Surgical Strategy for Spinal Metastases

Surgical management for spinal metastasis is controversial. The primary goals of surgery are controlling the burden of local disease, preventing or slowing neurologic deterioration, and spinal stabilization when necessary. This chapter proposes to develop a novel, comprehensive, prognosis-based scoring system to guide specific treatment in patients with metastatic spine disease. Three factors were utilized for a prognostic evaluation: malignant grade of the primary tumor, visceral metastases to vital organs, and bone metastases. The chapter represents a retrospective review of patients identified and treated for metastatic spine disease from 1987 to 1991. Primary and metastatic tumors were identified and evaluated via multiple imaging modalities including standard radiographs, bone scintigraphy, magnetic resonance imaging, and computed tomography scans. The chapter explains the importance of the therapies on patient survival. It determines appropriate treatment in patients who were treated for spinal metastases between 1993 and 1996.