How are primary malignant spinal tumors treated?

Updated: Nov 01, 2018
  • Author: Andrew A Sama, MD; Chief Editor: Jeffrey A Goldstein, MD  more...
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Answer

Treatment of primary malignant tumors of the spine has been summarized by Levine and Crandall. [20]  For treatment of astrocytomas, a less common spinal tumor, see Minnehan et al. [21]  For treatment of nonambulatory patients, see Kondo et al. [22]  For a discussion of palliative surgery for metastatic thoracic and lumbar tumors, see Cho and Sung. [23]

Kaloostian et al conducted a review of the literature regarding treatment and outcomes of patients with metastatic disease or primary tumors of the spinal column. [24]  They reported that en-bloc resection is the mainstay of treatment for malignant primary tumors of the spinal column, whereas intralesional resection is generally appropriate for benign primary tumors. Low-quality evidence supports the use of chemotherapy in select primary tumors. Radiation therapy is often used for incompletely resected or unresectable lesions.

According to this review, surgical considerations for the treatment of metastatic disease (see Metastatic Tumors in the Spine) are more nuanced and require consideration of patient performance status and the pathology of the primary tumor. [24]  Treatment of metastatic and primary tumors of the spinal column requires a multidisciplinary approach.

Glennie et al carried out a systematic review with consensus expert opinion regarding optimal reconstructive approaches after en-bloc resection of primary osseous spinal tumors. [25]  The reached the following conclusions:

  • Posterior reconstruction with at least two vertebral levels above and below is recommended
  • Cages should be employed for single-level defects
  • Structural bone graft, either alone or in combination with a cage, should be employed for spanning a defect greater than two vertebral bodies

The authors also noted that postoperative radiation therapy, if planned, may affect fusion strategy. [25]


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