Decision-Making Algorithms for Surgical Treatment of Spine Metastatic Disease

Brenton H. Pennicooke, Ibrahim Hussain, Ali A. Baaj

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


The surgical treatment paradigm for treating metastatic disease to the spine continues to evolve as the long-term survival of patients with metastatic disease improves. There has been a significant advancement in radiation therapy and chemotherapy in the treatment of metastatic disease; however, surgery has evolved as a major treatment option for patients with spinal metastases. Surgical decompression is particularly useful in treating patients with high-grade ESCC (epidural spinal cord compression) and CEC (cauda equina compression), and instrumentation/stabilization is indicated for treating spinal instability. The use of NOMS (neurologic, oncologic, mechanical, systemic) framework provides a treatment algorithm that facilitates coordination between a multidisciplinary team to offer safe, reliable, and reproducible treatment for patients with metastatic spinal disease.

Original languageEnglish
Title of host publicationCentral Nervous System Metastases
Subtitle of host publicationDiagnosis and Treatment
PublisherSpringer International Publishing
Number of pages6
ISBN (Electronic)9783030429584
ISBN (Print)9783030429577
StatePublished - Jan 1 2020


  • Cauda equina compression (CEC)
  • Epidural spinal cord compression (ESCC)
  • Instability
  • NOMS (neurologic, oncologic, mechanical, systemic)
  • Radiation therapy (RT)
  • SINS (Spine Instability Neoplastic Score)
  • Spine
  • Stereotactic radiosurgery (SRS)
  • Surgery
  • Tumor
  • Vertebrae


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