Primary benign and malignant musculoskeletal tumors of the spine

The prognosis for survival has drastically improved for cancer patients in the past three decades. New approaches on multiple fronts have prolonged survival event in cases where cure is not possible. Any patient presenting with some neurological function and enough physical reserve to withstand surgery will benefit from a stable spine, relief of intractable pain, and neural decompression; there are very few exceptions. Methods of correcting deformity and of preventing iatrogenic deformity have improved outcome. Newer fixation techniques, using better materials, promise to eliminate many of the causes of hardware failure and loss of fixation previously seen. Vertebrectomy, considered a last-ditch alternative in the past, is performed in increasing numbers of patients, with good outcomes. Caution is the word, and appropriate referral to the definitive treating physician surgeon or nonsurgeon can't be emphasized enough. Surgical treatment can have a dramatic impact on function and outcome in selected patients with tumors of the spinal column, and should never be dismissed without serious consideration. Continued advances in fixation systems, local and systemic therapy, and our increasing experience with these patients promise greater improvements in the future.