{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T02:09:57Z","timestamp":1793239797100,"version":"4.5.0"},"reference-count":110,"publisher":"The Korean Spinal Neurosurgery Society","issue":"3","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["e-neurospine.org"],"crossmark-restriction":true},"short-container-title":["Neurospine"],"published-print":{"date-parts":[[2025,9,30]]},"abstract":"<jats:p>Metastatic spine disease represents a growing therapeutic challenge that demands a balance between incorporating emerging technologies while respecting the fundamental principles during clinical decision-making. Advances in adjuvant therapies, including stereotactic body radiotherapy (SBRT) and chemotherapy, have significantly improved long-term patient survival. Surgical decision-making should be guided by well-established frameworks such as the NOMS (neurologic, oncologic, mechanical, systemic) criteria, the ESCC (epidural spinal cord compression) scale, and the SINS (spinal instability neoplastic score), ensuring a structured and evidence-based approach to treatment. The integration of minimally invasive techniques, including percutaneous instrumentation, ablation techniques, and biportal endoscopic approaches, has reduced surgical morbidity and facilitated faster recovery. Additionally, carbon fiber implants are revolutionizing spinal stabilization by allowing better postoperative visualization of any local recurrence and easier radiation planning. SBRT has emerged as a critical modality, offering precise, high-dose radiation with minimal toxicity to the spinal cord, improving local tumor control and patient outcomes. A multidisciplinary approach remains paramount, requiring collaboration between spine surgeons, radiation oncologists, and medical oncologists. In this narrative review, we aim to provide a comprehensive overview of the current state of metastatic spine tumor management, focusing on: (1) fundamentals of metastatic spine care, (2) minimally invasive surgical techniques, (3) the use of carbon fiber screws, (4) SBRT, and (5) ways to maximize patient safety.<\/jats:p>","DOI":"10.14245\/ns.2550476.238","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T07:24:06Z","timestamp":1759130646000},"page":"829-845","update-policy":"https:\/\/doi.org\/10.14245\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Advances in Metastatic Disease Spinal Oncology: Novel Technology Without Forgetting the Fundamentals of Surgical Treatment"],"prefix":"10.14245","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9396-3989","authenticated-orcid":true,"given":"Harsh","family":"Jain","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8194-3056","authenticated-orcid":true,"given":"Ranbir","family":"Ahluwalia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilya","family":"Laufer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2951-2942","authenticated-orcid":true,"given":"Scott L.","family":"Zuckerman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"5355","reference":[{"key":"ref1","volume-title":"Spinal metastasis [Internet]","author":"Ziu"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1056\/nejm199208273270907"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20190211"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2020.04.183"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbo.2022.100446"},{"key":"ref6","first-page":"513","volume-title":"","author":"Vlachostergios","year":"2020"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2021.626873"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.3390\/diseases11030109"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.3171\/2010.3.spine09459"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2012-0293"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1177\/2192568217697691"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.rpor.2015.03.004"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2024.108393"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2024.1403423"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1374915"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1097\/brs.0000000000002378"},{"key":"ref17","first-page":"1319","volume-title":"Does low-grade versus high-grade bilsky score influence local recurrence and overall survival in metastatic spine tumor surgery?","author":"Bendfeldt","year":"2023"},{"key":"ref18","first-page":"207","volume-title":"Local disease control for spinal metastases following \u201cseparation surgery\u201d and adjuvant hypofractionated or high-dose single-fraction stereotactic radiosurgery: outcome analysis in 186 patients: clinical article","author":"Laufer","year":"2013"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2023.07.019"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.14245\/ns.2244290.145"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1177\/21925682241250327"},{"key":"ref22","first-page":"1037","volume-title":"Short-course radiotherapy (8 Gy x 2) in metastatic spinal cord compression: an effective and feasible treatment","author":"Maranzano","year":"1997"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1016\/j.semradonc.2022.11.006"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.14823"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1093\/ons\/opy137"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyaa380"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1007\/s10143-024-03123-3"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2013.10.028"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1002\/jso.24620"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200102010-00016"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000180401.06919.a5"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.21873\/anticanres.15519"},{"key":"ref33","first-page":"303","volume-title":"Metastatic spine disease: should patients with short life expectancy be denied surgical care? an international retrospective cohort study","author":"Dea","year":"2020"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1007\/s10143-019-01123-2"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.14245\/ns.2040060.030"},{"key":"ref36","first-page":"431","volume-title":"","author":"Edstr\u00f6m","year":"2022"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.31616\/asj.2020.0637"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.3171\/2015.5.focus15129"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.1097\/brs.0000000000003690"},{"key":"ref40","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2018.01.176"},{"key":"ref41","doi-asserted-by":"publisher","DOI":"10.3171\/2024.1.focvid23222"},{"key":"ref42","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-022-05191-2"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12165165"},{"key":"ref44","first-page":"575","volume-title":"","author":"Rothrock","year":"2020"},{"key":"ref45","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2015.03.037"},{"key":"ref46","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2018.08.182"},{"key":"ref47","doi-asserted-by":"publisher","DOI":"10.1007\/0-387-36083-2_9"},{"key":"ref48","doi-asserted-by":"publisher","DOI":"10.3171\/2017.5.spine1746"},{"key":"ref49","doi-asserted-by":"publisher","DOI":"10.1016\/s1470-2045(11)70008-0"},{"key":"ref50","doi-asserted-by":"publisher","DOI":"10.3171\/2021.2.focus201121"},{"key":"ref51","doi-asserted-by":"publisher","DOI":"10.1007\/s10195-011-0164-9"},{"key":"ref52","doi-asserted-by":"publisher","DOI":"10.1055\/s-0030-1261786"},{"key":"ref53","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-015-1813-2"},{"key":"ref54","first-page":"S73","volume-title":"Spinal laser interstitial thermal therapy: a novel alternative to surgery for metastatic epidural spinal cord compression","author":"Tatsui","year":"2016"},{"key":"ref55","doi-asserted-by":"publisher","DOI":"10.1080\/17434440.2023.2214678"},{"key":"ref56","doi-asserted-by":"publisher","DOI":"10.14444\/8412"},{"key":"ref57","doi-asserted-by":"publisher","DOI":"10.14245\/ns.2346226.113"},{"key":"ref58","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2024.123582"},{"key":"ref59","doi-asserted-by":"publisher","DOI":"10.1177\/15330338221142160"},{"key":"ref60","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-012-2848-7"},{"key":"ref61","doi-asserted-by":"publisher","DOI":"10.1186\/s12893-017-0265-3"},{"key":"ref62","doi-asserted-by":"publisher","DOI":"10.1177\/2192568220958403"},{"key":"ref63","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-031-53578-9_9"},{"key":"ref64","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2021.05.100"},{"key":"ref65","doi-asserted-by":"publisher","DOI":"10.1177\/21925682241259778"},{"key":"ref66","doi-asserted-by":"publisher","DOI":"10.3171\/2023.5.spine23106"},{"key":"ref67","doi-asserted-by":"publisher","DOI":"10.14245\/ns.2244920.460"},{"key":"ref68","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-018-5538-8"},{"key":"ref69","doi-asserted-by":"publisher","DOI":"10.3390\/fib4010001"},{"key":"ref70","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14215275"},{"key":"ref71","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2020.03.013"},{"key":"ref72","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2017.04.091"},{"key":"ref73","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.12905"},{"key":"ref74","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-024-04842-9"},{"key":"ref75","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noad225"},{"key":"ref76","doi-asserted-by":"publisher","DOI":"10.1177\/2192568217694016"},{"key":"ref77","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2011.06.1980"},{"key":"ref78","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2012.03.009"},{"key":"ref79","doi-asserted-by":"publisher","DOI":"10.3171\/2015.6.spine15294"},{"key":"ref80","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2013.07.022"},{"key":"ref81","doi-asserted-by":"publisher","DOI":"10.1667\/rr2773.1"},{"key":"ref82","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2009.10.056"},{"key":"ref83","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2009.03.019"},{"key":"ref84","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2005.04.754"},{"key":"ref85","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2023.109969"},{"key":"ref86","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/not101"},{"key":"ref87","doi-asserted-by":"publisher","DOI":"10.1016\/s1470-2045(11)70384-9"},{"key":"ref88","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2010.06.037"},{"key":"ref89","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2008.19.3508"},{"key":"ref90","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2012.04.034"},{"key":"ref91","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2013.50.1411"},{"key":"ref92","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-015-1990-z"},{"key":"ref93","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2010.08.021"},{"key":"ref94","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2009.05.023"},{"key":"ref95","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2015-0085"},{"key":"ref96","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-012-1387-x"},{"key":"ref97","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2019.08.197"},{"key":"ref98","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2891-9-69"},{"key":"ref99","doi-asserted-by":"publisher","DOI":"10.3390\/jcm8060775"},{"key":"ref100","first-page":"29S","volume-title":"Malnutrition in spine oncology: where are we and what are we measuring?","author":"De la Garza Ramos","year":"2025"},{"key":"ref101","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2024.12.032"},{"key":"ref102","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2015.11.064"},{"key":"ref103","doi-asserted-by":"publisher","DOI":"10.1186\/s12957-017-1118-3"},{"key":"ref104","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.a1899"},{"key":"ref105","doi-asserted-by":"publisher","DOI":"10.3171\/2017.2.spine16861"},{"key":"ref106","doi-asserted-by":"publisher","DOI":"10.25259\/sni_837_2022"},{"key":"ref107","doi-asserted-by":"publisher","DOI":"10.3390\/curroncol29030121"},{"key":"ref108","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2024.04.118"},{"key":"ref109","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics14101059"},{"key":"ref110","doi-asserted-by":"publisher","DOI":"10.3171\/2024.4.spine231254"}],"container-title":["Neurospine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/e-neurospine.org\/upload\/pdf\/ns-2550476-238.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-neurospine.org\/journal\/view.php?doi=10.14245\/ns.2550476.238","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-neurospine.org\/upload\/pdf\/ns-2550476-238.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:25:37Z","timestamp":1782087937000},"score":1,"resource":{"primary":{"URL":"http:\/\/e-neurospine.org\/journal\/view.php?doi=10.14245\/ns.2550476.238"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,30]]},"references-count":110,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,9]]}},"URL":"https:\/\/doi.org\/10.14245\/ns.2550476.238","relation":{},"ISSN":["2586-6583","2586-6591"],"issn-type":[{"value":"2586-6583","type":"print"},{"value":"2586-6591","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,30]]},"assertion":[{"value":"2025-04-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-30","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-30","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}