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Decision-making frameworks, such as NOMS, SINS, and Tokuhashi score, provide structured guidance for selecting metastatic patients for surgery and defining individualized treatment strategies. En bloc resection remains the gold standard for selected primary malignant tumors, whereas separation surgery combined with stereotactic radiosurgery represents the cornerstone of modern metastatic spine disease management. Minimally invasive techniques represent a paradigm shift toward less invasive, patient-tailored surgical strategies in spine oncology, complementing rather than replacing traditional open approaches. Future developments in robotics, ablation technologies, and biomaterials are expected to further refine surgical precision and expand treatment indications.<\/jats:p>","DOI":"10.1530\/eor-2026-0089","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T15:57:06Z","timestamp":1788364626000},"page":"913-929","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-16","source":"Crossref","is-referenced-by-count":0,"title":["Surgery of the tumors of the 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