SPINAL TUMOR SURGERY IN THE ELDERLY: SPECIAL CONSIDERATIONS AND OUTCOMES

Spinal tumors in the elderly present unique clinical challenges due to age-related physiological decline, increased frailty, and multiple comorbidities. While metastatic disease constitutes the vast majority of spinal tumors in this population, primary neoplasms of the vertebral column, spinal cord, and menin-ges, though rare, are increasingly encountered with rising life expectancy. Comprehensive preoperative evaluation including frailty scoring, comorbidity indices, and functional assessment is critical for risk stratification and treatment planning. Advances in minimally invasive surgery, stereotactic radiosur-gery, and vertebral augmentation techniques have significantly improved safety profiles, allowing for individualized, function-preserving interventions. The NOMS decision framework (Neurologic, Onco-logic, Mechanical stability, Systemic condition) provides a structured approach to managing spinal me-tastases, emphasizing patient-centered outcomes such as pain relief, neurological preservation, spinal stability, and quality of life. Despite elevated perioperative risks, appropriately selected elderly patients may achieve meaningful functional recovery and symptom control. Optimal outcomes require a multi-disciplinary strategy integrating neurosurgery, oncology, geriatrics, and rehabilitation medicine. As the geriatric population continues to expand, evidence-based and geriatric-focused strategies are essential for improving surgical safety, postoperative recovery, and long-term outcomes in spinal oncology.