Preoperative assessment and surgical indications: Separation surgery

Area of Science:

• Oncology
• Neurosurgery
• Radiation Oncology

Background:

• Neurological compression is a common complication (10-20%) of spinal metastases.
• Advances in oncology, surgical techniques, and radiation therapy have evolved treatment paradigms.

Purpose of the Study:

• To outline the multidisciplinary, personalized approach to managing spinal metastases with neurological compression.
• To highlight the shift in surgical goals towards spinal cord decompression for radiosurgery enablement.

Main Methods:

• Multidisciplinary team consensus and tumor prognostic categorization are key decision factors.
• Assessment includes patient's biological status, spinal instability, and neurological deficit.
• Surgical strategy has evolved from cytoreduction to direct spinal cord decompression.

Main Results:

• Personalized, multidisciplinary decision-making is now standard for these complex cases.
• Surgical intervention aims to decompress the spinal cord, facilitating subsequent treatment.
• The goal is to enable safe and effective radiosurgery by relieving tumor-induced compression.

Conclusions:

• Modern management of spinal metastases with neurological compromise necessitates a tailored, team-based approach.
• Surgical decompression is crucial for optimizing outcomes and enabling advanced therapies like radiosurgery.
• This strategic shift improves patient care by prioritizing spinal cord function and safe oncological treatment delivery.