Surgical treatment for spinal metastases.

The treatment of spinal metastases aims to improve or maintain neurological status, achieve local control of the disease and maintain or restore spinal stability. Three types of surgery are possible: ▪ Palliative (the most frequent): consists of laminectomy and posterior stabilization. It is performed to treat complications from the metastases (pathological fractures and spinal cord compression), but it does not directly treat the bone lesion, leaving its treatment to other therapies (radio–chemo–hormone–immunotherapy). It is indicated in patients with a severe prognosis or with a good predictive response to radiotherapy (Figure 7.1) [1–4];▪ Adjuvant (frequent): consists of total or partial piecemeal removal of the lesion combined with other local therapies, such as radiation, embolization and thermal ablation. It is indicated in all patients who have a fair prognosis (Figure 7.2);▪ Radical (rare): consists of complete en bloc removal of the metastasis with a layer of healthy surrounding soft tissue to free patients from the disease, at least in that site. It is indicated in patients with good prognosis (Figure 7.3) [1–4]