Thoracolumbar spine: Surgical treatment of metastatic disease

Spinal metastases are likely to become an increasingly common clinical problem as advances in cancer management continue to improve the life expectancy for patients with various neoplastic conditions. The role of surgery is controversial, largely because of a lack of controlled clinical studies comparing the many available treatment modalities. Evolving techniques of spinal instrumentation and reconstruction have allowed the radical resection of metastatic vertebral lesions, and provided effective treatment for painful instability secondary to pathologic vertebral collapse. The current state of surgical treatment for metastatic thoracolumbar disease is discussed, including indications for surgery, options for the surgical approach, and techniques for reconstruction and stabilization. Innovative minimally invasive surgical strategies are also addressed.