Management of metastatic disease of the spine.

Accurate assessment of spinal cord stability, pain, and neurologic function is essential to any rational approach to metastatic disease of the spine. The Harrington classification is useful in terms of selecting treatment options and planning appropriate interventional and adjuvant therapy. For milder cases, with bone involvement in the absence of structural deformity, adjuvant therapy usually is appropriate. In cases of bone collapse, with or without neurologic compromise, surgical consideration should be given to patients with appropriate life expectancy. Surgical principles revolve around anterior decompression and reconstruction, for anatomic and biomechanical reasons. More widespread use of anterior instrumentation may obviate the need for subsequent posterior stabilization, but additional long-term study is required in this area.