Abstract
This special focus issue from the 2023-2024 AOSpine Knowledge Forum Tumor represents a culmination of years of experience devoted to advancing the care of patients with both metastatic and primary spinal tumors. We have learned much since the fundamental assessments of instability that led to the Spinal Instability Neoplastic Score (SINS), the grading of epidural disease utilizing the Epidural Spinal Cord Compression Scale (aka Bilsky grade), as well as the development of tumor-specific health related quality of life assessments such as the Spine Oncology Study Group Outcome Questionnaire (SOSGOQ). These tools have enabled us to make several prior recommendations for the appropriate use of advanced surgical techniques such as en bloc resection and the use of stereotactic body radiotherapy (SBRT) to optimize patient care.
In this issue we focus on what the modern spine surgeon needs to know in the era of personalized precision medicine. We have specific articles on molecular prognostication and the potential role of liquid biopsies, which are increasingly relevant as we manage patients with metastatic disease that are living far longer than previously expected. We are also focused on objective assessments to ensure that our patients can withstand our planned surgical procedures. Sarcopenia, malnutrition, and frailty are highly relevant in the oncology population and can influence our decision making when recommending aggressive vs more conservative management strategies. We must also continue to evolve and refine our understanding of spinal pain syndromes, etiology of neurologic deficits, and intermediate spinal instability, to improve our decision-making processes. New surgical, medical, and radiation technologies are also gaining ground and we need to examine the evidence to guide practice. We summarize the role of SBRT and particle therapy for metastatic and primary tumors, novel biologic therapies, and the role of carbon fiber implants. Lastly, we must always be mindful of the impact of wound complications as, in the cancer patient, this can delay life-prolonging treatments that are critical following the initial surgical procedures. We present a detailed systematic review with clinical considerations to optimize wound management. It is an honor for us to share with our community this special focus issue as we evolve into the era of advanced personalized care for patients with spinal tumors. We thank all authors, Niccole Germscheid, and Janneke Loomans from the AO Spine Knowledge Forum Tumor for their dedicated efforts to realize this special issue.
Footnotes
Acknowledgments
This focus issue was organized and funded by AO Spine through the AO Spine Knowledge Forum Tumor, a focused group of international Tumor experts. AO Spine is a clinical division of the AO Foundation, which is an independent medically-guided not-for-profit organization.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
