[Surgical management of the spinal metastases]

Seventy per cent of patients with cancer have evidence of metastases and spinal involvement may occur in up to 50 %. Pain is the most frequent symptom and it occurs in 90 % of the patients. It exist three different type of spinal pain : inflammatory, radicular and mechanical pain. Pain could be related to a neurological compromise and treatment becomes urgent. Steroids are introduced even if surgery is indicated. The Spinal Instability Neoplastic Score is a useful tool in order to determine instability in spinal metastases. Early recognition of instability could allow to minimal invasive surgery and even vertebroplasty. Tokuhashi score facilitates patient's selection during the decision-making process to the multidisciplinary team.