Current Concepts in the Management and Treatment of Spinal Metastases—A Systematic Literature Review
by
Adriana Palacio Giraldo
1,2,*, 
Verena Dammerer
3,
Johannes Neugebauer
1,2,
Gianpaolo Leone
1,2,
Melanie Schindler
1,2 and
Dietmar Dammerer
1,2 1
Department of Orthopedics and Traumatology, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria
2
Division of Orthopedics and Traumatology, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria
3
Regional Hospital Scheibbs, Eisenwurzenstraße 26, 3270 Scheibbs, Austria
*
Author to whom correspondence should be addressed.
Cancers 2025, 17(8), 1296; https://doi.org/10.3390/cancers17081296
Submission received: 23 February 2025
/
Revised: 31 March 2025
/
Accepted: 6 April 2025
/
Published: 11 April 2025
(This article belongs to the Topic Individualized Molecular Mechanisms and Treatment in Tumor Metastasis)
Simple Summary
This literature review focuses on the symptoms, diagnosis and treatment of spinal metastases, which represent a late complication of the primary tumor. The main treatment goals for spinal metastases include local control, pain relief, improvement or prevention of neurologic symptoms, and maintenance of stability. Magnetic resonance imaging is considered the gold standard for diagnosing spinal metastases, although alternative imaging modalities are also described. Treatment options include systemic therapies, radiotherapy, and surgical techniques for metastatic lesions. The combination of stereotactic body radiotherapy with surgical spinal decompression of the spine is an evolving treatment approach with promising results. Several treatment management algorithms, including the NOMS (neurology, oncology, mechanical stability, and systemic disease), and LMNOP (localization, mechanical instability, neurology, oncology) algorithms, have been proposed to aid in the decision-making process regarding individual treatment modalities. The primary factors influencing treatment decisions are primary tumor histology and life expectancy.
Abstract
Background: The advent of novel cancer therapies has significantly improved both life expectancy and quality of life for cancer patients. However, this has also led to an increased incidence of metastases, particularly spinal metastases, which pose a significant clinical challenge due to their potential to compromise spinal stability, mobility and neurological function. Objective: The aim of this study is to identify current symptom scores, determine the diagnosis, evaluate treatment modalities, and review prognostic scores and management algorithms for spinal metastases to aid in therapeutic decision making. Methods: A systematic literature review was conducted in PubMed focusing on available full-text review articles published in English between 1 January 2012 and 1 July 2022. The search terms were “spinal metastasis OR spinal metastases OR spine metastasis OR spine metastases AND treatment OR management”. Results: Several treatment algorithms, including NOMS (neurology, oncology, mechanical stability, and systemic disease) and LMNOP (localization, mechanical instability, neurology, oncology), have been proposed to guide clinical decision making. However, the development of prognostic scores that incorporate the impact of newer treatment modalities remains an important area of research. Conclusions: Effective management of spinal metastases requires a multidisciplinary approach, with emphasis on early diagnosis. Treatment decisions are individualized. Further research is essential to refine treatment strategies and improve patient outcomes.
