Assessment and Treatment of Malignant Primary Spinal Tumors

Though the majority of primary intradural spinal cord tumors are benign, malignant lesions can and do arise. When encountered, they are associated with significant morbidity and mortality and often pose unique challenges in their diagnostic workup, surgical approach, and oncologic management. Although the gold standard of treatment, complete surgical resection is often difficult to achieve. This is due to the lack of well-defined surgical planes of dissection and the proximity of critical neural structures nearby. Moreover, due to their rarity, there is a paucity of data to guide adjuvant radiation and chemotherapy. Ultimately, many cases will progress despite aggressive multimodal treatment, and recurrence rates are high. In the future, there is hope that more data, including genetic signature, and better treatment modalities will lead to improved outcomes.