Minimally invasive treatments for metastatic tumors of the spine.

Minimally invasive approaches are finding their way into all aspects of metastatic spinal disease from diagnosis to treatment of patients who are diagnosed early in their course as well as patients with multifocal metastases. For patients who are found to have asymptomatic spinal metastases, diagnosis is important to guide management and treatment so as to prevent future morbidity. These patients also now have the option of less invasive techniques for resection,reconstruction, and stabilization, including endoscopy and less invasive surgical approaches. Patients who are treated later in their course, with multifocal metastatic disease also have more options for palliation of pain and for stability,including vertebroplasty/kyphoplasty and radio-frequency tumor ablation as well as some of the percutaneous methods of stabilization described previously. As techniques evolve and im-prove, patients will continue to have more access to less invasive options for treatment of spinal metastases.