The purpose of both oncologic staging and various surgical staging is to implement the concept of oncologic treatment into spinal tumor surgery so that surgery can be scientifically planned to achieve extensive resection. The long-term survival of patients with primary malignant tumors of the spine is significantly related to the extent of the first surgery and the type of tumor, and those with extensive resection will have a better prognosis. If the first surgery for a primary malignancy of the spine does not achieve the local control that should be achieved, this opportunity may be lost forever. Both Tomita and Boriani have chosen the pedicle as the osteotomy site, which is anatomically the most appropriate site for osteotomy. It is the narrowest part connecting the anterior vertebral body to the posterior accessory structures, and because it is thin, the amount of osteotomy is minimal and does not easily damage the nerve roots and spinal cord. Tomita et al. designed a special wire saw, made of miniature stainless steel wire, with smooth surface and good toughness, with a diameter of only 0.54 mm, so that the bone loss can be almost disregarded, which makes it easier to achieve extensive resection of the tumor (if the osteotomy line is adjacent to the tumor cells). The osteotomy should be treated differently according to the different lesions. If one side of the pedicle is involved, contralateral pedicle osteotomy and ipsilateral laminectomy should be performed to achieve wide or marginal resection. If all posterior structures such as the arch and lamina are involved bilaterally, the arch is still the best osteotomy site because its narrowness minimizes the chance of tumor cell contamination even if the arch is involved. Boriani approach (anterior-posterior approach): In 1996, Boriani reported 29 cases of thoracolumbar tumors resected as a whole (5 multisegmental) and the specimens were examined histologically at the resection margins, which showed that the whole resection border was reached in 20 cases, the marginal resection border was reached in 8 cases, and the intra-focal border was reached in 1 case. 7 cases had contaminated margins. There was no recurrence at an average follow-up of 30 months. There are three surgical methods: 1. Whole spine resection: suitable for tumors located in zones 4-8 or 5-9, with central vertebral body and at least one side of the pedicle not invaded by the tumor. The operation can be completed in two stages or one stage. Firstly, the posterior structures are resected in a prone posterior approach, and the fibrous ring and posterior longitudinal ligament are severed to facilitate hemostasis of the epidural plexus and posterior fixation. Then ligation of segmental arteries (focal plane and superior and inferior planes), proximal and distal discectomy (or bone cutting with a bone chisel through the adjacent vertebrae according to the preoperative plan) is performed via the anterior route, resulting in the removal of the entire vertebral body and anterior reconstruction. 2. Sagittal fan resection: suitable for tumors located in zones 3-5 or 8-10 (centered on the pedicle). The first step of the combined anterior-posterior approach is the same as that of total spine resection, in which the normal posterior structures (including the pedicle) are first removed to allow space for dural displacement, and the nerve roots of the corresponding segment are ligated if necessary. Then, in the lateral position, a T-shaped incision is formed in the thoracic spine from the posterior mid-incision combined with an oblique open thoracotomy in the corresponding rib plane, and a traditional retroperitoneal approach is used in the lumbar and thoracolumbar segments, with a bone gouge or bone knife to perform vertebral resection at a distance from the tumor (at least one zone is tumor-free). 3. simple posterior arch resection: suitable for tumors located in the 10-3 zone. In order to achieve enbloc laminectomy, the dural sac must be revealed above and below the tumor, and the lateral arch must be revealed, and the arch must be cut with a bone gouge or wire saw. WBB advocated that in case of incomplete spine resection, the resection should be done at least one zone away from the tumor, with posterior resection of the vertebral arch in zone 10-3 lesions, revealing the pedicle, and removing the attachments after truncation with a bone chisel or wire saw; in case of total spine resection or performing sagittal hemivertebral resection, the anterior-posterior surgery should be performed in stages or completed in one go, with a sequential, posterior-anterior approach, interrupting the circumferential structure of the spine and trying to osteotomy at the healthy bone tissue. Boriani et al. suggest that the posterior structures are removed first to facilitate hemostasis of the epidural vein and reconstruction of posterior stability, and then the vertebral body is extensively resected in an anterior free approach. Tomita approach (posterior approach): Tomita has introduced this new approach to TES in several reports since 1994, and of his seven patients, all but one died 7 months after surgery from mediastinal metastases not directly related to the procedure itself, and the remaining six were recurrence-free and survived tumor-free. Histological margins were achieved with extensive or marginal resection (except at the pedicle and occasional intradural invasion). The procedure consists of two parts: (1) Exposure: A prone posterior mid-incision is made and the small joints and transverse processes are exposed with a spinal joint retractor designed for this procedure. In the thoracic spine, the corresponding ribs 3-4 cm long lateral to the transverse rib joints should be removed and the pleura bluntly separated. (2) Introduction of a T-shaped wire saw guide: The soft tissue below the intervertebral joint is separated to form a channel for the wire saw guide, and a 0.54 mm diameter wire saw is introduced through the intervertebral foramen into the T-shaped wire saw guide. (3) Resection of the posterior structures: the arch root is severed with the wire saw and the entire posterior structures (including the spinous process, upper and lower articular processes, transverse processes and the arch root) are resected. (2) Whole vertebral body resection (anterior column resection): (1) Blunt dissection of the vertebral body: identify the segmental arteries bilaterally and ligate and cut the vertebral branches of the segmental arteries that travel along the nerve roots. In the thoracic spine the nerve root on one side may be severed to remove the diseased vertebra from that location. The segmental arteries are separated from the vertebral body by bluntly separating the vertebral body laterally and anteriorly from both sides in the plane between the pleura (or iliopsoas muscle) and the vertebral body. The aorta is separated from the anterior aspect of the vertebral body with the curved vertebral stripper and the operator’s fingers. After the tips of the operator’s two fingers meet in front of the vertebral body, the serial curved strippers are inserted sequentially starting from the smallest size to enlarge the separation surface, keeping the largest size stripper to protect the adjacent tissues and organs and to enlarge the operative field to accommodate the operation of the anterior column. (2) The intervertebral disc is identified, and the wire saw is passed proximally and distally to the vertebral body to be removed. (3) Dissect the spinal cord and remove the vertebrae: separate the spinal cord from the adjacent venous plexus and ligamentous tissues with a curved spinal cord stripper, use a spinal cord protector to prevent slippage of the wire saw, and cut the anterior column and anterior and posterior longitudinal ligaments of the vertebral body with the wire saw. The free anterior column was removed by rotation along the spinal cord. (4) Anterior reconstruction and posterior fixation: Anchor holes are made in the preserved vertebral body, and the anterior column is reconstructed with autologous bone, allograft bone, various prostheses or titanium mesh, and the posterior instrumentation is fixed and made slightly compressed. Tomita believes that total vertebral resection is appropriate for types 2-5, while types 1 and 6 are relative indications and not for type 7. Tomita proposes that the procedure is indicated for primary malignant or benign invasive tumors of the spine: (1) without invasion of adjacent internal organs; (2) with no invasion of the spinal cord; and (3) with no invasion of the spinal cord. (2) no or minimal adhesions to the vena cava and aorta; (3) no multiple metastases, and lesions with more than three consecutive spinal stages are considered relative contraindications. It has been reported that the spine has natural barriers to tumor spread: anterior and posterior longitudinal ligaments, periosteum of the spinal canal, ligamentum flavum, lamina, spinous process periosteum, supraspinous and interspinous ligaments, cartilage endplates, and fibrous annulus, so that each vertebra represents an intervertebral compartment surrounded by several barriers, which seems to facilitate extensive resection for surgery. However, it was Tomita et al. who proposed TES that this ring structure of the spinal cord encapsulated in the middle of the spine, the important blood vessels and internal organs immediately adjacent to the spine, and the complex anatomical relationships existing between the spine, spinal cord, important blood vessels, and internal organs prevented extensive resection by surgery, so even for malignant tumors, extensive resection is impossible in the strict sense of tumor resection. The so-called whole spine resection is often not guaranteed to achieve extra-tumor manipulation at the vertebral arch either, so efforts can only be made to achieve wide resection in most areas, so that the area of marginal resection or intracapsular resection is minimized. This is because except for stage S1 or S2 lesions, intracapsular resection will still bring a very high recurrence rate, even when supplemented with local management and radiotherapy and chemotherapy.