title: Shifting paradigms in the treatment of metastatic spine disease.
abstract: METHODS
  Systematic review and evidence appraisal.
  
  
  OBJECTIVE
  To evaluate the optimal treatment for patients with spinal cord compression secondary to solid metastases and in patients with solitary renal metastases, without spinal cord compression.
  
  
  METHODS
  Focused Medline and OVID database searches were conducted using relevant keywords. Only clinical articles that evaluated specific end points of interest were included in the literature review. The quality of evidence provided by each article was assessed using the ATS guidelines. The expert opinion was synthesized based on the evidence and rated as strong or weak, depending on the quality of the supporting literature.
  
  
  RESULTS
  Twelve surgical and 7 radiation clinical series were identified that evaluated post-treatment ambulation in patients with metastatic spinal cord compression. Only 1 surgical article met the criteria for moderate quality evidence while the remaining surgical and radiation articles presented very low quality of evidence. All articles that evaluated treatment of solitary renal metastases presented very low quality of evidence.
  
  
  CONCLUSIONS
  A strong recommendation is made for patients with high-grade cord compression due to solid tumor metastases to undergo surgical decompression with stabilization followed by radiation therapy. A weak recommendation is made for patients with solitary renal metastases without spinal cord compression to undergo spinal stereotactic radiosurgery.
authors.affiliation: Department of Neurological Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. bilskym@mskcc.org
authors.forename: Mark H
authors.initials: MH
authors.lastname: Bilsky
authors.forename: Ilya
authors.initials: I
authors.lastname: Laufer
authors.forename: Shane
authors.initials: S
authors.lastname: Burch
mesh_terms: D019299:Decompression, Surgical; D019317:Evidence-Based Medicine; D006801:Humans; D016634:Radiosurgery; D011879:Radiotherapy Dosage; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000150:complications / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery*; D013131:Spine / Q000601:surgery