Evidence-based review of the surgical management of vertebral column metastatic disease.
OBJECTIVE
Significant controversy exists over the most appropriate treatment for patients with metastatic disease of the vertebral column. Treatment options include surgical intervention, radiotherapy, or a combination of the two; nevertheless, a standard of care that yields the best survival, outcome, and quality of life has not been established. The purpose of this review was to determine the foundation in the literature of views favoring surgical intervention for spinal metastatic disease.


METHODS
A search of the English-language literature published between 1964 and 2003 was performed for the subject of spinal metastatic disease. Papers were selected based on the inclusion criteria described, and evidentiary information was compiled and graded using previously described methods.


CONCLUSIONS
Although there is insufficient evidence to support a standard for surgical treatment in patients with metastatic spinal disease, the authors present guidelines and recommendations based on the evidence provided by the current literature.
Ryken
Timothy C
TC
Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. timothy-ryken@uiowa.edu
Eichholz
Kurt M
KM
Gerszten
Peter C
PC
Welch
William C
WC
Gokaslan
Ziya L
ZL
Resnick
Daniel K
DK
D003131:Combined Modality Therapy; D019299:Decompression, Surgical; D019317:Evidence-Based Medicine; D006801:Humans; D015994:Incidence; D007796:Laminectomy; D019637:Orthopedic Procedures; D010166:Palliative Care; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D013123:Spinal Fusion; D013125:Spinal Neoplasms / Q000150:complications / Q000453:epidemiology / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery*; D016896:Treatment Outcome