Surgical treatment of tumors and tumorlike lesions of bone

Abstract

The surgical treatment of tumors and tumorlike lesions of bone involves a multidisciplinary team approach. Workup begins with a detailed history, physical exam, and imaging. Biopsy and obtaining an accurate histologic diagnosis is an important step in the ability to defi nitively surgically manage these lesions. Surgical resection principles and adequate margins are important aspects of being able to obtain local control. Limb-sparing principles are largely employed if neurovascular structures can be preserved and a level of function maintained. umor grade and location dictate the type of excision required, and mechanical, chemical, and thermal adjuncts can be employed to further reduce the risk of recurrence in low-grade or benign tumors. High-grade and some aggressive benign tumors require a wide excision, and various reconstruction options, such as endoprosthesis and alloprosthetic composites, can be used to help restore function. Special anatomic considerations (axial skeleton) can make wide excision challenging. Ultimately the surgical treatment of bone tumors provides unique challenges for surgeons, and advances in imaging, surgical techniques, prosthetic design, and adjuvant treatments have continued to assist surgeons in improving functional outcomes.