[Surgical management of spinal metastases]

Spinal metastases from malignant tumors represent an increasingly relevant clinical problem due to improved systemic therapies, prolonged survival, and the growing prevalence of long-term survivors with metastatic disease. The spine is not only a central biomechanical component of the musculoskeletal system, but also protects the spinal cord and spinal nerves. Accordingly, the treatment of spinal metastases is complex and must always be embedded within an overarching oncological treatment concept.

This review summarizes epidemiological and pathophysiological principles and presents contemporary indications and operative strategies for spinal metastases. The central goals of surgery are histological diagnosis, decompression of neural structures, restoration or preservation of mechanical stability, pain relief, and maintenance of neurological function and quality of life. Surgical decision-making should be interdisciplinary and should consider not only imaging findings and neurological status, but also tumor biology, radiosensitivity, systemic treatment options, prognosis, patient preference, and rehabilitation potential.

Modern surgical treatment of spinal metastases has undergone a paradigm shift: maximal tumor resection is no longer routinely the primary objective; instead, the focus has shifted toward function-preserving, low-morbidity interventions embedded within a multimodal treatment strategy. Concepts such as NOMS, SINS, and the Bilsky grading system support structured decision-making.

Minimally invasive procedures, percutaneous instrumentation, navigation, intraoperative three-dimensional imaging, modern implant materials, and increasingly AI-based prognostic models allow a patient-specific calibration of surgical invasiveness. The overall aim is to preserve neurological function and quality of life, control local tumor progression, and minimize treatment-delaying morbidity.