Recent Trends in the Management of Spinal Metastasis: A Narrative Review of the Literature

Background data: Approximately 60% of osseous metastases are in the spine, and 10% of patients with spinal metastases are expected to develop spinal cord compression. In our opinion, there is a need for a recent review of the management of spinal metastases and the role of oncological spine surgeons due to recent advances in the diagnosis and management of spinal metastases. Purpose: This study aims to review the available data about the current concepts regarding decision making and treatment options for spinal metastasis. Study design: A narrative literature review was performed. Patients and methods: The authors reviewed the English literature published over the past two decades for recent and relevant data about decision making and treatment options in cases of spinal metastases. A PubMed search was con-ducted, and the most relevant articles according to the study aim and spine surgeon ' s practice were extracted. Results: The classi fi cation-based approaches described by Tokuhashi and colleagues and Tomita and colleagues are well-established methods to estimate life expectancy in patients with spinal metastasis; however, they do not consider newer radiotherapy technologies and chemotherapies to treat these metastases. Recent advances in molecular genetics might explain why survival might be different in patients having the same tumor histopathology and metastases. Survival is related to genes in tumors, and this is proven for melanoma, breast cancer, and non-small-cell lung cancer. Neurologic, oncologic, mechanical, and systemic framework was recently developed and provided a comprehensive assessment of metastatic spinal tumors, including four pillars: neurologic, oncologic, mechanical, and systemic assessment. In this framework, the role of oncological spine surgeons is limited to separation surgery or restoring spinal stability, whereas the rest of the management depends mainly on radiotherapy. Targeted therapeutics are recent drugs that have the potential to improve markedly the outcomes in cases of spinal metastases. Several targeted therapies have been approved for metastatic renal cell carcinoma. Conclusion: Prognosis in cases of spinal metastases seems to be more in fl uenced by genetic subtyping. The role of spinal oncological surgery is fading away. Surgery is limited to separation surgery and surgeries for restoration of spinal stability. The future of spinal metastases management lies in the recent advances in techniques of radiotherapy and targeted therapeutics (2021ESJ254).