Surgical Management of Metastatic Disease to the Spine

Abstract

The surgical management of spinal metastases has unique challenges not encountered in other aspects of spine surgery due to the needs of the oncologic patient. Among the key steps in the surgical management is the decision-making process, which must take into account the systemic and adjuvant therapies that are also necessary for systemic and local control of the disease. Decision-making frameworks, such as the NOMS system, have been designed to take into account the multiple factors that can affect the prognosis of the oncologic patient and reach an optimal surgical plan that incorporates available adjuvant treatment, such as radiation therapy. Surgical intervention for spinal metastases has evolved from large reconstructive procedures to less invasive techniques, which still allow for the preservation of neural function and restoration of spinal stability, but with the strategy of selecting the optimal intervention which can best synergize with available adjuvant therapies for effective local disease control. Advancement of surgical strategies such as “separation surgery” and minimally invasive percutaneous stabilization techniques can achieve surgical goals with decreased morbidity and shortened recovery times, which allows for minimal disruption of adjuvant or systemic therapies. The development of conformal radiation techniques such as radiosurgery has greatly assisted in achieving these goals.