Surgical management of malignant tumors of the adult bony spine

Modern diagnostic imaging techniques and new methods for anterior and posterior decompression and reconstruction of the bony spinal column have dramatically improved the surgeon's ability to treat malignant tumors of the adult bony spine. The day of the laminectomy and Harrington rod reconstruction has passed, and an aggressive surgical approach is now justified for many primary and secondary malignant lesions of the spine. This article addresses the diagnosis and therapy of malignant tumors of the bony spine, emphasizing the common primary tumors of the spine and even more common metastatic lesions. Specific tumor types and therapeutic approaches at different levels of the spine are addressed, and newer techniques available to the treating clinician are reviewed. Current specific approaches to myeloma/plasmacytoma, breast carcinoma, prostate carcinoma, lung carcinoma, renal cell carcinoma, and chordoma and primary rectal carcinoma of the sacrum are reviewed in detail.