Vertebral tumors: surgical versus nonsurgical treatment

The treatment of spinal tumors represents a challenge to spine care professionals. Fortunately, the incidence of new cases of primary malignant bone tumors is lower compared with that of other tumors. In the United States approximately 2000 malignant bone tumors of 7000 new sarcomas are diagnosed each year. Of these, 4% to 20% (80-400 tumors) of bone tumors are spinal tumors. Metastatic tumors are the most frequent tumor of bone and the most frequent tumor of the spinal column regardless of the origin of the primary tumor. More than 90% of spinal tumors are metastatic. Thirty to seventy percent of patients who die from cancer have evidence of vertebral metastases visible on careful postmortem examination, with the potential that this number could reach 85% in patients with breast cancer. Less than 10% of patients with spinal tumors present with spinal instability requiring surgical treatment; this accounts for approximately 18,000 new cases yearly. We will focus on the most recent advances in nonsurgical and surgical treatment of vertebral tumors. In surgical treatment, the evaluation and selection of patients, indications and surgical strategies, open and minimally invasive techniques, outcomes and complications will be discussed.

Level V (expert opinion). See the Guidelines for Authors for a complete description of the levels of evidence.