Application of deformity principles in the management of spinal neoplasms: A Primer.

Background: With advances in surgical techniques, radiation, and systemic therapy, prognoses and quality of life have improved amongst patients with primary and metastatic vertebral column tumors. Sagittal deformity is known to have an adverse impact on patient quality of life but has been largely ignored in this study population. Methods: A comprehensive literature review was conducted, focusing on articles germane to the study of spinal deformity in the context of oncologic disease. Articles included those focusing on bone health, the association of spinal deformity with oncologic spine disease, and both pelvic and anterior column reconstruction in patients treated for primary tumors. Results: Little to date has focused specifically on the management of spinal deformity in the context of spinal tumors. However, it is known that tumor involvement of the vertebral column is associated with poorer screw purchase, which can be further worsened by radiotherapy. Instrumentation techniques that seek to address underlying deformity must also balance the need for radiographic follow-up, which is improved with novel carbon fiber-reinforced polyetheretherketone implants, and the need for intraoperative contouring. Last, residual deformity is associated with poorer patient reported outcomes and increased mechanical complications in adult spinal deformity, but better study within the spinal oncology population is merited. Conclusion: The potential negative impact of spinal deformity on patient quality of life in the spinal oncology population is now better appreciated amongst spinal oncologists, but studies have been limited to date. Further investigation is merited as survival outcomes continue to improve.