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Spinal cord biopsy: Do the benefits outweigh the risks?
Spine Health | Last Active: Nov 10, 2023 | Replies (10)Comment receiving replies
I had a 20 minute phone conversation yesterday with my neurosurgeon's nurse regarding my potentioal spine lesion biopsy. The biopsy would be a full surgery, 3-4 hours. The neurosurgeon would make a 2"-3" incision and take a sample of the lesion. I would be in the hospital for two days. The possible risks include but not limited to sensory changes(in addition to the numbness from toes to waist I already have), bladder function, infection, existing symptoms worsening, stroke, or paralysis. Those possible risks aside, once the tissue is biopsied, perhaps they would be able to determine if the lesion is inflammation or a tumor. What would a treatment for each look like? After treatment, what would my functional status be? What's the end point if, after the biopsy, we still don't know what the lesion is? What if my option is to do nothing? Do I go from a walker to a wheelchair? Will the numbness continue to spread, eventually rendering any mobility "null and void" ? What will the quality of life look like at this point? Nothing was mentioned about a CT-guided percutaneous vertebral biopsy - a minimal invasive ,safe, and accurate procedure for definite tissue diagnosis of a vertebral lesion - (often best alternative to a surgical biopsy). I am 73 and the primary caregiver for my wife, who is in the middle stages of Alzheimer's. My biopsy decision affects not only my life but the life of my wife, and my interaction with my two grown sons, granddaughter, and three siblings. Again, I do want to become my own best advocate, so the more information I can have, the more confident I will be to make an informed decsion regarding a lesion biopsy of the spine. I have a video conference with my Mayo neurologist on Friday. I am hoping he will provide some more answers to help guide my decision. I would hope to make an informed decision by the weekend. As of now, with the information I have, the risks seem to edge out the benefits of a spinal lesion biopsy.
Replies to "I had a 20 minute phone conversation yesterday with my neurosurgeon's nurse regarding my potentioal spine..."
If I was you, I’d explore the CT guided percutaneous vertebral biopsy because it is minimally invasive. It sounds a lot safer than the alternative. Being under anesthesia for 3 to 4 hours is not good for elderly people in general. It can affect you mentally possibly putting you into the situation your wife is in. My partner had his hip replaced and although I urged him to have a spinal rather than general anesthesia , he chose the latter which affected him mentally. He has virtually no short term memory now and repeatedly asks the same questions over and over and he was not like that prior to the anesthesia.
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@upnort I know this is a very difficult decision that must be made with minimal information. In your comments, you seemed to be more at ease with a minimally invasive procedure with image guidance, than an open surgery. This is something to discuss at your next appointment. Minimally invasive surgery isn't always better. In an open surgery, the surgeon can see the area, and that also uses image guidance to make sure they are in the correct place, but they have the advantage of being able to see the lesion. Open surgery may also give the option to examine the tissue in pathology quickly during surgery rendering a treatment decision. If it is found to be malignant, they may be able to remove it on the spot and avoid another surgery. This is something to ask about, as I am not a surgeon and I just think this may be a possible option.
There's also the question of if you choose not to have the biopsy, will you wonder what could have been? If the condition worsens and you don't know if treatment could have helped, that would be a difficulty too. If you didn't have the responsibility of being the caregiver to your wife, would this be easier to decide what to do? Perhaps, if you have help, it would be better.
I know you have a lot of responsibility for your wife, and that is hard enough by itself. I hope you can find someone who will be able to help you. If you know you have some help (even temporary), that may make your decision as to your own treatment a bit easier. Do you have family or a pastor or church that you can reach out to for a bit of comfort or possible help with chores or groceries?
Jennifer