Fernando Checo, MD was recently featured in Long Island MDNews, a print and online publication covering highly ranked orthopedists and emerging treatment practices.
At Neurological Surgery, P.C., Neurosurgeon Sachin Shah, MD, combines his surgical expertise with that of Fernando Checo, MD, orthopedic surgeon at The Central Orthopedic Group, to treat spine tumors.
Since 2012, Drs. Shah and Checo have combined their expertise and highly personalized care to treat spinal cord tumors. Both fellowship-trained, they bring a multidisciplinary approach to challenging procedures and provide the most advanced surgical techniques to patients.
“While spinal cord tumors are often highly treatable through resection, many spine specialists aren’t experienced enough to deal with the unique risks and challenges those procedures present,” Dr. Shah say, “These surgeries have been done for many years, but there’s always the concern of causing neurological injury, especially in someone of a young age. So, having highly qualified surgeons who are comfortable treating these types of conditions is paramount,
Diagnosis and Treatment
The spinal column is the most common site for bone metastasis, treatment for which accou. for the majority of surgeries Drs. Shah and Checo perforrn together. Regardless of the type of tumor, however, they consider the same factors — size, neurologic cornpromise and spinal instability — in determining whether surgery would be beneficial.
“Such treatment decisions are highly consequential,” Dr. Shah says. “Left untreated, a benign turnor can cause pain and loss of neurological function, while a metastatic tumor can make patients too unstable for cancer therapy.”
That’s why a referral to a spine specialist should be the first step when symptoms present. The most frequent symptom is nonmechanical back pain. But any back pain is worrisome, especially if it worsens at night, is progressive and recalcitrant to anti-inflarnrnatories, or spreads to the hips or limbs. Bowel or bladder symptorns and neurological dysfunction are red flags, as well.
Patients with these symptoms are far more likely to have a degenerative spinal condition rather than a tumor, but they always merit further evaluation.
“Patients often don’t know they have a tumor until they receive an MRI,” he says. “They come with typical complaints of nerve symptoms — numbness and tingling in the hands or legs.” When a tumor is indicated, a differential diagnosis is postulated based upon the imaging, and a needle biopsy may be performed.
Some spinal tumors, like lymphoma and multiple myeloma, can be treated nonsurgically. Among nonsurgical treatments are observation, chemotherapy and radiation. For tumors causing pathological fractures, a minimally invasive spinal fusion or percutaneous balloon kyphoplasty can reduce pain.
“Minimally invasive surgery should be considered with metastatic tumors, as surgery may not be appropriate when there is extensive disease and a poor prognosis,” Dr. Shah says. “A minimally invasive fusion procedure can treat patients’ pain, allowing them to leave the hospital in a day or two and return to cancer treatment.”
If surgery is indicated, Drs. Shah and Checo consult with other medical specialists to plan treatment based on the patient’s prognosis, overall health and goals of care.
Through consultation, the surgeons determine whether to perform a palliative or en bloc resection and how to decompress the spinal cord and stabilize the spine, if necessary. An extremely vascular tumor may require preoperative embolization.
While a posterior approach to spine tumors is still preferred if the tumor can be reached from the back, Drs. Shah and Checo can also take an anterior or lateral approach — or even a staged, 360- degree approach — depending on the turnor’s location, extent of resection and neurological goals of stabilization and/or decompression. The lateral approach is often used for thoracic or lumbar tumors because it allows for a smaller incision and eliminates the need for an approach surgery.