Primary Tumors of the Spine

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Abstract
Eighty-two cases of primary neoplasms of the spine, diagnosed and treated at the University of Iowa, were reviewed in an attempt to identify features of diagnostic and prognostic importance, and to evaluate the effectiveness of surgical treatment with respect to survival. Thirty-one benign and 51 malignant tumors were identified. The mean follow-up in benign lesions was 9.7 years and 3.8 years in malignant lesions. Plain roentgenograms demonstrated the spinal lesion in 81 of 82 cases (99%). All spinal segments were involved, the cervical spine least frequently. Malignancy proved to be associated with an older age at diagnosis, a higher incidence of neurologic deficit, and a higher incidence of occurrence in the vertebral body. Five-year survival for patients with benign tumors was 86%, with no significant relationship between type of surgery and survival. Five-year survival in malignant lesions did correlate with the extent of initial surgery and with the tumor type. Five-year survival in patients undergoing curettage for malignancy was nil, in those undergoing incomplete resection, 18.7%, and in patients having complete excision, 75%. Plain anteroposterior and lateral roentgenograms should be obtained as a screening study in patients with persistent or atypical back pain or neurologic signs. CT scanning, myelography, and magnetic resonance imaging studies may be utilized to establish the physical margins of the lesion and to evaluate cord impingement. Surgical extirpation should be attempted whenever possible in malignant and benign aggressive lesions. In this series, the prolonged survival seen with complete excision justifies an aggressive surgical approach to the treatment of these tumors. Spine tumors should only be biopsied and treated by surgeons experienced in the approach and management of these most difficult problems.

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