Table 6.

The surgical options to be considered in spinal metastasis

Presentation	Intervention	Aims and comments
Metastasis from highly vascularized primary tumour	Preoperative embolisation of metastasis	- Reduce blood loss in surgery
		- More precise and extensive tumour resection
Dorsal thoracic or lumbar metastasis	Dorsal spine decompression	- Pain relief, neurological improvement
		- Reduce tumour volume
		- Resect structures bordering spinal canal dorsally (laminectomy and hemi-facetectomy)
		- Prevent spinal cord transection
		- Spine stabilisation
Cervical metastasis	Ventral decompression with coroporectomy, vertebral body replacement, and ventral stable-angle plate osteosynthesis	- As for thoracic and lumbar metastasis
Solitary spinal metastasis	Ventral tumour resection	- Removal of malignancy
		- Prognosis good
Vertebral metastasis without neurologically compromise	Vertebroplasty/kyphoplasty	- Stabilisation
		- Pain relief
		- Prevent destruction of vertebral body
		- Possible benefit to neurological function