Washington University Orthopedic spine specialists are leading the way in diagnoses and treatment planning. Recently published in the Journal of the American Academy of Orthopedic Surgeons (JAAOS), by Matthew Goodwin, MD, PhD, FACSM, and Jacob Buchowski, MD, PhD, is a comprehensive review of guidelines pertaining to spinal tumors, titled Spinal Tumors: Diagnosis and Treatment.
Spinal tumors located within or surrounding the spine can be difficult to diagnose and treat. These tumors are generally of two types: the relatively rare primary tumors, and the more commonly occurring metastatic tumors. An accurate diagnosis of the specific tumor type can ensure effective treatment with better patient outcomes.
In a recent JAAOS review article, spine tumor specialists, Drs. Goodwin and Buchowski, from Washington University Orthopedics have collaborated with others to present a comprehensive overview of guidelines to help surgeons diagnose and treat both types of spinal tumors.
The article suggests that both primary and metastatic lesions can be identified and treated through appropriate workup and planning. A complete history and physical examination, along with pertinent imaging, typically help generate a differential diagnosis. Factors like patient age, lesion location, and tumor characteristics all may be considered when generating this differential diagnosis.
Further lab tests and then a tissue biopsy typically lead to the diagnosis. Sometimes a second biopsy may even be needed to confirm the diagnosis.
Once the tumor is identified, a spine tumor board comprised of experts in spinal oncology from different disciplines should discuss the case and the available treatment options. This is critical to treatment planning. Surgery is typically indicated for one of the following reasons: 1) to completely remove a primary tumor; 2) to decompress the spinal cord or nerve roots; or 3) to stabilize an unstable spine.
When treating primary tumors, the goal should be to completely remove the tumor, or achieve “Enneking-appropriate margins,” to ensure the patient the greatest chance of survival. Often this means the tumor is removed in one piece, without entering it or disturbing it, leaving the margins around it free of tumor.
Contrarily, metastatic tumors may need to be treated with surgical decompression of the spinal cord and/or stabilization of the spine, with adjuvant treatments like chemotherapy and radiation.
The timing of surgery is also critical. When surgery is needed, it is usually performed only after there has been appropriate staging and planning. However, in rare cases, a patient with an unknown primary tumor causing spinal cord compression may undergo rapid neurological decline and need a decompression surgery before a formal diagnosis is made in order to avoid complete paralysis.
These key recommendations can help surgeons adopt a multidisciplinary approach to treat spinal tumors and improve the quality of care.
Dr. Goodwin shares, "This was really a unique opportunity to contribute our spine tumor experience and expertise toward more clear guidelines when caring for patients with spinal tumors. Taking care of these patients can be very challenging. Dr. Buchowski and I, along with our collaborators Dr. Sciubba and Dr. Schwab, worked hard to create a review that summarizes the key components of caring for these patients, with an emphasis on multidisciplinary care. This approach is modeled here at WashU and Barnes-Jewish Hospital, where patients with spinal lesions will get their case reviewed at our spine tumor board, with the final plan typically involving input from orthopedic spine surgery, neurosurgery, radiation oncology, interventional radiology, oncology, and the patient themselves!”
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