Complex reconstruction in tumor patients

Spine tumor patients require unique considerations as tumor location, patient biology, and adjuvant treatment status can all affect reconstruction techniques. The primary goal of reconstruction is to remove the tumor and provide neural decompression while simultaneously stabilizing the spinal column and correcting any deformity. Surgical approaches can consist of anterior column resection with reconstruction, traditional posterior-based decompression and reconstruction techniques, or anterior column resection through a posterior-based approach. Large segment resections such as total en bloc spondylectomy require restoration of mechanical stability with expandable cages, bone graft, and multilevel segmental fixation. The development of carbon-fiber implants allows radiolucent instrumentation to be used with subsequent imaging for monitoring disease progression. While traditional bone graft techniques such as iliac crest autograft continue to be important in obtaining fusion, advanced techniques such as free fibula or rib grafts and the potential use of biologics in the future may play a significant role.