Primary Spine Tumors: Diagnosis and Treatment

Michelle J. Clarke, MD; Ehud Mendel, MD; Frank D. Vrionis, MD, PhD


Cancer Control. 2014;21(2):114-123. 

In This Article

Abstract and Introduction


Background: Primary tumors are rare and those localized to a single location offer the potential for cure. To achieve this, early recognition of the primary tumor and proper workup and treatment are essential.

Methods: The authors reviewed the literature and best practices to provide recommendations on primary spine tumor treatment. Appropriate workup of primary spine tumors and treatment algorithms are also discussed.

Results: Patients suspected of a primary spine tumor should undergo fine-needle aspirate biopsy following consultation with the surgical team to ensure the biopsy tract is surgically resectable should the need arise. Once pathology is confirmed, metastatic workup should be performed to guide the level of treatment. If a localized lesion with poor radiation and chemotherapeutic response is diagnosed, then en bloc resection may be required for cure. If en bloc resection is not feasible or metastatic lesions are present, then radiation and medical oncology specialists must work in conjunction with the surgical team to determine the best treatment options.

Conclusions: Patients with suspected primary tumors of the spine should be treated in a multidisciplinary fashion from the outset. With thoughtful management, these lesions offer the opportunity for surgical cure.


Primary vertebral tumors are rare, accounting for fewer than 5% of all neoplasms in the spinal column,[1] making them 40 times less common than spinal metastases.[2] These tumors are uncommon and infrequently encountered in practice. Nevertheless, because specific diagnostic and treatment modalities may impact outcome, these lesions must be included in the health care professional's differential diagnosis.

Unlike metastatic spine tumors, primary tumors localized to a single location offer the potential for true cure. However, this possibility may be eliminated by late recognition or improper workup. Becase many of these lesions poorly respond to chemotherapeutic agents and radiation therapy, missteps can have a devastating effect on outcome. Thus, this paper focuses on a systematic approach to the diagnosis and treatment of primary spine tumors.