The Management of Upper Thoracic Spine Tumors

The surgical management of primary and metastatic spine tumors is an essential treatment modality. Because the most spine tumors are metastatic, surgical management of spine tumors is often palliative. However, when indicated, decompression and stabilization can lead to improved quality of life. There are a variety of primary benign and malignant tumors that can involve the spine, and each has its own general management principles. For all tumor types, the diagnostic evaluation and staging of the tumor are essential to determine appropriate management. Surgical management, when indicated, is either palliative or curative, and the gold standard is en bloc spondylectomy. The upper thoracic spine represents a unique region with anatomical obstacles to adequate access, making complete surgical excision difficult. This region of the spine also has unique biomechanical considerations and requires instrumentation for stabilization. Because of the difficulty in accessing the upper thoracic spine, several different approaches have been developed and modified. The management of upper thoracic spine tumors will be presented here, including a case study involving a primary malignancy involving the T1 vertebral body.