22 сентября 2025
General evaluation and decision-making in primary vertebra tumors: WFNS spine committee recommendations
Idris Avc, Onur Yaman, Mehmet Zileli, Francesco Costa, Artem O. Gushcha, Zan Chen, Mirza Pojskic, Corinna C. Zygourakis, Salman Sharif
Interdisciplinary Neurosurgery: Advanced Techniques and Case Management https://doi.org/10.1016/j.inat.2025.102115
Objectives: Primary vertebral tumors (PVT) are rare neoplastic lesions distinct from metastatic spinal tumors. Due
to their diverse nature and complex management, the World Federation of Neurosurgical Societies (WFNS) Spine
Committee aimed to establish a consensus on the classification, diagnosis, and treatment of PVT to standardize
clinical practice and improve patient outcomes.
Material and methods: A systematic literature review including last 10 years was conducted using PubMed,
Medline, and Google Scholar, focusing on PVT diagnosis and treatment. After applying exclusion criteria, 12
relevant articles were selected. Additionally, the WFNS Spine Committee convened two consensus meetings,
employing the Delphi method. Spine experts participated in structured discussions and anonymous voting, with
consensus defined as ≥66 % agreement. Core topics included classification, diagnostic modalities, and treatment
strategies.
Results: PVT were categorized as benign or malignant, requiring distinct diagnostic and therapeutic approaches.
MRI was recommended for tumor evaluation, while CT was preferred for assessing bony involvement. Biopsy was
deemed essential for histopathological confirmation. Benign tumors were managed with curettage or en-bloc
resection, with pharmacologic options for selected cases. Malignant PVT management included radiotherapy,
chemotherapy for specific tumors, and en-bloc excision for resectable cases. Stereotactic body radiation therapy
is suggested for unresectable tumors. The necessity of a multidisciplinary approach is emphasized.
Conclusions: Standardized classification, advanced imaging, and multidisciplinary approach are essentials for
managing PVT. The WFNS Spine Committee’s recommendations provide a structured framework to guide
diagnosis and treatment, improving decision-making and patient care.