Multidisciplinary management of vertebral metastases in patients not amenable to surgery

Bone metastases occur in up to 70% of cancer patients, and frequently involve the spine. Spine metastases are often associated with pain, disability and progressive deformity, and may also have neurological complications, all of which can dramatically impair quality of life. There are a number of different approaches to managing vertebral metastases, including surgery, vertebroplasty and radiotherapy. The variety of treatment modalities involved, the presence of underlying cancer and frequent severe pain means that patients with vertebral metastases need to be managed by a multidisciplinary team, ideally including a medical oncologist, radiation oncologist, interventional radiologist, pain therapist and spine surgeon. Although a number of different multidisciplinary therapeutic algorithms have been proposed, there is no clear consensus on the best way to manage vertebral metastases. After reviewing current literature, this article proposes a new visual algorithm created by merging some existing guidelines and introducing additional interventional radiology techniques.