Spinal tumors: literature review

Abstract

Problems epidemiology, classification, diagnosis, and treatment of spinal tumors are considered. Data on morbidity and characteristics of different histological forms of benign and malignant vertebral tumors are presented. Features of spinal tumor diagnosis, classic radiological signs, and current noninvasive visualization and invasive (biopsy) techniques are discussed. Literature data on techniques and capabilities of surgical treatment are analyzed. Current trends in selection of surgical intervention radicality level depending on the type of spinal tumor using staging classifications by Ennеking, Weinstein–Boriani–Biagini and Tomita are described. Current indications for radical en bloc resection performed in a limited number of cases is considered. Minimally invasive spine surgery is discussed: from vertebroplasty, radiofrequency ablation and intervention removal of metastatic tumor to separation surgery for epidural compression. Apart from surgical treatment, neoadjuvant and adjuvant radiotherapy of vertebral tumors are analyzed: conventional, conformal, including stereotaxic, beam therapy and radiosurgery. Data on current trends in treatment selection depending on histological nature of the tumor, its radiosensitivity and probability of post-radiation malignant transformation are presented. Drug treatment, in particular chemotherapy, is an indispensable in treatment of secondary and some primary spinal tumors. Data on chemosensitivity of various tumors and tactics of combination and complex treatment are presented. Evidently, the current trend is to decrease the level of surgical invasiveness and selection of minimally invasive methods of surgical treatment. Moreover, it is concluded that considering the biological nature of hemopoietic tumors and some sarcomas, currently surgical treatment is not the main method of treatment of these malignant tumors.