Reviews: Review Article

Spinal Tumors: Diagnosis and Treatment

Goodwin, Matthew L. MD, PhD; Buchowski, Jacob M. MD, MS; Schwab, Joseph H. MD, MS; Sciubba, Daniel M. MD, MBA

From the Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO (Goodwin and Buchowski), the Department of Orthopedic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA (Schwab), and the Department of Neurosurgery, Northwell Health, New York, NY (Sciubba).

Goodwin or an immediate family member receives royalties from Kendall Hunt publishing; serves as consultant to Augmedics; serves as consultant and has stock held in ROM3; has received fellowship support from AO Spine/Globus; and has stock held in Pfizer, BioNTech, Moderna, and Johnson and Johnson. Buchowski or an immediate family member receives royalties from Globus Medical and K2M/Stryker and has received institutional fellowship support from AO North America and OMeGA. Schwab or an immediate family member serves on a scientific advisory board of the Chordoma Foundation. Sciubba or an immediate family member serves as a consultant to DePuy-Synthes, Medtronic, Stryker, and Baxter; has stock held in Augmedics; and is an equity owner of BioPhy. All authors serve on the North American spine society (NASS) spine oncology subcommittee.

Journal of the American Academy of Orthopaedic Surgeons 30(17):p e1106-e1121, September 1, 2022. | DOI: 10.5435/JAAOS-D-21-00710

Abstract

Tumors that present in or around the spine can be challenging to diagnose and treat. A proper workup involves a complete history and physical examination, appropriate staging studies, appropriate imaging of the entire spine, and a tissue biopsy. The biopsy defines the lesion and guides treatment, but in some rare instances, rapid neurological decline may lead to urgent or emergent surgery before it can be analyzed. “Enneking-appropriate” margins should remain the goal for primary tumors while adequate debulking/separation/stabilization are often the goals in metastatic disease. Primary tumors of the spine are rare and often complex tumors to operate on—achieving Enneking-appropriate margins provides the greatest chance of survival while decreasing the chance of local recurrence. Metastatic tumors of the spine are increasingly more common, and timing of surgery must be considered within the greater framework of the patient and the patient's disease, deficits, stability, and other treatments available. The specific tumor type will dictate what other multidisciplinary approaches are available, allowing for chemotherapy and radiation as needed.

Erratum

In the September 1, 2022, issue of Journal of the American Academy of Orthopaedic Surgeons in the article by Goodwin et al, “Spinal Tumors: Diagnosis and Treatment”, Table 2 should have appeared as it does below and the legend for Figure 3 should read as “Diagram showing blood supply to the spinal cord. Note how segmental arteries from the aorta (sometimes referred to as intercostal arteries in the thoracic spine and lumbar arteries in the lumbar spine) give rise to a ventral and dorsal branch, of which the latter gives rise to a spinal branch. This branch travels within the dural root sleeve along the nerve root, and gives rise to an anterior and posterior branch. These branches are typically present bilaterally at each root level, and are referred to as radicular arteries when they supply the root and pia but do not directly supply the anterior or posterior spinal arteries. When a branch travels to the anterior or posterior spinal artery directly, it is referred to as radiculomedullary. These radiculomedullary arteries are not present at each level; one radiculomedullary artery may provide blood supply to several spinal levels. The largest of these arteries is referred to as the Artery of Adamkiewicz (AA), which typically displays the “hairpin” turn as it enters into the anterior spinal artery, as seen here. Note that ligating and transecting the nerve root proximal to the dorsal root ganglion (as recommended) includes sacrifice of the arteries at that level. In spine tumor surgery, up to three levels of thoracic nerve roots have been sacrificed bilaterally with little to no deleterious effects, even if the AA has been included. Despite this, it is still advisable to preserve the AA when feasible. (Reproduced with modification with permission from Amato and Stolf.³⁴)”

The Publisher regrets these errors.

JAAOS - Journal of the American Academy of Orthopaedic Surgeons. 31(11):e504-e506, June 1, 2023.