Advanced Neuroimaging for Spine Metastasis

A multidisciplinary approach with medical oncology, radiation oncology, surgery, and interventional radiology is required for optimal treatment of spinal metastasis while offering pain relief, preservation of neurologic function, and prevention of morbidity. Since 2013, the multidisciplinary process has been incorporated into a more comprehensive framework, called the Neurologic, Oncologic, Mechanical, and Systemic (NOMS) decision framework. NOMS incorporates treatment options such as interventional procedures, external beam radiation, stereotactic radiosurgery, and open surgery. Imaging plays a key role in this framework, especially in Spinal Instability Neoplastic Scoring, which assigns score based on location, lytic vs. blastic vs. mixed features, spinal alignment, vertebral body collapse, and involvement of the posterior vertebral elements. In nearly all patients with spinal metastases, imaging plays a central role in diagnosis, treatment planning, and follow-up.