Abstract
Over the last 30 yr, the treatment of primary and metastatic tumors of the cervical, thoracic, and lumbar spine has evolved dramatically. In the case of primary tumors of the spine, advances in neoadjuvant treatments and instrumentation techniques have offered patients with previously inoperable disease new options with reasonable chances of cure. When the overall morbidity of radical resection makes it a poor treatment option, radiation therapy can be combined with more conservative surgical procedures or can be used in lieu of surgery for palliation, or even cure in some instances. With new advances in radiotherapy techniques, greater doses of radiation (often tumorocidal doses) can be administered to the majority of tumor volume with fewer effects on the surrounding structures and, most particularly, minimal risk to the spinal cord. It is imperative for the clinician and surgeon to be familiar with these new techniques so that the care of their patients can be optimized, with the highest potential for long-term survival and reduced morbidity.