Abstract and Introduction
Tumors that present in or around the spine can be challenging to diagnose and treat. A proper workup involves a complete history and physical examination, appropriate staging studies, appropriate imaging of the entire spine, and a tissue biopsy. The biopsy defines the lesion and guides treatment, but in some rare instances, rapid neurological decline may lead to urgent or emergent surgery before it can be analyzed. "Enneking-appropriate" margins should remain the goal for primary tumors while adequate debulking/separation/stabilization are often the goals in metastatic disease. Primary tumors of the spine are rare and often complex tumors to operate on—achieving Enneking-appropriate margins provides the greatest chance of survival while decreasing the chance of local recurrence. Metastatic tumors of the spine are increasingly more common, and timing of surgery must be considered within the greater framework of the patient and the patient's disease, deficits, stability, and other treatments available. The specific tumor type will dictate what other multidisciplinary approaches are available, allowing for chemotherapy and radiation as needed.
Spinal tumors range from relatively rare primary tumors requiring a complete en bloc resection[1–4] to the increasingly common metastatic disease of the spine, where patients may require decompression of the spinal cord/nerve roots and/or stabilization.[5–7] Although primary tumors of the spine are rare (<10% of spinal tumors), the number of patients with metastatic disease to the spine is substantial. Spinal metastases will be found in approximately 20% of all patients diagnosed with cancer (and in ≈70% of those with metastatic disease). Approximately 300,000 patients are diagnosed with metastatic disease to the skeleton each year in the United States alone, with ≈70% of those lesions being found in the spine (thoracic spine being the most common location [≈70%], followed by lumbar [≈20%], cervical, and sacrum).[8,9] The workup of the new spinal lesion can be challenging; primary tumors of the spine are rare, and improper workup/treatment can lead to poor outcomes. By contrast, metastatic disease of the spine is relatively common, yet surgical indications differ between institutions and providers. Here, we provide an overview and guidelines to aid the spine surgeon in working up, diagnosing, and treating spinal lesions, both primary and metastatic, with an emphasis on the need for collaborative and multidisciplinary efforts.
J Am Acad Orthop Surg. 2022;30(17):e1106-e1121. © 2022 American Academy of Orthopaedic Surgeons