Orthopaedic management of spinal metastases

Spinal metastases result in severe spinal pain, neurologic deficits, or both. These symptoms usually are caused by spinal instability, in which conservative therapy can have no effect, and surgical treatment is required to restabilize the destroyed spinal segments. Surgical indications are instability of the spine, pain and/or paresis resistant to radiation therapy, acute progressing paresis, and unknown histologic diagnosis. There are 2 surgical approaches for vertebral metastases: prosthetic replacement and posterior stabilization. Single or 2 consecutive diseased vertebrae should be treated with replacement surgery. In this series, excellent surgical outcome was attained with this procedure, and surgical benefit was maintained until the terminal stage of each patient. Multiple vertebral metastases are treated with posterior stabilization using various instrumentation systems that provide rigid stabilization. To choose the most appropriate procedure for each patient, the local condition of the lesion and general status of the patient, including prediction of life expectancy, should be evaluated fully. Spinal metastases develop early and are not terminal events. Therefore, not only palliative treatment but also surgical intervention should be considered for spinal metastases when indicated.