title: Current paradigms for metastatic spinal disease: an evidence-based review.
abstract: BACKGROUND
  Management of metastatic spine disease is quite complex. Advances in research have allowed surgeons and physicians to better provide chemotherapeutic agents that have proven more efficacious. Additionally, the advancement of surgical techniques and radiosurgical implementation has altered drastically the treatment paradigm for metastatic spinal disease. Nevertheless, the physician-patient relationship, including extensive discussion with the neurosurgeon, medicine team, oncologists, radiation oncologists, and psychologists, are all critical in the evaluation process and in delivering the best possible care to our patients. The future remains bright for continued improvement in the surgical and nonsurgical management of our patients with metastatic spine disease.
  
  
  METHODS
  We include an evidence-based review of decision making strategies when attempting to determine most efficacious treatment options. Surgical treatments discussed include conventional debulking versus en bloc resection, conventional RT, and radiosurgical techniques, and minimally invasive approaches toward treating metastatic spinal disease.
  
  
  CONCLUSIONS
  Surgical oncology is a diverse field in medicine and has undergone a significant paradigm shift over the past few decades. This shift in both medical and surgical management of patients with primarily metastatic tumors has largely been due to the more complete understanding of tumor biology as well as due to advances in surgical approaches and instrumentation. Furthermore, radiation oncology has seen significant advances with stereotactic radiosurgery and intensity-modulated radiation therapy contributing to a decline in surgical treatment of metastatic spinal disease. We analyze the entire spectrum of treating patients with metastatic spinal disease, from methods of diagnosis to the variety of treatment options available in the published literature.
authors.affiliation: Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: P E
authors.initials: PE
authors.lastname: Kaloostian
authors.forename: A
authors.initials: A
authors.lastname: Yurter
authors.forename: P L
authors.initials: PL
authors.lastname: Zadnik
authors.forename: D M
authors.initials: DM
authors.lastname: Sciubba
authors.forename: Z L
authors.initials: ZL
authors.lastname: Gokaslan
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D009362:Neoplasm Metastasis; D011379:Prognosis; D016634:Radiosurgery; D013125:Spinal Neoplasms / Q000556:secondary* / Q000601:surgery*