Commentary.

Primary tumors of the spinal cord are rare entities that represent 2–4% of all primary tumors of the central nervous system.[1] Nonetheless, for specialized spine centers, these tumors may be encountered somewhat frequently.[2] Epidemiological studies, especially those in remote regions where access to healthcare may be limited, are important to compare outcomes, treatment strategies and raise awareness of the different pathologies that are treated. These studies may help clinicians to better counsel patients with accurate data from their respective country and may also encourage other researchers to start collecting data on their patients.

Bhat et al.[3] present their experience with spine tumors in a single center for more than thirty years of practice. They treated 531 benign and malignant neoplasms of the spine over this period. The low overall incidence highlights the rarity of these entities. The diversity of the histological diagnosis[3] encountered shows how different tumors may affect any part of the spine. I commend the authors for keeping a detailed database of the patients over a long period. Patients who present with tumors of the spine will often also need adjuvant therapy and must be closely monitored to provide the best care possible. In addition, the mean follow-up time for this series was 4 years with more than half of the patients followed over 5 years. Long-term follow-up and management is a key factor to successfully treat spine tumors.

This study was performed in a hospital in the Kashmir region, the only tertiary care center available to treat these tumors; adequate referral strategies to specialized centers and knowledge of the existence of these pathologies will benefit the patients in the long term as shown in their results. The clinician should be aware of these tumors as their symptoms may be, in most cases, nonspecific or lack clear pathognomonic symptoms.[4] A high index of suspicion is necessary to adequately diagnose any spine tumor. This study highlights the importance of a specialized referral center as it will offer the best outcome possible for these patients. It is not infrequent that some of these tumors may require complex surgical approaches with multiple surgeons, which can only be provided in expert hands.

It is critical that a patient with a suspicion or confirmation of a spine tumor receives medical care in a high-complexity facility. Referral networks for spine tumors should exist so that a multidisciplinary team is available to offer the best care (and best outcomes) to these patients.[56]