Primary Spine Tumors: Diagnosis and Treatment

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

Disclosures

Cancer Control. 2014;21(2):114-123. 

In This Article

Hematopoietic Malignancies

Lymphoma, multiple myeloma, and solitary plasmacytoma are the most common malignant neoplasms of the spine.[2] Radiotherapy is the mainstay of treatment for these lesions, with excellent local control. Although these tumors are considered radiosensitive, recurrences following radiation may rarely occur and are especially seen in long-term survivors. Approximately 50% of patients with solitary plasmacytoma will develop multiple myeloma within 2 years.[10–12] Thus, systemic chemotherapy may be useful in cases with widespread disease or in the setting of plasmacytoma conversion to multiple myeloma.

Surgical intervention can be avoided in many cases. However, in the setting of neurological deficit due to spinal canal compromise or instability causing mobility-limiting pain, surgery may be considered. In these cases, CT scanning is helpful in defining the lesion. Canal compromise caused by bony intrusion, such as that caused by a retropulsed pathological fracture, is unresponsive to radiation and must be mechanically decompressed. In the case of radiation-responsive tumors, the goals of surgery are to decompress the spinal canal and restore the stability and load-bearing capacity of the spine. This is accomplished by performing vertebral augmentation. Complete resection and reconstruction is occasionally completed; however, at a minimum, a reasonable margin between the tumor and spinal cord ("separation surgery") should be developed to optimize subsequent radiation treatment.

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