Anesthesia for Spine Cancer Surgery

Spinal cancer is primarily a metastatic disease with >90% having originated from another source. There is no proven curative treatment for metastatic spinal disease and therefore the goals are pain control and functional preservation. Many primary tumors affect persons of advanced age; therefore consideration for comorbidities, fitness for therapy, and patient preference are fundamental in guiding management plans to provide holistic care. Oncologic spine surgeries vary in duration and complexity, and the potential for massive blood loss and hemodynamic instability must be considered. Pain control in the postoperative setting can be challenging and usually requires a multimodal approach. Advances in regional techniques, particularly novel fascial plane blocks such as the erector spinae plane (ESP) block, show promise in reducing reliance on opioids and in reducing opioid-related side effects. Laboratory and retrospective clinical research has suggested that certain anesthetic techniques may minimize metastatic spread in the perioperative period. These include the use of total intravenous anaesthesia (TIVA) (volatile sparing anesthetic), regional anesthesia techniques (and avoidance of opioids), use of IV lidocaine, and the avoidance of blood transfusion. However, robust prospective clinical data are lacking, and currently there are no trials evaluating the association between anesthetic technique and metastasis after spinal cancer surgery. These principles have been discussed more generally elsewhere in this book. In the management of these complex patients, a well-formulated perioperative plan and effective communication between the multidisciplinary team are essential to ensure optimal patient outcomes.