Primary Bone Tumor of the Spine—An Evolving Field: What a General Spine Surgeon Should Know

Abstract

Study Design: A narrative review of the literature. Objective: This article reviews the general principles of treatment and investigation for primary bone tumors of the spine. Furthermore, it explores the emerging alternatives. Methods: A review was performed using Medline, Embase, and Cochrane databases. Results: Primary bone tumors of the spine are rare entities that general spine surgeons may encounter only a few times in their career. The treatment algorithm of these complex tumors is filled with nuances and is evolving constantly. For these reasons, patients should be referred to experienced tertiary or quaternary centers who can offer a comprehensive multidisciplinary approach. For most malignant spinal bone tumors, surgery remains the cornerstone of treatment. Respecting oncologic principles has been associated with improved survival and decreased local recurrence in multiple settings. However, even in experienced centers, these surgeries carry a significant risk of adverse events and possible long-term neurologic impairment. The associated morbidity of these procedures and the challenges of local recurrence have encouraged professionals caring for these patients to explore alternatives or adjuncts to surgical treatment. Conclusions: Over the past few years, several advances have occurred in medical oncology, radiation oncology and interventional radiology, changing the treatment paradigm for some tumors. Other advances still need to be refined before being applied in a clinical setting.

Editorial Comment on the Article by Mushkin M.A. et al. “Effect of Prehospital Pause on the Outcomes of Emergency Decompression and Stabilization Procedures in Patients with Tumor and Infectious Spine Diseases”

“…Складывается тревожная ситуация. В арсенале спинальных хирургов содержатся алгоритмы и классификации для первичных и вторичных опухолей позвоночника [3,4,5], инфекционных спондилитов [6], патологических переломов на фоне остеопороза [7] и прочие специфические гайдлайны. Но у нас нет адекватных инструментов для комплексной оценки деструктивного процесса как синдрома.…”

Assessing the Mechanical Weakness of Vertebrae Affected by Primary Tumors: A Feasibility Study

“…However the SINS score is only partially helpful for surgeon as a treatment guide [8]: there is a large grey zone of "potentially unstable" (SINS 7 to 12), were spine surgeons currently must rely on their own experience to determine whether instability is present in the setting of spinal neoplasia and surgery is urgently indicated. A recent review [9] confirmed that the recommendations for treating the primary bone tumors are based on moderate quality evidence and expert opinions.…”

3D-Printed Patient-Customized Artificial Vertebral Body for Spinal Reconstruction after Total En Bloc Spondylectomy of Complex Multi-Level Spinal Tumors

“…The spine is a complex skeletal anatomic structure involved in weight bearing, shock absorption, and motion. Tumors involving the spine, whether primary or metastatic, may cause severe back pain, limb numbness, weakness and/or paralysis[ 5 ]. Total en bloc resection of spinal tumors is the most direct and effective way to relieve symptoms, recover function, and prevent tumor progression[ 6 ].…”