Introduction. Advances in spine tumor management: innovations in surgery, radiation, and biomarkers

T he management of metastatic and primary spinal column tumors-both malignant and benign-continues to advance rapidly, driven by the integration of cutting-edge technologies and evidence-based medicine.These developments have significantly improved outcomes, enhancing local tumor control while minimizing morbidity in this complex patient population.This issue of Neurosurgical Focus covers significant advances that have fundamentally affected and will continue to change international practice patterns.Most importantly, the editors hope that this issue will help facilitate assessments and contemporary treatment approaches for these extraordinary patients entrusted to us.The first 3 articles examine outcomes and surgical techniques that will advance the treatment of benign intradural tumors, including meningiomas and syndromic schwannomas associated with schwannomatosis.These studies provide insights into optimizing management strategies for these challenging lesions.The remaining articles focus on innovations in the treatment of metastatic and primary malignant spinal tumors, addressing both surgical and radiation-based strategies.Two articles address management strategies for acute neurologic decompensation from a newly diagnosed tumor causing a patient to present to an emergency department with vascular decompensation from hypotension or occlusion of radiculomedullary arterial feeders.These articles provide a road map for optimizing neurological outcomes in severely paretic or even paralyzed patients.Over the past decade, surgical management of metastatic spine disease has largely transitioned from aggressive gross-total resection to separation surgery followed by stereotactic radiosurgery, a.k.a.hybrid therapy. 1 The next 5 papers review both technical outcomes associated with separation surgery and the evolution of pedicle screwbased strategies focused on carbon fiber-reinforced PEEK implants, short-segment PMMA-augmented screws, and minimally invasive percutaneous approaches.The remaining articles examine outcomes and complications related to hybrid therapy and stereotactic radiosurgery including a large series on stereotactic body radiotherapy for the treatment of chordoma, adding to the extensive growing literature on integrating ablative radiation into treatment paradigms for this complicated primary tumor. 2 Finally, from an oncological perspective, the issue concludes with an impactful study on Napsin A as a prognostic biomarker in lung carcinoma, offering potential implications for precision medicine in spinal oncology.