Oncological Principles

Surgical resection of neoplastic spinal pathology requires a multifactorial understanding and appreciation of the anatomy and biomechanics of the spinal column, pathologic characterization of the lesion, multidisciplinary options available, best guidelines for treatment, patient presentation, and feasibility of resection. When counseling patients with spinal pathologies, in my practice, I distill decision-making into three key questions: “(1) What is the tumor histology? (2) What is it doing to the patient neurologically and mechanically? (3) What are the patient’s options?” The first question aims at identifying a conclusive radiographic and pathologic diagnosis. The second assesses the patient’s symptomatology, clinical presentation, spinal stability, and systemic burden. These two dictate the final query – describing treatment options and indications/extent of surgical resection. This chapter aims to provide an overview of essential principles in spinal oncology.