Matsumoto Yoshihiro
Department of Orthopaedic Surgery, Fukushima Medical University.
Fukushima J Med Sci. 2025 Apr 19;71(2):85-95. doi: 10.5387/fms.24-00008. Epub 2025 Feb 8.
The diagnosis and treatment of malignant spinal tumors are complex and require an integrated approach known as Jaffe's triangle. This review discusses recent topics in the diagnosis and treatment of primary and metastatic malignant spinal tumors. Integrated diagnostic methods, including the development of a dumbbell scoring system for benign-malignant differentiation and the use of positron emission tomography and magnetic resonance imaging (PET-MRI), have improved diagnostic accuracy. Curative resection techniques such as vertebrectomy, sagittal resection, and posterior resection are crucial for primary malignant tumors. Heavy particle radiation therapy, such as carbon-ion radiotherapy, shows promise against radiation-resistant tumors, whereas novel drug therapies, such as denosumab, are effective for giant cell tumors of the bone arising in the spine. For metastatic spinal tumors, the collaborative efforts of the Bone Metastasis Cancer Board and minimally invasive spine stabilization have expanded surgical indications and improved patient outcomes. The treatment system has shifted towards preventive surgery and outpatient management, aiming to maintain quality of life and continue chemotherapy. Interdisciplinary collaboration is essential for improving treatment outcomes in both primary and metastatic malignant spinal tumors.Primary malignant spinal cord tumors (PMST) and metastatic spinal tumors (MST) are among the most difficult areas of orthopedic surgery. Their diagnosis and treatment require multidisciplinary diagnostic and therapeutic strategies that integrate knowledge and skills in orthopedics, pathology, and diagnostic radiology (the so-called Jaffe triangle), as well as in clinical oncology and tumor biology, which have made remarkable progress in recent years. Here, we review recent topics related to the diagnosis and treatment of PMST and MST.
恶性脊柱肿瘤的诊断和治疗较为复杂，需要采用一种称为贾菲三角的综合方法。本综述讨论了原发性和转移性恶性脊柱肿瘤诊断与治疗方面的最新话题。综合诊断方法，包括用于良恶性鉴别的哑铃状评分系统的开发以及正电子发射断层扫描和磁共振成像（PET-MRI）的应用，提高了诊断准确性。椎体切除术、矢状切除术和后路切除术等根治性切除技术对原发性恶性肿瘤至关重要。重粒子放射治疗，如碳离子放射治疗，对耐辐射肿瘤显示出前景，而新型药物疗法，如地诺单抗，对脊柱骨巨细胞瘤有效。对于转移性脊柱肿瘤，骨转移癌委员会的协作努力和微创脊柱稳定技术扩大了手术适应症并改善了患者预后。治疗体系已转向预防性手术和门诊管理，旨在维持生活质量并继续化疗。多学科协作对于改善原发性和转移性恶性脊柱肿瘤的治疗效果至关重要。原发性恶性脊髓肿瘤（PMST）和转移性脊柱肿瘤（MST）是骨科手术中最具挑战性的领域之一。它们的诊断和治疗需要多学科的诊断和治疗策略，整合骨科、病理学和诊断放射学（所谓的贾菲三角）以及近年来取得显著进展的临床肿瘤学和肿瘤生物学方面的知识和技能。在此，我们综述与PMST和MST诊断和治疗相关的最新话题。
