[Treatment strategies for spinal metastases]

Spinal metastases occur in 10 % of all carcinoma patients in the course of their oncologic disease. Spinal metastasis is a manifestation of a systemic oncologic disease. The treatment of the metastasis does not influence the overall oncological outcome. Treatment decision is depending from the primary tumor, presence of neurological symptoms, stability of the spine, extent of visceral and osseous dissemination, general state of the patient and his life expectancy. Therapy should focus on the patient's needs and be correlated with the expectations and prognosis of the patient. There exist a number of valid prognostic scores to support and objectify the decision. There has been a change of paradigmata with regard to surgical treatment, supported by an improvement in oncosurgical and anesthesiological fields. Surgery is indicated in case of instability or neurological compromise, in respect of the general state and life expectancy and can be performed from a ventral, dorsal or combined approach. Alternative or complimentary treatment methods are radiotherapy, chemotherapy, hormonotherapy, stereotactic radiosurgery and additive therapies like sequential embolization, antiresorptive medication or corticoid therapy. Therapy should be established by a multidisciplinary tumor board. Main issue for treatment decisions is palliation and optimizing the patient's quality of life.