When people see Daniel M. Sciubba, MD, for a spinal tumor, there’s a good chance they’ve been through a lot. Dr. Sciubba—Chair of Neurosurgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell—explains that this type of tumor is most often spurred by the spread of cancer elsewhere in the body. That can mean the patient has already undergone grueling treatment such as surgery, chemotherapy and possibly radiation treatment.

That’s why managing a spinal tumor takes patience and perspective, says Dr. Sciubba. “The patient needs good advice on avenues of treatment, and they need someone who can help assess and manage their symptoms,” he says. “The goal is to find a solution that suits their needs and expectations.”

Below, Dr. Sciubba provides answers to patients’ questions.

Is surgery the only option?

Sometimes more complicated surgeries can simply lead to more risks, including longer hospital stays and difficult recoveries. On the flip side, surgery may be a patient’s only choice given the risk the tumor poses. All of this has to be decided with the patient and their family.

The location of the tumor plays a role, too. Depending on its location, either the tumor or the procedure to manage it can cause deformity. For instance, if I’m treating a fit, young patient who has a tumor in her spinal cord, not in her bony spine, it’s challenging because the tumor could cause paralysis if left untreated. But the surgery itself includes cutting into the spinal cord. We have to weigh the options and make the best decision for the patient.

How do the patient and doctor make a decision on treatment?

It’s important to ask if the tumor is causing debilitating side-effects and whether radiation might be needed to shrink the tumor before surgery. In most spinal tumor cases, the tumor is not sensitive to radiation, or we have to use a very high dose of radiation, which sometimes works, but may leave the patient with other side effects.

A big help in decision making is an app that allows surgeons to input the tumor location, patient pain levels, spinal alignment, and other factors. The app makes a calculation and gives back a score known as SINS, which stands for spinal instability neoplastic score. This number indicates whether the patient’s condition is stable, potentially unstable or clearly unstable. The more unstable their condition, the higher their need for treatment.

How important is surgeon-patient communication?

It’s vital, and quality of life must be a top consideration. I challenge surgeons to think about this and work from a patient’s point of view.

As doctors, we need to understand a patient’s expectations and encourage them to express those thoughts clearly so we can help them and their loved ones determine the best option. Each patient is different. One patient will be told that they’re going to walk with a cane after surgery. If that’s what they expected, they’re fine with it.

Daniel Sciubba, MD, serves as the senior vice president of neurosurgery at Northwell Health, chair of neurosurgery at North Shore University Hospital and Long Island Jewish Medical Center, Co-Director of the Institute for Neurology and Neurosurgery at Northwell Health and Chair of Neurosciences at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.