[Oncological surgery of the spine]

Spine surgery has been significantly influenced during the past 20 years by improvements in anaesthesia and radiology. This progress has also been promoted by technical developments in spinal instrumentation, mainly the introduction of pedicle screws and anterior support with cages. Both techniques allow correction and stabilisation methods that have had a major effect on tumour surgery. These advancements have allowed less experienced spine surgeons to perform tumour surgery, which may have a negative effect on the outcome. From our point of view, it should be required that tumour surgery be performed only in hospitals managing a certain number of tumours annually. For optimal results, en bloc resection and intralesional marginal resection in particular are highly demanding of the surgeon's technical skills and experience. Second and third operations complicate the intervention unnecessarily. Normally, R0 resection can not be achieved by a second or third revision. For this reason tumour surgery requires a standardised overall concept which must be suited to individual problems. This can be best decided in a tumour board meeting for choosing the options for adjuvant therapy. Only by such a coordinated effort may good mid- and long-term results be achieved.It must be pointed out that en bloc resection is the only surgical therapy that makes a curative approach possible. On the other hand it can also be demonstrated that by making extended, intralesional marginal resections as radical as possible, good mid-term results can be achieved. Here the adjuvant chemo- and radiotherapy play an important role.