Surgical management of spinal metastatic disease

Spinal metastatic disease is a common occurrence in oncology. Spinal metastases may result in pain, spinal deformity, and neurologic deterioration. Surgical intervention is a key component in the effective management of spinal metastatic disease. The principles of neural decompression and spinal stabilization are hallmarks of the surgical care for patients with metastatic spinal disease. Several classification systems exist for spinal metastatic disease to aid in assessing preoperative spinal instability and the need for operative intervention. Treatment modalities include separation surgery, stereotactic radiosurgery, conventional radiotherapy, vertebral body augmentation, and laser-interstitial thermal therapy. Various open surgical approaches exist that may be employed to achieve operative goals during separation surgery. The spinal surgeon should be intimately involved in the overall care of patients with spinal metastatic disease to ensure the best clinical outcomes.