The spine is the most common, and most clinically challenging, site of bony metastasis (Abel, Keil, Schlager, & Akbar, 2008). Individual functional status and overall disease prognosis vary considerably, and this leads to significant heterogeneity in the management of the spinal metastasis. In many individuals with symptomatic compression of the spinal cord, the cancer has progressed to a point where surgical intervention is not considered curative. Rather, the rationale for surgery and (neo)adjuvant chemotherapy or radiation is to relieve pain and to prevent or reverse neurologic deficits.
Attempts to decompress the spinal cord or stabilize the spine may employ an anterior, posterior or combined approach. Specifically, the mechanical instability and extent of cord compression caused by the lesion will affect the surgical strategy. While many studies have compared the outcomes of such procedures, unfortunately, most groups include individuals with variable pre-operative neurological deficits and do not provide enough details regarding neurological outcomes. However, as summarized in Table 8, several studies have aimed to determine the possible advantages of different surgical approaches.