lumbar spine.
- Spinal fusion surgery, both open and minimally invasive.
- Intraoperative 3D planning using preoperative or intraoperative 2D/3D CT.
- Implant-brand independence: compatible with any commercially available cannulated screw.
A real benefit for the patient: a reduction in mean hospital stay from 9.4 to 6.8 days documented with robotic assistance in spinal fusion, together with lower intraoperative radiation exposure for both patient and team.
↑
Greater accuracy
Significantly more accurate pedicle screw placement than with conventional technique.
↓
Minimally invasive
Less tissue damage, lower risk of infection and faster postoperative recovery.
⏱
Shorter operating time
An intuitive workflow and fast set-up that shorten the length of the procedure.
☢
Lower radiation
The system minimises the number of image acquisitions needed during surgery.
Patient reviews
What our patients say
High-grade glioma
"I arrived with a glioma I had been told was inoperable. Here they reviewed it at the tumour board and offered me a plan. The surgery was a success. Four years on, I am well."
Cervical disc herniation
"For years I had a cervical disc herniation, operated on by another team with no improvement. Minimally invasive surgery gave me back my mobility and took the pain away."
International patient
"I travelled from outside Spain. The team reviewed my case before I came and gave me a clear plan. Caring people and impeccable technique."
Request information
Enquiry about spinal cord tumour or syringomyelia
Send us your contrast-enhanced spinal MRI and neurological report. We review the case in a multidisciplinary committee and respond with a personalised plan.