The treatment of spinal metastases aims to improve or maintain neurological status, achieve local control of the disease and maintain or restore spinal stability. Three types of surgery are possible for spinal metastases: palliative (the most frequent), adjuvant (frequent) and radical (rare). Four criteria must be met before surgery for spinal metastases: patient's ability to tolerate surgery, neurological status, oncological status and mechanical instability of the spine. Since radiation therapy alone has a limited role on neurological improvement, moreover making surgery more difficult and risky, surgery should be performed before radiation therapy.
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