Staging, classification and oncological approach for spinal column metastases

The Spine is the most common osseous site for metastatic disease and may be involved in up to 40% of patients with cancer. The prevalence of cancer patients is expected to rise, because of the aging population and prolongation of overall survival. In the past, a simple palliative approach was advocated for the majority of patients with metastatic spinal disease. However, with the on going improvements in diagnosis and treatment, a more complicated algorithm has evolved requiring a multidisciplinary approach. As a result, patients with metastatic disease are living longer so that management of spine instability due to spinal metastasis comes more into focus. In the following chapter we discuss the various treatment options for these patients with emphasis on staging, classification and surgical treatment options.