Surgical palliation of symptomatic spinal metastases

Spinal metastases are common in malignant disease. For selected patients with severe pain or neurological dysfunction, surgical treatment offers valuable palliation. During the last few years, we have treated between 100 and 120 patients annually with spinal metastases at the Department of Orthopedics, Uppsala University Hospital, Uppsala, Sweden. A detailed preoperative analysis is mandatory for optimal patient selection. Preoperative embolization of spinal metastases of renal cell carcinoma minimizes the peroperative blood loss. Most cervical spinal metastases are best treated via an anterior approach with vertebral body resection and primary reconstruction of the anterior column. Most thoracic or lumbar spinal metastases are best treated via a posterior approach with decompression and stabilization, using a transpedicular fixation device. However, patients with an expected survival exceeding 6-12 months, a secondary reconstruction of the anterior column should be considered.