Differential diagnosis and surgical treatment of pathologic spine fractures

The prognosis for survival has improved dramatically for cancer patients over the past three decades. Advances in systemic therapy have prolonged survival even in those who cannot be cured. The importance of managing spinal column disease and protecting the spinal cord has subsequently been amplified. Almost any patient presenting with detectable neurologic function and enough physical reserve to withstand an operation will benefit from a spinal stabilization, pain relief, and neural decompression; there are few exceptions. Advances in surgical technique and biomaterials have not only improved survival and functional outcome, they have diminished many of the postoperative complications that plagued earlier treatment techniques. Methods of preventing or correcting iatrogenic deformity have improved outcome. Newer fixation techniques promise to eliminate many of the causes of hardware and fixation failure previously seen. Improved medical management, antibiotics, and preoperative planning, along with techniques of preoperative embolization and early postoperative mobilization have made surgical management much less risky. Vertebrectomy, considered a last alternative in the past, is now coming to be seen as the conservative approach to tumor management in many situations. Appropriate surgical treatment can have a dramatic impact on function and outcome in patients with tumors of the spinal column, and should never be dismissed as an option without serious consideration. Advances in fixation systems, local and systemic therapy, and in our understanding of the biology of cancer promise even greater improvements for the future.