The complex anatomy of the spine and its proximity to vital organs make surgical removal extremely difficult once a tumor occurs. And in recent years, as the number of patients with spinal metastases increases, what surgical treatment method is better for them? 1. Increased incidence of spinal metastases Spinal tumors are a relatively small group of tumors, which can be divided into primary and metastatic. Primary spinal tumors include chordoma, chondrosarcoma, and giant cell tumor of bone. In recent years, the incidence of metastatic tumors of the spine has gradually increased and is much higher than that of primary tumors due to the improvement of the treatment effect of other tumors and the prolonged survival of patients suffering from tumors with effective treatment. It has been reported that spinal metastases can be found in about 30% to 40% of patients who die from cancer at autopsy, and about 50% of these metastases originate from breast, lung, and prostate cancers. Due to the aggressive growth of spinal tumor itself and the pathological fracture caused by it, the compression of spinal cord can lead to progressive neurological dysfunction, severe pain, paralysis and even death, which seriously affects the quality of life of patients. 2.Surgical treatment is difficult The complex anatomical structure of spine, adjacent to the spinal cord, and the tumor often adheres to the surrounding important organs and large blood vessels, making surgical resection extremely difficult, with large intraoperative bleeding, many postoperative complications, high recurrence rate, disability rate and death rate, which is a forbidden area for surgical treatment of spinal tumor. This makes the previous surgical procedures only perform palliative resection, but it easily leads to deformities such as posterior spine protrusion and recurrence in a short period of time. On the contrary, it aggravates the disease. At present, the scraping or gradual occlusion methods mostly adopted for the treatment of spinal tumors in China to remove the affected vertebral body can easily lead to the spread and recurrence of tumors. We also often encounter such patients, who lose good treatment conditions due to inappropriate and incomplete treatment, and the quality of life and survival period of patients are greatly reduced. The latest concept is that the surgical treatment of spinal tumor requires radical resection of the tumor, which is performed outside the tumor and its pseudo-envelope, and the operation is performed in the normal tissue outside the tumor as much as possible. However, because the spinal cord, an important nerve, is encased in the middle of the spine, it is not possible to remove the entire spine during spinal surgery; instead, the ring-like structure of the spine must be broken. How to open the “ring” of the spine is the key to large block resection surgery. The Japanese scholar Tomita developed and improved a single posterior total spinal mass resection, in which the affected vertebral segment is first separated from the anterior mediastinal organs, taking care to protect the surrounding important tissues and organs, the dura and nerve roots at the level of the affected vertebral segment are carefully separated from the posterior wall of the vertebral body, the vertebral body is separated from the disc level through a special wire saw, and the diseased vertebra is removed from the posterior side around the spinal cord. Massive spinal tumor resection was proposed and applied as an important surgical concept in spinal tumor surgery. This concept emphasizes the removal of the tumor as a whole, with the operation being performed in the normal tissue outside the tumor as much as possible, and the removal of the tumor and its pseudo-envelope. A series of relevant clinical data show that its postoperative recurrence rate is much lower than that of simple intra-focal resection, the cure rate of tumor is significantly higher, and the survival cycle and quality of life of patients are guaranteed. In 2005, our hospital introduced this technology and made a series of improvements and innovations, which were successfully applied to patients with spinal tumors, and the safety of the surgery was significantly improved. 4. High requirements for surgeons and patients Large spinal tumor resection surgery requires very high requirements for surgeons and surgical conditions, which cannot be performed by untrained surgeons. Because the spine is surrounded by important blood vessels and structures, if the blood vessels alone are not handled well, it is difficult to guarantee the patient’s life during the process of performing the surgery. The chances of paralysis after surgery are also increased if the spinal cord within the spine is not handled properly during the operation. More importantly, if the first operation is not successful and the tumor is not completely removed, the deterioration of the tumor after recurrence is accelerated, the patient’s survival cycle is shortened, and the recurrent tumor adheres seriously to the surrounding tissues, which greatly increases the difficulty of the second operation, increases the amount of bleeding during the operation, aggravates the surrounding injuries, or deprives the patient of the opportunity of surgical treatment. In principle, this new technique is mainly suitable for: primary spinal tumors; patients with metastatic tumors are expected to survive for more than 6 months, the primary lesion can be effectively treated, isolated metastatic lesions are located in one or two adjacent vertebrae, there are no metastatic lesions in other vital organs of the body, and the patient’s physical condition can withstand major surgical trauma. .