Neurologic, Oncologic, Mechanical, and Systemic and Other Decision Frameworks for Spinal Disease

Neurosurg Clin N Am. 2020 Apr;31(2):151-166. doi: 10.1016/ Epub 2020 Feb 6.


The incidence of metastatic spinal disease is increasing as systemic treatment options are improving and concurrently increasing the life expectancy of patients, and the interventions are becoming increasingly complex. Treatment decisions are also complicated by the increasing armamentarium of surgical treatment options. Decision-making frameworks such as NOMS (neurologic, oncologic, mechanical, and systemic) help guide practitioners in their decision making and provide a structure that would be readily adaptable to the evolving landscape of systemic, surgical, and radiation treatments. This article describes these decision-making frameworks, discusses their relative benefits and shortcomings, and details our approach to treating these complex patients.

Keywords: LMNOP; Metastatic epidural spinal cord compression; NOMS; Spinal Instability Neoplastic Score; Stereotactic body radiotherapy; Stereotactic radiosurgery.

Publication types

  • Review

MeSH terms

  • Combined Modality Therapy / methods
  • Decision Making*
  • Humans
  • Radiosurgery / methods
  • Spinal Cord Compression / etiology
  • Spinal Cord Compression / surgery*
  • Spinal Neoplasms / radiotherapy*
  • Spinal Neoplasms / secondary
  • Spinal Neoplasms / surgery*
  • Treatment Outcome