Abstract
The surgical management of spinal tumors has grown increasingly complex as treatment algorithms for both primary bone tumors of the spine and metastatic spinal disease have evolved in response to novel surgical techniques, rising complication rates, and additional data concerning adjunct therapies. In this review, we discuss actionable interventions for improved patient safety in the operative care for spinal tumors. Strategies for complication avoidance in the preoperative, intraoperative, and postoperative settings are discussed for approach-related morbidities, intraoperative hemorrhage, wound healing complications, cerebrospinal fluid (CSF) leak, thromboembolism, and failure of instrumentation and fusion. These strategies center on themes such as pre-operative imaging review and medical optimization, surgical dissection informed by meticulous attention to anatomic boundaries, and fastidious wound closure followed by thorough post-operative care.
Highlights
Extradural spinal tumors are categorized as primary when they arise directly from structures of the spine, and as metastatic when they arrive in the spine or epidural space, usually through hematogenous spread from other organs
The role of surgery in treatment differs between the two: primary spinal tumors are generally resistant to chemotherapy and radiation, and surgery for tumors such as chordomas and chondrosarcomas aims at more complete removal through en bloc resection, often requiring collaboration by multiple surgical specialties
Surgery may be curative for spinal tumors with a single metastasis, operations for spinal metastases are frequently performed with palliative intent
Summary
Extradural spinal tumors are categorized as primary when they arise directly from structures of the spine, and as metastatic when they arrive in the spine or epidural space, usually through hematogenous spread from other organs. The role of surgery in treatment differs between the two: primary spinal tumors are generally resistant to chemotherapy and radiation, and surgery for tumors such as chordomas and chondrosarcomas aims at more complete removal through en bloc resection, often requiring collaboration by multiple surgical specialties. Most metastatic spinal tumors are managed primarily with chemotherapy and radiation, and surgery is reserved for spinal instability to alleviate the mechanical pain. Operative management is termed separation surgery when used to create a safe margin between the spinal cord and the tumor for radiation which might otherwise cause radiation injury to the spinal cord at the doses required to effectively treat the tumor. With the advent of minimally invasive surgical techniques, novel targeted therapies, and newer modes of radiation, the treatment algorithm for spinal tumors is evolving. In our discussion of surgical techniques and complications, we shall describe actionable interventions in the preoperative, intraoperative, and postoperative settings that reduce surgical complications and maximize patient safety
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