Radiation, robotics, and reconstructive options in spine tumor surgery

Operating on tumors of the spine presents the surgeon with unique challenges. Among those are challenges in obtaining the appropriate oncologic resection, which includes use of preoperative and intraoperative imaging modalities. Traditionally, radiographs and intraoperative fluoroscopy have been heavily utilized, but at the cost of radiation exposure to the surgeon and patient that varies with numerous factors. More recently, advanced intraoperative imaging has allowed better visualization of tumors and margins during complex resections, as well as less radiation to the surgeon, who can typically step out of the room for an intraoperative CT scan. Finally, the introduction of navigation and now robotics into spinal surgery has opened the door to increasingly complex tumor resections with what we hope to be decreasing difficulty and decreasing rates of complications. As technology advances, care must be taken to also continue training surgeons in the anatomically grounded, freehand technique of instrumenting the spine. This will not only optimize patient safety but also allow surgeons to critically evaluate and optimize how new technology is used as it emerges.