Fig. 1.

(A, B; spinal MRI) Fifty-five-year-old man with metastatic melanoma presented with back pain exacerbated by movement (SINS 12) and was diagnosed with T9 metastasis causing spinal cord compression (Bilsky ESCC 3). Patient underwent separation surgery using posterior-approach instrumented spinal stabilization, T8–T10 laminectomy, left-sided removal of the facet and pedicle, and excision of epidural tumor. (C) Postoperative X-ray illustrating a pedicle screw and rod system used for spinal stabilization. (D) Postoperative CT-myelogram used for SBRT planning, demonstrating circumferential spinal cord decompression achieved through removal of the lamina, facet complex, pedicle, and epidural tumor. Patient was treated with 900 cGy × 3 fractions SBRT. (E) MRI obtained 11 months after SBRT confirming local tumor control.