Tumors of the spine

Abstract

Spine tumors comprise a small percentage of reasons for back pain and other symptoms originating in the spine. The majority of the tumors involving the spinal column are metastases of visceral organ cancers which are mostly seen in older patients. Primary musculoskeletal system sarcomas involving the spinal column are rare. Benign tumors and tumor-like lesions of the musculoskeletal system are mostly seen in young patients and often cause instability and canal compromise. Optimal diagnosis and treatment of spine tumors require a multidisciplinary approach and thorough knowledge of both spine surgery and musculoskeletal tumor surgery. Either primary or metastatic tumors involving the spine are demanding problems in terms of diagnosis and treatment. Spinal instability and neurological compromise are the main and critical problems in patients with tumors of the spinal column. In the past, only a few treatment options aiming short-term control were available for treatment of primary and metastatic spine tumors. Spine surgeons adapted their approach for spine tumors according to orthopaedic oncologic principles in the last 20 years. Advances in imaging, surgical techniques and implant technology resulted in better diagnosis and surgical treatment options, especially for primary tumors. Also, modern chemotherapy drugs and regimens with new radiotherapy and radiosurgery options caused moderate to long-term local and systemic control for even primary sarcomas involving the spinal column.

Keywords: Spinal column; Sarcoma; Metastasis; Spinal neoplasms; Palliative surgery

Core tip: Primary tumors involving the spine are rare, while spinal column metastases are present in up to 70% of cancer patients. Both primary and metastatic tumors of the spine are often asymptomatic or have non-specific symptoms because in spine tumors, delayed diagnosis is not very unusual. Goal of treatment in spinal column metastases is to optimize the patient’s quality of life by providing effective pain relief and preserving or restoring neurological functions. Treatment strategy for primary tumors should be planned after both oncological and surgical staging. Because of that, biopsy is a very important step in primary tumors. Surgery in metastatic tumors are mostly palliative, aiming short-term control. Primary benign and malignant lesions mainly cause canal compromise and are treated surgically according to oncological staging and Weinstein-Boriani-Biagini classification.