Abstract
The diagnosis and treatment of malignant spinal tumors are complex and require an integrated approach known as Jaffe's triangle. This review discusses recent topics in the diagnosis and treatment of primary and metastatic malignant spinal tumors. Integrated diagnostic methods, including the development of a dumbbell scoring system for benign-malignant differentiation and the use of positron emission tomography and magnetic resonance imaging (PET-MRI), have improved diagnostic accuracy. Curative resection techniques such as vertebrectomy, sagittal resection, and posterior resection are crucial for primary malignant tumors. Heavy particle radiation therapy, such as carbon-ion radiotherapy, shows promise against radiation-resistant tumors, whereas novel drug therapies, such as denosumab, are effective for giant cell tumors of the bone arising in the spine. For metastatic spinal tumors, the collaborative efforts of the Bone Metastasis Cancer Board and minimally invasive spine stabilization have expanded surgical indications and improved patient outcomes. The treatment system has shifted towards preventive surgery and outpatient management, aiming to maintain quality of life and continue chemotherapy. Interdisciplinary collaboration is essential for improving treatment outcomes in both primary and metastatic malignant spinal tumors.Primary malignant spinal cord tumors (PMST) and metastatic spinal tumors (MST) are among the most difficult areas of orthopedic surgery. Their diagnosis and treatment require multidisciplinary diagnostic and therapeutic strategies that integrate knowledge and skills in orthopedics, pathology, and diagnostic radiology (the so-called Jaffe triangle), as well as in clinical oncology and tumor biology, which have made remarkable progress in recent years. Here, we review recent topics related to the diagnosis and treatment of PMST and MST.