MANAGEMENT OF METASTATIC TUMORS OF THE SPINE: STRATEGIES AND SURGICAL INDICATIONS

Advancements in diagnostic modalities and systemic therapies have prolonged survival in cancer pa-tients, leading to an increased incidence of metastatic lesions particularly in the axial skeleton, with the spine being the most commonly affected site. Symptomatic spinal involvement occurs in roughly one out of every ten individuals diagnosed with a malignant tumor, with breast, prostate, lung, and thyroid cancers being the primary sources of these metastases. Among spinal regions, the thoracic spine is most frequently affected, accounting for approximately 70% of cases, followed by the lumbar spine in about 20% and the cervical spine in 10%. In nearly 10% of cases with vertebral body metastasis, spinal cord compression develops, posing a significant risk of permanent disability if not promptly managed. One of the most prominent clinical manifestations of spinal metastases is severe axial pain, often due to pathological compression fractures of the vertebral bodies. In addition to pain, patients may experience progressive neurological deterioration from direct tumor-induced spinal cord compression. Therefore, the primary goal of treatment in spinal metastases is not curative but palliative aimed at reducing pain, preserving neurological function, and improving the patient’s quality of life. Over the past two decades, spinal oncology surgery has evolved substantially, moving beyond traditional decompres-sion methods that are now considered insufficient for most patients. Modern surgical approaches are strategic and multifaceted, aiming to restore spinal stability, relieve spinal cord compression, enable the delivery of stereotactic radiosurgery (SRS) or stereotactic body radiotherapy (SBRT) by reducing epidural tumor burden, obtain tissue for histopathological analysis, and achieve local tumor control in cases where radiation therapy is contraindicated or insufficient. This chapter provides a comprehen-sive overview of metastatic spinal tumors involving the vertebral column, focusing on their clinical presentation, indications for surgery, and contemporary strategies in both surgical and non-surgical management. Special attention is given to the role of surgery in the modern era, where integration with advanced radiotherapy has redefined treatment goals shifting the focus from terminal care to functional preservation and quality of life improvement.