Primary spinal tumors are inherently rare entities and the absolute minority looking at all mostly peripheral skeletal primary tumors. Despite their importance, clinical studies and scientific investigations of spinal oncology have long time lagged behind similar work on oncosurgical studies of the extremities. However, several publications lately presented multicentre-based data gathering important information about these entities. Notably, among the partly unknown prognostic variables decisively influencing course and outcome of spinal malignancies, the underlying tumor biology has been turned out to be most important factor. Thus, the spine tumor community must provide answers to the questions how these heterogeneous tumor biologies guide treatment and - whenever possible - the different surgical and oncological concepts can be tailored to the individual disease.
The diagnosis of a primary malignant spinal tumor can cause an ordeal for the patients as well as their families. Specialist multidisciplinary management is mandatory and the key-step to achieve maximum treatment success. Latest findings underlined the enormous value of surgery with curative intent using “Enneking- appropriate resections”. In combination with multidisciplinary adjuvant therapies they are clearly associated with a better local tumor control and increased patients` overall survival. To obtain the mentioned goals all phases of treatment for primary spinal tumors should be centralised for the various diagnostic steps, neo-/ adjuvant oncological care and specialist spinal oncology surgery. However, the number of intralesionally and “out-of-center” pre-treated patients as well as revision cases rises steadily demonstrating the discrepancy between wish and reality. Benign tumors should in first line be treated according to their biological behaviour with the need of a graded multidisciplinary treatment approach to achieve sustainable therapeutical success. But heterogeneous entities with different underlying tumor behaviour complicate standardized assessments and decision-making while general recommendations are either not uniform or even lacking. Thus a clear need exists to foster further understanding of vertebral tumor treatment, thereby facilitating development of diagnostic and treatment algorithms, new techniques to advance resection and to improve outcome and effectiveness of spine tumor surgery.
We anticipate that specific recommendations for future research and treatment of spinal resection and reconstruction techniques will evolve from the comprehensive collection of topics, which in turn subsequently promote intense exchange of experiences in usually very creative and entertaining discussions.
Looking forward seeing you all in Dresden again!
Prof. Dr. Dr. med. Alexander C. Disch
Prof. Dr. med. Klaus-Dieter Schaser