Clinical evaluation, diagnosis, and decision-making for metastatic spine tumors: WFNS spine committee recommendations

Introduction: Spinal metastases are a significant concern for patients with advanced cancer, leading to pain, neurological deficits, and reduced quality of life. They occur in up to 70% of cancer patients, with the vertebral column being the most common osseous site for metastatic disease^1-3. An approximate 10% of patients with vertebral body metastases eventually develop spinal cord compression, which can potentially cause severe and permanent disability^4-6. This article aims to summarize the consensus statements developed by the World Federation of Neurosurgical Societies (WFNS) Spine Committee on the clinical evaluation, diagnosis, and decision-making for metastatic spine tumors.

Methods: A systematic literature search was conducted in PubMed and Google Scholar from 2014 to 2023 using the search terms "clinical evaluation" + "spine metastases," "spine metastases" + "diagnosis," and "spine metastases" + "decision making" + "treatment." Based on the review of this literature, six members of the WFNS Spine Committee developed five consensus statements using the Delphi method, which were voted on during two rounds of voting at two international meetings.

Results: We agree that a high index of suspicion is required for early detection and diagnosis of spinal metastasis in cancer patients and adult patients more than 60 years presenting with new onset fractures / neurological deficits. Pain is the most common symptom followed by motor deficit. Bowel and bladder dysfunction is noted in nearly half of patients with metastatic spinal cord compression. An effective treatment for spinal metastases should be able to achieve pain relief, tumor control, prevention of neurological compromise and treat instability. Separation surgery combined with SRS is an effective treatment for spinal metastases.

Conclusion: These consensus statements provide evidence-based guidelines for clinical evaluation, diagnosis, and decision-making in patients with metastatic spine tumors.