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Before treatment can start, a clear idea is needed of which kind of treatment would be best.There are three main choices:

• Surgical treatment
• Radiotherapy
• Chemotherapy

However, when it is not entirely clear what sort of tumour is present, a biopsy (taking a sample of tissue) may be necessary to decide on the best treatment. Although this can sometimes be done under local anaesthetic with a large needle, it may require a small operation.

Biopsy
If done by needle, local anaesthetic may be all that is required, depending on the location and the size of the lesion. Either X-ray equipment is used for guidance of the needle, or a CT scanner may be used. It usually has to be done whilst lying face down. Some people find this procedure rather uncomfortable.

An open surgical biopsy is carried out under general anaesthetic and involves making a small cut, typically over the back of the spine. Removal of a small amount of bone is usually all that is necessary to obtain a suitable sample of the tumour. Biopsy results take a few working days before answers become available.

Surgical removal
Surgical removal is used for benign tumours, for example those within the membranes surrounding the spinal cord and nerves and at least some malignant tumours, e.g. chordoma. Often benign tumours can be removed completely in this way, but not always. In some circumstances, it is safer to leave a small fragment behind than to risk serious damage trying to remove the tumour completely.Tumours inside the spinal cord are particularly difficult to treat and complete removal may not be possible.

Tumours of the bone, although separated from the nerves and spinal cord by the protective membranes, may be very difficult to remove. This is due to a combination of size, access to the whole of the tumour lump (which may extend round the spinal cord from the front to the back) and the need to preserve stability of the bony structure of the spine. However, even if complete removal of a spinal tumour is not possible, relief of pressure on the spinal cord and nerves may permit recovery of weakness or paralysis. In some cases, the spine will need to be strengthened by an implant, which may involve a rather bigger operation and a longer recovery period.

The basic process of opening the spinal canal to deal with a tumour is usually carried out from behind and is called a laminectomy.

Radiotherapy
Radiotherapy is frequently used to treat malignant tumours and may be the main treatment of choice once the nature of the tumour is known. It may also be used after surgery to deal with any remaining disease. If a primary cancer has been diagnosed for the first time elsewhere in the body, during the tests and treatment of a secondary deposit, radiotherapy may also be used to treat the primary cancer.

Although radiotherapy is not always available at the same hospital where neurosurgical treatments are carried out, there is always a close link with a hospital nearby. Radiotherapy is planned by radiotherapists or oncologists (who specialise in treatment of all cancers).

Radiotherapy in the form of high energy X-rays is used to damage or destroy tumour cells. Radiation may delay tumour regrowth or cure the condition entirely.The exact method of giving the radiotherapy varies a great deal, depending on the type of tumour and the purpose of the treatment. For example, a single dose may be all that is necessary to relieve pain, whereas multiple treatments on a daily basis may be necessary to cure a tumour. Radiotherapy does not affect anyone other than the patient.

Common side effects of radiotherapy may include a temporary worsening of the symptoms of the tumour and inflammation of the skin, which is rather like sunburn.The effects on the skin gradually improve although it is best to avoid washing the affected area too vigorously and to stay out of direct sunlight until any reaction has disappeared. Other side effects may include bone fractures and changes in the bone marrow.

Chemotherapy
Drugs can be given to destroy tumour cells. Chemotherapy is mostly used for cancers with secondary deposits in the spine from primary cancers that are known to be sensitive to chemotherapy.

Steroid treatment
Steroids are often used when there is pressure on the spinal cord or nerves.They are usually given during a course of radiotherapy or at the time of surgery.They reduce swelling in the spinal cord and nerves and provide some degree of protection from compression. The most common steroid used is dexamethasone. Side effects can include an increased appetite and an improvement in mood, both of which affect people to different degrees. After several weeks of treatment, weight gain, acne, stretch marks, muscle weakness and even diabetes can develop. Since steroid tablets can irritate the lining of the stomach, they increase the likelihood of developing ulcers.This effect can be reduced by taking anti-ulcer drugs or antacids. Steroids are usually tapered off slowly if they have been taken for more than a couple of weeks. Side effects tend to reverse after withdrawal.