title: Spinal neoplastic instability: biomechanics and current management options.
abstract: BACKGROUND
  Often the spine is afflicted from primary or metastatic neoplastic disease, which can lead to instability. Instability can cause deformity, pain, and spinal cord compression and is an indication for surgery. Although overt instability is uniformly agreed upon, it is sometimes difficult for specialists to agree on subtle degrees of instability due to lack of objective criteria.
  
  
  METHODS
  In this article, treatment options and the spine instability neoplastic system are discussed and the neoplastic instability literature is reviewed.
  
  
  RESULTS
  The Spinal Instability Neoplastic Score helps specialists determine whether instability is present and when surgery may be indicated. However, other parameters such as spinal cord compression and extent of disease dictate whether surgery is the most appropriate option. A wide range of fusion techniques exists, each one tailored to the location of the lesion and goals for surgery.
  
  
  CONCLUSIONS
  To optimize results, expert knowledge on the techniques and patient selection is of importance. Furthermore, a multidisciplinary approach is required because treatment of neoplastic disease is multimodal.
authors.forename: Andreas K
authors.initials: AK
authors.lastname: Filis
authors.forename: Kamran V
authors.initials: KV
authors.lastname: Aghayev
authors.forename: James J
authors.initials: JJ
authors.lastname: Doulgeris
authors.forename: Sabrina A
authors.initials: SA
authors.lastname: Gonzalez-Blohm
authors.forename: Frank D
authors.initials: FD
authors.lastname: Vrionis
mesh_terms: D001696:Biomechanical Phenomena; D006801:Humans; D013125:Spinal Neoplasms / Q000503:physiopathology* / Q000601:surgery / Q000628:therapy*