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).
J Am Acad Orthop Surg. 2022 Sep 1;30(17):e1106-e1121. doi: 10.5435/JAAOS-D-21-00710.
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.
脊柱内或周围的肿瘤在诊断和治疗上具有挑战性。适当的检查包括完整的病史和体格检查、适当的分期研究、整个脊柱的适当影像学检查以及组织活检。活检确定病变并指导治疗，但在某些罕见情况下，在对其进行分析之前，快速的神经功能下降可能导致紧急或紧急手术。“Enneking 适当”的切缘仍然是原发性肿瘤的目标，而在转移性疾病中，充分的减瘤/分离/稳定通常是目标。脊柱原发性肿瘤罕见，通常是复杂的手术肿瘤——实现 Enneking 适当的切缘提供了最大的生存机会，同时降低了局部复发的机会。脊柱转移性肿瘤越来越常见，手术时机必须在患者和患者疾病、缺陷、稳定性和其他可用治疗的更大框架内考虑。具体的肿瘤类型将决定哪些其他多学科方法可用，允许根据需要进行化疗和放疗。
