Multidisciplinary Management of Spinal Metastasis and Vertebral Instability: A Systematic Review

Dylan N. Greif, Alexander Ghasem, Alexander Butler, Sebastian Rivera, Motasem Al Maaieh, Sheila Ann Conway

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objective: The aim of this systematic literature review is to evaluate recent attempts in creating a standardized multidisciplinary approach combining tumor treatment with current vertebral stabilization techniques for palliative treatment of vertebral metastasis in patients who do not fall into the NOMS (neurologic, oncologic, mechanical, systemic) framework. Methods: We performed a systematic literature search for studies using a tumor modality in conjunction with kyphoplasty or vertebroplasty. In addition, the bibliographies of selected articles were examined for additional studies not viewed in database searches, which led to the use of additional search terms. Results: A total of 563 articles were found after our database search. Eighteen studies fulfilled our inclusion criteria. Articles were then divided into categories based on combinations of tumor modality. Multiple studies reported significant decreases in visual analog scale scores after combined procedures with very low rates of symptomatic complications. Studies that compared their combination with control treatment groups showed greater clinical efficacy. Conclusions: Although multidisciplinary management of spinal metastasis using a combination of tumor ablation techniques with vertebral stabilization has been recommended in the previous literature, this review shows that no combination of treatment carried demonstrably different results in pain score reduction, reduced analgesic intake, or improved quality of life. In addition, there is no consensus of standardized variables to evaluate efficacy of treatment, limiting the efficacy of treatment results for the analyzed studies. Although not explicitly included in the initial NOMS framework, our results support the consideration of concomitant percutaneous kyphoplasty or vertebroplasty in these patients on a case-by-case basis.

Original languageEnglish (US)
Pages (from-to)e944-e955
JournalWorld neurosurgery
StatePublished - Aug 2019


  • Combination therapy
  • Kyphoplasty
  • Radiation
  • Radiofrequency ablation
  • Radiosurgery
  • Spinal metastasis
  • Vertebroplasty

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Fingerprint Dive into the research topics of 'Multidisciplinary Management of Spinal Metastasis and Vertebral Instability: A Systematic Review'. Together they form a unique fingerprint.

Cite this