{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T14:46:31Z","timestamp":1774277191321,"version":"3.50.1"},"reference-count":104,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T00:00:00Z","timestamp":1678924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Metastatic spine disease (MSD) and metastatic spinal cord compression (MSCC) are major causes of permanent neurological damage and long-term disability for cancer patients. The development of MSD is pathophysiologically framed by a cooperative interaction between general mechanisms of bone growth and specific mechanisms of spinal metastases (SM) expansion. SM most commonly affects the thoracic spine, even though multiple segments may be affected concomitantly. The great majority of SM are extradural, while intradural-extramedullary and intramedullary metastases are less frequently seen. The management of patients with SM is particularly complex and challenging, with multiple factors\u2014such as the spinal stability status, primary tumor radio and chemosensitivity, cancer biological burden, patient performance status and comorbidities, and patient\u2019s oncological prognosis\u2014influencing the clinical decision-making process. Different frameworks were developed in order to systematize and support this process. A multidisciplinary, personalized approach, enriched by the expertise of each involved specialty, is crucial. We reviewed the most recent evidence and proposed an updated algorithmic approach to patients with MSD according to the clinical scenario of each patient. A flowchart-based approach offers an evidence-based management of MSD, providing a valuable clinical decision tool in a context of high uncertainty and quick-acting need.<\/jats:p>","DOI":"10.3390\/cancers15061796","type":"journal-article","created":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T03:14:35Z","timestamp":1678936475000},"page":"1796","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Multidisciplinary Approach to Spinal Metastases and Metastatic Spinal Cord Compression\u2014A New Integrative Flowchart for Patient Management"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6858-7341","authenticated-orcid":false,"given":"Miguel","family":"Esperan\u00e7a-Martins","sequence":"first","affiliation":[{"name":"Medical Oncology Department, Centro Hospitalar Universit\u00e1rio Lisboa Norte, 1649-028 Lisboa, Portugal"},{"name":"Lu\u00eds Costa Lab, Instituto de Medicina Molecular\u2014Jo\u00e3o Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal"},{"name":"S\u00e9rgio Dias Lab, Instituto de Medicina Molecular\u2014Jo\u00e3o Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3467-8525","authenticated-orcid":false,"given":"Diogo","family":"Roque","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Centro Hospitalar Universit\u00e1rio Lisboa Norte, 1649-028 Lisboa, Portugal"}]},{"given":"Tiago","family":"Barroso","sequence":"additional","affiliation":[{"name":"Medical Oncology Department, Centro Hospitalar Universit\u00e1rio Lisboa Norte, 1649-028 Lisboa, Portugal"}]},{"given":"Andr\u00e9","family":"Abrunhosa-Branquinho","sequence":"additional","affiliation":[{"name":"Radiotherapy Department, Centro Hospitalar Universit\u00e1rio Lisboa Norte, 1649-028 Lisboa, Portugal"}]},{"given":"Diogo","family":"Belo","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Centro Hospitalar Universit\u00e1rio Lisboa Norte, 1649-028 Lisboa, Portugal"}]},{"given":"Nuno","family":"Simas","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Centro Hospitalar Universit\u00e1rio Lisboa Norte, 1649-028 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4782-7318","authenticated-orcid":false,"given":"Luis","family":"Costa","sequence":"additional","affiliation":[{"name":"Medical Oncology Department, Centro Hospitalar Universit\u00e1rio Lisboa Norte, 1649-028 Lisboa, Portugal"},{"name":"Lu\u00eds Costa Lab, Instituto de Medicina Molecular\u2014Jo\u00e3o Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"570","DOI":"10.3322\/caac.21727","article-title":"Oncologic emergencies and urgencies: A comprehensive review","volume":"72","author":"Rothberg","year":"2022","journal-title":"CA Cancer J. 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