An update in the management of spinal metastases.
The best clinical treatment for spinal metastases requires an integrated approach with input from an interdisciplinary cancer team. The principle goals of treatment are maintenance or improvement in neurologic function and ambulation, spinal stability, durable tumor control, and pain relief. The past decade has witnessed an explosion of new technologies that have impacted our ability to reach these goals, such as separation surgery and minimally invasive spinal procedures. The biggest advance, however, has been the evolution of stereotactic radiosurgery that has demonstrated durable tumor control both when delivered as definitive therapy and as a postoperative adjuvant even for tumors considered markedly resistant to conventional external beam radiation. In this paper, we perform an update on the management of spinal metastases demonstrating the integration of these new technologies into a decision framework NOMS that assesses four basic aspects of a patient's spine disease: Neurologic, Oncologic, Mechanical Instability and Systemic disease.
Departamento de Neurologia, Universidade Estadual de Campinas, Campinas, SP, BR.
Andrei F
AF
Joaquim
Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, US.
Ann
A
Powers
Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, US.
Ilya
I
Laufer
Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, US.
Mark H
MH
Bilsky
D003131:Combined Modality Therapy; D003657:Decision Making; D006801:Humans; D011836:Radiation Tolerance; D016634:Radiosurgery; D013117:Spinal Cord Compression / Q000628:therapy; D013122:Spinal Diseases / Q000175:diagnosis / Q000601:surgery; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy*; D016896:Treatment Outcome