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Metastatic spinal disease

48 citationsUpdated Sep 2026

Overview

Management of metastatic spinal disease is a multidisciplinary effort guided by a logical protocol aimed at maximizing overall quality of life [2]. Decision-making relies on histology, clinical presentation, patient prognosis, and spinal stability [1]. For the thoracic and lumbar spine, management is specifically directed by neurologic compromise, spinal instability, and individual patient factors [11]. The Oswestry Spinal Risk Index (OSRI) predicts life expectancy based on primary tumor pathology and general condition, assisting in difficult clinical decisions [8]. While surgical treatment may not appreciably extend survival, it generally improves quality of life by providing spinal stability and pain relief [5]. Surgical intervention offers significant benefits in pain reduction and functional improvement [3], and can improve living conditions, particularly in patients with solitary spinal metastasis and neurologic involvement [14].

Surgical outcomes are favorable across various presentations. Palliative surgery for cervical spine metastasis improves performance status and quality of life [15], and surgical treatment of cervical metastases is considered a treatment of choice [16]. In the thoracolumbar region, posterior decompression and fixation using CDI permits most patients to retain ambulation without external orthotics [42]. Anterior decompression has enabled many patients to regain the ability to walk, supporting the reconsideration of surgery as a primary treatment for epidural compression [24]. Appropriate indications for massive spinal resection yield good oncological and functional results [7]. However, a cervicothoracic junction lesion may be a risk factor for poor outcomes in cervical palliative surgery [15].

The complication rate for surgical treatment of spinal metastases is comparable to complex spine surgery [3], with procedures associated with significant and potentially catastrophic blood loss [13]. Symptomatic local recurrence after surgery may be influenced by the extent of spinal and extraspinal bone metastasis, pathologic fractures, surgical approach, and tumor origin, such as renal cell carcinoma [6]. Orthoplastic management should include a strategy for preoperative recognition of patients at risk of compromised wound healing [19]. Dedicated Cancer Centers (DCCs) provide high-value care, evidenced by lower complication rates and reduced reimbursements [22]. The value of surgical procedures to society varies according to patient population features [17], and palliative surgery improves performance status, activities of daily living, and quality of life regardless of age [23].

Anatomy & Pathophysiology

Bony Anatomy

The spine comprises 7 cervical, 12 thoracic, 5 lumbar, 5 fused sacral, and 4 or 5 fused coccygeal vertebrae [57]. Each vertebral body is a cylindrical mass of bone connected by pedicles to the posterior arch, which consists of the lamina and spinous process [57]. The vertebral bodies primarily bear weight and transfer forces to the pelvis and hips, while the posterior elements protect neural structures and function as a tension band [57]. The thoracic spine represents two transitional zones, moving from the highly mobile cervical spine to the rigid thoracic region and then to the mobile lumbar spine [74]. Its rigidity, combined with the ribs and sternum, forms a bony "cube" that is inherently stable [74]. Thoracic vertebral bodies are larger than cervical but smaller than lumbar vertebrae [74]. The posterior arch encloses the spinal canal, which is narrowest in the thoracic region [74]. Lumbar vertebral bodies are large, with a transverse diameter greater than the anterior-posterior diameter [81]. Lumbar pedicles arise from the superior aspect of the vertebral bodies and project more horizontally than thoracic pedicles [81]. The sagittal orientation of lumbar facet joints allows flexion and extension while providing resistance to axial rotation and translation [81].

Spinal Cord Anatomy

Within the spinal cord, dorsal cells are primarily sensory and ventral cells are primarily motor [78]. The dorsal columns transfer vibration, deep pressure, and proprioception [78]. The lateral spinothalamic tract lies anterolaterally and transmits pain and temperature sensation [78], while the ventral spinothalamic tract transmits light touch [78]. Efferent voluntary motor function travels along the lateral corticospinal tracts [78]. Upper extremity fibers are located deeper within the spinal column, with torso and lower extremity fibers located sequentially more superficially [78]. The conus medullaris lies around the L3 level at birth but descends to the L1-L2 level by adulthood [78]. In the cervical spine, nerve roots exit above the same-numbered pedicle, except for the eighth nerve root which exits under the C7 pedicle [78]. From T1 distally, nerve roots exit below the same-numbered pedicle [78]. The 31 pairs of spinal nerves consist of 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal nerves [78].

Vascular Anatomy

The thoracic and lumbar levels are supplied by paired segmental arteries originating directly from the posterior surface of the aorta [76]. The cervical spine derives its circulation primarily from the vertebral arteries, which typically enter the transverse foramen at the C6 level [76]. The spinal cord’s vascular supply comes primarily from medullary branches of the segmental spinal arteries, which merge to feed the anterior spinal artery [76]. The anterior spinal artery supplies approximately 80% of the spinal cord’s vascular supply [76]. The arteria medullaris magna (AMM), or artery of Adamkiewicz, is the largest anterior segmental artery and typically arises on the left side between the T8 and L1 levels [76]. The spinal canal is narrowest and blood supply is poorest at T4-9, constituting the critical vascular zone of the spinal cord [79]. Longitudinal arterial trunks are largest in the cervical and lumbar regions near ganglionic enlargements and much smaller in the thoracic region due to higher metabolic demands of gray matter [79].

Ligaments

The anterior longitudinal ligament is strong, thickest at the center of the vertebral body, and resists hyperextension [85]. The posterior longitudinal ligament is weaker than the anterior longitudinal ligament and extends from the occiput to the posterior sacrum [85]. It is hourglass shaped, with wider yet thinner sections located over the discs [85]. The ligamentum flavum is a strong yellow elastic ligament connecting the laminae, running from the anterior surface of the superior lamina to the posterior surface of the inferior lamina [85]. Hypertrophy of the ligamentum flavum may contribute to nerve root compression [85]. The supraspinous ligament lies dorsal to the spinous processes and begins at C7 in continuity with the ligamentum nuchae [85].

Biomechanics

Normal cervical alignment is approximately 15° of lordosis, the thoracic spine ranges from 20° to 40° of kyphosis, and the lumbar spine has approximately 40° to 50° of lordosis [75]. The functional spinal unit consists of two vertebrae, the disk between them, and the facet joints and their capsules [75]. Vertebral bodies bear 70% to 90% of the static axial load of the spine [75]. Facet joints support 10% to 20% of axial load in a standing, neutral alignment [75]. In extension, facet joints may bear up to 30% of the axial load, whereas in flexion they may be burdened with up to 50% of the anterior shear load [75].

Pathophysiology of Metastatic Disease

Metastases most commonly involve the vertebral body rather than the posterior elements [32]. Between 5% and 10% of patients who die of metastatic carcinoma will have microscopic disease in their spine [32]. Metastatic disease can cause moderate to severe pain persisting for months before the onset of focal neurologic deficits [32]. The onset of pain is occasionally sudden following a pathologic compression fracture [32]. Metastatic tumors spread to the vertebral body first and later to the pedicles [34]. Most spinal tumors are osteolytic and are not demonstrated on plain films until greater than 30% of the vertebral body has been destroyed [34]. The absence of a pedicle, known as the winking owl sign on anteroposterior radiograph, is a radiographic change associated with spinal tumors [34]. Malignant tumors occur more frequently in the lower spinal levels (lumbar > thoracic > cervical) and in the vertebral body [34]. Malignant tumors have decreased T1 and increased T2 signal intensities on MRI [34]. Breast, lung, thyroid, renal, gastrointestinal, and prostate metastases are the most common tumors to metastasize to bone [34].

Surgical treatment for spinal metastases has a complication rate comparable to complex spine surgery [3]. While surgical treatment may not appreciably extend survival, it generally improves quality of life by providing spinal stability and pain relief [5]. Symptomatic local recurrence after surgery for metastatic spinal cord compression may be influenced by the extent of spinal and extraspinal bone metastasis, pathologic fractures, surgical approach, and tumor origin (RCC) [6]. Immediate and sustained neurological recovery can be achieved with posterior decompression and stabilization for spinal metastases [63]. Multilevel kyphoplasty in the cervical spine via one minimally invasive antero-lateral approach is a feasible and effective procedure for palliative treatment of metastatic lesions [37]. Cervical kyphoplasty is technically feasible with satisfactory initial clinical results [47].

Classification

NOMS and Revised Tokuhashi: A multidisciplinary team utilizing the NOMS framework combined with the Revised Tokuhashi scoring system for spinal metastasis surgery demonstrates better clinical efficacy than the sole use of the Revised Tokuhashi scoring system [50].

Spinal Instability Neoplastic Score (SINS): The SINS correlates with epidural spinal cord compression [100].

Modified Frailty Index (mFI): The mFI serves as a useful tool to predict the incidence and the severity of postoperative complications in spinal metastases surgery [116].

Clinical Presentation

Metastatic spinal disease is frequently identified incidentally on bone scans during routine metastatic workups in patients with known cancer [32]. When the disease progresses, it typically causes moderate to severe pain that persists for months before focal neurologic deficits emerge [32]. Pain onset may also be sudden following a pathologic compression fracture [32]. In patients without a history of cancer, a compression fracture requires evaluation to distinguish between osteoporosis and bone metastasis [32]. Delayed diagnosis of spinal metastasis permits disease progression and potential neurologic compromise, which can result in permanent functional deficits [32].

Diagnostic Indicators and History

Specific clinical features raise suspicion for spinal metastasis. Diagnostic indicators include recent unexplained weight loss, night pain, and age older than 50 years [34, 35]. Careful physical and neurologic examinations are vital for diagnosis [34, 35]. Most patients with hematologic malignancies presenting with spinal involvement exhibit systemic findings such as weight loss, fatigue, or fever [32].

Imaging and Radiographic Findings

Imaging for suspected spinal metastasis should include plain radiographs of the entire spine [34, 35]. The classic plain radiographic finding is loss of a pedicle on an anteroposterior view, referred to as the "winking owl sign" [32, 34, 35]. Other radiographic changes include cortical erosion or expansion and vertebral collapse [34, 35]. Metastatic disease spreads to the vertebral body first and later to the pedicles [34, 35]. Malignant spinal tumors occur more frequently in the lower spinal levels (lumbar > thoracic > cervical) and in the vertebral body [34, 35].

MRI is the diagnostic modality of choice for spinal tumors [34, 35]. Malignant spinal tumors demonstrate decreased T1 and increased T2 signal intensities on MRI [34, 35]. The sensitivity of MRI for detecting malignant spinal tumors increases with the use of gadolinium [34, 35]. MRI with gadolinium of suspected levels is required for diagnosis and may require imaging of the entire neuraxis [34, 35]. MRI can also differentiate an osteoporotic compression fracture from one caused by a malignant lesion [32].

CT scans provide information on bony involvement and mechanical stability [34, 35]. CT scans of the chest, abdomen, and pelvis help identify a possible primary lesion [34, 35]. Bone scans can be helpful in cases of protracted back pain or night pain [34, 35]. They assist in assessing for a primary lesion and remote sites of involvement, although results can be negative in up to 25% of cases [34, 35].

Diagnostic Confirmation and Biopsy

When complete replacement of the vertebral segment, multiple vertebral body lesions, pedicle involvement, and an intact intervertebral disk are present, metastatic disease is most likely [32]. Some patients with myeloma, lymphoma, or leukemia may present with osteopenia of the vertebra [32]. Lymphoma and myeloma are also common causes of spinal metastasis [34, 35].

Patients with a suspected malignancy should undergo biopsy, while others may be treated symptomatically [32]. If a patient treated for an osteoporotic compression fracture does not respond to treatment or exhibits progressive bone destruction, a biopsy is indicated [32]. Percutaneous biopsy of a spinal lesion may avoid surgical open biopsy and can confirm the diagnosis [34, 35]. Percutaneous CT-guided needle biopsy of vertebral lesions can be performed with local anesthesia and intravenous sedation [32]. To determine if a patient has a hematologic malignancy, a bone marrow aspirate should be considered [32].

Prognosis and Risk

If a metastatic lesion in the spine is identified, the patient is at risk of having additional skeletal lesions [32]. The metastases most commonly involve the vertebral body rather than the posterior elements [32]. The majority of patients with microscopic spinal metastasis will not have clinically significant spine disease during their lifetime and will not need treatment specific to this location [32].

Investigations

Other Considerations: Provider-based decision-making for patients with spinal metastases is influenced by numerous factors, including multidisciplinary team dynamics, business pressure, and clinician experience [12]. Alignment and the characteristics and location of spinal cord compression help determine the ideal surgical approach [41]. A preoperative angiogram should be carried out prior to thoracolumbar corpectomy or vertebrectomy to perform embolization if the tumor is hypervascular [118].

Treatment

Non-Operative

Nonoperative management is appropriate for tumors that are radiosensitive, chemosensitive, or hormonally responsive [34]. Radiation therapy is indicated for patients presenting with pain but no neurologic compromise or risk of impending fracture [32]. It is also utilized for radiation-sensitive tumors, such as lymphoma or myeloma, even when neurologic compromise is present [32]. In cases where cord compression results from tumor extension with minimal or no bone destruction, emergent radiation is recommended [32]. A short course of high-dose corticosteroids should be administered to reduce peritumoral edema contributing to compression and neurologic damage [32]. Additional indications for radiation include patients with medical comorbidities precluding surgery, those with a life expectancy of 6 weeks or less, and patients with multilevel disease [32]. Cyberknife radiosurgery serves as an alternative to major surgery, particularly for patients who have received prior external beam radiation; this computer-assisted, minimally invasive procedure focuses small radiation beams from multiple directions via a robotic arm and can be performed as an outpatient in one to three sessions [32]. Vertebroplasty is a minimally invasive alternative to open surgery for metastatic disease of the spine, such as myeloma or breast cancer, in the absence of instability or neurologic compromise [34]. Multilevel kyphoplasty in the cervical spine via a single minimally invasive antero-lateral approach is a feasible and effective palliative procedure for metastatic lesions, offering rapid pain relief and fast recovery of mobility [37].

Operative

Indications: Life expectancy plays a significant role in determining whether surgery is performed for spinal metastases [34]. Surgical treatment is indicated for disease progression after radiation, neurologic compromise caused by bony impingement or radioresistant tumors within the spinal canal, impending fracture, or spinal instability resulting from pathologic fracture or progressive deformity [32]. Specific indications include progressive neurologic dysfunction unresponsive to radiation, persistent pain despite radiation, the need for an open diagnostic biopsy, pathologic mechanical instability, and radioresistant tumors [34]. Surgical intervention combined with adjuvant radiation and/or chemotherapy should be considered for patients with mechanical instability or evolving/progressive neurologic deficits [34]. In patients with metastatic epidural spinal cord compression (MESCC), direct decompressive surgery combined with radiation therapy is more effective than radiation therapy alone for improving ambulatory ability [46]. For epidural spinal cord compression, radiation therapy should be combined with direct decompression to achieve the best clinical outcomes [34]. Preoperative palsy score has no statistically significant association with survival in non-small-cell lung cancer patients with spinal metastases undergoing spinal surgery [73].

Surgical Approach / Technique: Because malignant tumors predominantly involve the vertebral body, anterior decompression is most often necessary to remove the pathologic process responsible for neurologic deterioration and pain [66]. Anterior decompression yields pain improvement in 80% to 95% of patients and restores neurologic function in 75% [66]. Excision is often intralesional, though decompression is acceptable when stability can be restored using structural grafts or devices [66]. Laminectomy provides little value for progressive paralysis caused by malignant spinal tumors in the anterior column, with successful results reported in only 30% to 40% of patients, which is inferior to radiation alone [66]. However, radical laminectomy is valuable and should be considered when compression is caused by lesions in the posterior elements compressing the dura [66]. For patients with anterior column involvement who cannot tolerate a thoracotomy, or those with circumferential spinal cord or neural constriction, costotransversectomy is useful in the thoracic spine and a posterior approach is useful in the lumbar spine [66]. Posterior decompression and stabilization can achieve immediate and sustained neurological recovery [63]. Posterior decompression and occipitocervical fixation followed by intraoperative vertebroplasty is a safe and valuable palliative method with relatively less invasion for treating metastatic involvement of the axis [55]. The learning curve for minimally invasive separation surgery (MISS) for spinal metastases is not steep [40].

Implant Selection: Decompression often creates instability requiring reconstruction with instrumentation, allografts, and occasionally structural bone cement [66]. Although circumferential instrumentation is superior for stabilization, anterior instrumentation alone often suffices if the posterior osteoligamentous complex is intact and resection is less than a complete spondylectomy [66]. Additional posterior decompression and stabilization in a combined approach are often necessary if the spinal canal is compressed anteriorly and posteriorly or if the posterior column is attenuated [66]. High-grade instability, contiguous vertebral involvement, destruction of anterior and posterior columns, and the need for en bloc resection are indications for combined anterior and posterior approaches [66].

Outcomes: Surgical treatment for spinal metastases provides significant benefits in pain reduction and functional improvement, with a complication rate comparable to complex spine surgery [3]. Palliative surgery for cervical spine metastasis improves performance status and quality of life, although cervicothoracic junction lesions may be a risk factor for poor outcomes [15]. Palliative surgery for spinal metastases improves performance status, activities of daily living, and quality of life regardless of age [23].

Perioperative Considerations: Preoperative embolization should be considered, particularly for renal cell and thyroid carcinomas [34]. Due to the hypercoagulable state of malignancy, especially in patients with paraplegia, the use of a preoperative inferior vena cava filter and perioperative anticoagulation therapy should be considered [66]. Radiation should be added preoperatively or postoperatively to improve local disease control when patients are treated with surgery [32]. Irradiation is best accomplished preoperatively or delayed until at least 3 weeks postoperatively if possible to improve fusion rates [66]. Symptomatic local recurrence may be influenced by the extent of spinal and extraspinal bone metastasis, pathologic fractures, surgical approach, and tumor origin (RCC) [6]. Dedicated cancer centers offer high-value care, evidenced by lower complication rates and reduced reimbursements after surgery for spinal metastases [22].

Complications

General Morbidity: Perioperative complications in the surgical treatment of spinal cord compression can be devastating [9]. Surgical treatment for vertebral metastasis is often a major undertaking that carries significant morbidity and may require a prolonged recovery [32]. An overall complication rate of approximately 10% is expected when correcting posttraumatic deformities [69].

Instability: Decompression alone for spinal deformity could result in increased postoperative deformity or iatrogenic instability [45]. Extending distal fusion to S1, rather than stopping at L5, increases operative time, complication rate, revision rate, and risk of pseudarthrosis [45].

Neurological Outcomes: Laminectomy has been shown to be of little value in the treatment of progressive paralysis caused by malignant spinal tumors in the anterior column, with successful results reported in only 30% to 40% of patients [66]. A cervicothoracic junction lesion is a risk factor for a poor outcome in patients undergoing palliative surgery for cervical spine metastasis [15].

Thromboembolism: The use of a preoperative inferior vena cava filter should be considered due to the hypercoagulable state of malignancy, especially in patients with paraplegia [66].

Recovery

Other Considerations: Surgical treatment of metastases to the cervical spine yields good outcomes [16]. In cases involving a palliative posterolateral transpedicular partial corpectomy without anterior reconstruction, implant stability can be maintained for up to 28 months, resulting in a satisfying functional outcome [109]. Prognostic value for survival following spinal bone metastasis surgery is confirmed by three biologic parameters: CRP level, albuminemia, and calcemia [121].

Key Evidence

  • [L5] Management decisions should be based on histology, clinical presentation, patient prognosis, and spinal stability. [1] (10.5435/jaaos-23-01-38)
  • [L5] Treatment of patients with metastatic disease of the spine should be a multidisciplinary effort that follows a logical, orderly protocol with the goal of maximizing the patient's overall quality of life. [2] (10.1097/01.blo.0000092977.12414.f9)
  • [L3] Surgical treatment for spinal metastases provides significant benefits in pain reduction and functional improvement, with a complication rate comparable to complex spine surgery. [3] (10.1016/j.otsr.2018.06.006)
  • [L4] Surgical treatment may not appreciably extend the length of a patient's survival, but it generally improves the patient's quality of life by providing spinal stability and pain relief. [5] (10.2106/00004623-197860060-00006)
  • [L3] Symptomatic local recurrence may be influenced by several factors, including the extent of spinal and extraspinal bone metastasis, pathologic fractures, surgical approach, and tumor origin (RCC). [6] (10.1186/s13018-024-05289-4)
  • [L4] Appropriate indications for massive spinal resection give good oncological and functional results. [7] (10.1016/j.otsr.2013.09.008)
  • [L2] The newly developed Oswestry Spinal Risk Index (OSRI), based on primary tumour pathology and general condition, predicts life expectancy accurately and is helpful in making difficult clinical decisions. [8] (10.1302/0301-620x.95b2.29323)
  • [L5] Surgical treatment is indicated for patients with objective myelopathic symptoms confirmed by imaging demonstrating spinal cord compression to halt progression of symptoms and improve function in some patients, though perioperative complications can be devastating. [9] (10.5435/jaaos-d-25-00026)
  • [L5] Management is guided by three key issues: neurologic compromise, spinal instability, and individual patient factors. [11] (10.5435/00124635-201101000-00005)
  • [L4] Numerous factors influence provider-based decision-making for patients with spinal metastases, including multidisciplinary team dynamics, business pressure, and clinician experience. [12] (10.2106/jbjs.20.00334)
  • [L1] Spinal surgery for metastatic disease is associated with significant blood loss and the possibility of catastrophic blood loss. [13] (10.1302/0301-620x.95b5.31270)
  • [L4] Surgical intervention can improve the living conditions and quality of life in patients with solitary spinal metastasis, especially in cases with neurologic involvement. [14] (10.1007/bf00434003)
  • [L3] Palliative surgery for cervical spine metastasis improved the performance status and quality of life, but a cervicothoracic junction lesion could be a risk factor for a poor outcome. [15] (10.1186/s13018-021-02562-8)
  • [L4] Surgical treatment of metastases to the cervical spine gives good outcomes and it ought to be a treatment of choice. [16] (10.1186/s12891-016-1175-8)
  • [L3] Our data suggest that the value to society of a surgical procedure for spinal metastases varies according to the features of the patient population. [17] (10.2106/jbjs.21.00023)
  • [L4] Orthoplastic management of spinal tumors should involve a strategy for preoperative recognition of patients at risk of compromised wound-healing. [19] (10.2106/jbjs.n.01353)
  • [L3] Based on our findings, it appears that DCCs offer high-value care, as evidenced by lower complication rates and reduced reimbursements after surgery for spinal metastases. [22] (10.1097/corr.0000000000001640)
  • [L3] Palliative surgery for spinal metastases improved the PS, activities of daily living, and quality of life, regardless of age. [23] (10.1302/0301-620x.102b12.bjj-2020-0566.r1)
  • [L4] In view of the large number of patients who regained the ability to walk after anterior decompression, the role of surgical intervention as a primary treatment for epidural compression by a malignant tumor should be reconsidered. [24] (10.2106/00004623-198567030-00004)
  • [L4] Multilevel kyphoplasty in the cervical spine via one minimally invasive antero-lateral approach is a feasible and effective procedure for palliative treatment of metastatic lesions showing rapid pain relief and fast recovery of mobility. [37] (10.1007/s00402-011-1270-0)
  • [L4] The learning curve of MISS for spinal metastases is not steep. [40] (10.1186/s12891-022-05191-2)
  • [L5] Alignment and the characteristics and location of spinal cord compression help determine the ideal surgical approach. [41] (10.5435/jaaos-d-14-00250)
  • [L4] In palliative surgery of the spine, posterior decompression and fixation using CDI permit most patients to retain ambulation without requiring external orthotics. [42] (10.1007/bf00572907)
  • [L1] In patients with metastatic epidural spinal cord compression (MESCC), direct decompressive surgery and radiation therapy was more effective than radiation therapy alone for improving the ability to walk. [46] (10.2106/jbjs.8805.ebo3)
  • [L3] Cervical kyphoplasty was technically feasible, with satisfactory initial clinical results. [47] (10.1016/j.otsr.2012.01.004)
  • [L1] A multidisciplinary team using the NOMS combined with the Revised Tokuhashi scoring system for spinal metastasis surgery showed better clinical efficacy than the sole use of the Revised Tokuhashi scoring system. [50] (10.1186/s13018-024-04668-1)
  • [L4] Posterior decompression and occipitocervical fixation followed by intraoperative vertebroplasty was a safe and valuable palliative method with relatively less invasion to treat metastatic involvement of the axis. [55] (10.1186/s12891-018-1928-7)
  • [L3] Immediate and sustained neurological recovery can be achieved with posterior decompression and stabilization. [63] (10.2106/00004623-199704000-00006)
  • [L3] Preoperative palsy score had no statistically significant association with survival in non-small-cell lung cancer patients with spinal metastases who underwent spinal surgery in this study. [73] (10.1186/s13018-015-0291-8)
  • [L3] [100] (10.1186/s12891-024-07756-9)
  • [L4] The results of this study suggest that the stability of implants can be maintained up to 28 months with satisfying functional outcome after a palliative posterolateral transpedicular partial corpectomy without anterior reconstruction. [109] (10.1186/s13018-015-0255-z)
  • [L2] The mFI is a useful tool to predict the incidence and the severity of postoperative complications in spinal metastases surgery. [116] (10.1302/0301-620x.106b12.bjj-2024-0100.r1)
  • [L3] A preoperative angiogram should be carried out prior to thoracolumbar corpectomy or vertebrectomy to perform embolization if the tumor is hypervascular. [118] (10.1016/j.otsr.2012.03.008)
  • [L4] The study confirmed the prognostic value of 3 biologic parameters (CRP level, albuminemia, calcemia) for survival after spinal bone metastasis surgery. [121] (10.1016/j.otsr.2019.11.031)

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