Treatment Strategy for Metastatic Spinal Tumors: A Narrative Review

Abstract

Metastatic spinal tumors are common, and their rising incidence can be attributed to the expanding aging population and increased survival rates among cancer patients. The decision-making process in the treatment of spinal metastasis requires a multidisciplinary approach that includes medical and radiation oncology, surgery, and rehabilitation. Various decision-making systems have been proposed in the literature in order to estimate survival and suggest appropriate treatment options for patients experiencing spinal metastasis. However, recent advances in treatment modalities for spinal metastasis, such as stereotactic radiosurgery and minimally invasive surgical techniques, have reshaped clinical practices concerning patients with spinal metastasis, making a demand for further improvements on current decision-making systems. In this review, recent improvements in treatment modalities and the evolution of decision-making systems for metastatic spinal tumors are discussed.

Keywords: Decision-making system; Minimally invasive surgical procedures; Radiosurgery; Separation surgery; Spinal metastasis.

Fig. 1.

A 68-year-old male with spinal metastasis of renal cell carcinoma at T9. The patient also had lung metastasis. (A) Preoperative MRI shows spinal cord compression and involvement of posterior elements and left rib head at the T9 level. (B) Following a separation surgery without spinal instrumentation, MRI at postoperative 2-weeks shows a decompressed spinal canal but residual metastatic tumor around the left 9th rib head. (C) In the postoperative 1-year MRI, the patient showed a near-complete response following a single session stereotactic radiosurgery (18Gy/1 fraction), which was performed 3 weeks after the separation surgery. MRI, magnetic resonance imaging. (D) Planning images for the postoperative stereotatic radiosurgery following a separation surgery.

Fig. 2.

A 63-year-old male with spinal metastasis of thyroid carcinoma at T8. (A) Preoperative MRI shows pathologic fracture and spinal cord compression at the T8 level. (B) Postoperative X-ray at 1 month shows removal T8 vertebra and reconstruction with an expandable cage following total en bloc spondylectomy. (C) MRI at postoperative 3-years shows a widely decompressed spinal canal with no tumor recurrence. (D) Postoperative X-ray at postoperative 5-years shows well-maintained instrumentation. (E) Bone scan at postoperative 5-years shows no evidence of bone metastasis. MRI, magnetic resonance imaging.