Multidisciplinary Approach to Spinal Metastases and Metastatic Spinal Cord Compression—A New Integrative Flowchart for Patient Management

SIMPLE SUMMARY: The prevalence of metastatic spine disease is progressively increasing, affecting a growing group of heterogeneous and complex patients. A multidisciplinary, personalized approach, enriched by the expertise of each involved specialty (namely oncologists, radiotherapists, neurosurgeons, orthopedic surgeons, hematologists, and neuroradiologists), is pivotal and achieves superior results in terms of clinical outcomes. We reviewed the most recent data regarding the pathophysiology of metastatic spine disease, prognostic scores, and available treatment options and formulated a proposal for an updated algorithmic approach to the pathology according to the clinical scenario of each patient. A flowchart-based approach to patients offers an evidence-based management of metastatic spine disease, providing a valuable clinical decision tool in a context of high uncertainty and quick-acting need. Nevertheless, we underline that the goal of this type of approach is to assist in clinical decisions, not to replace a case-by-case reflection concerning the specificities of each patient. ABSTRACT: Metastatic spine disease (MSD) and metastatic spinal cord compression (MSCC) are major causes of permanent neurological damage and long-term disability for cancer patients. The development of MSD is pathophysiologically framed by a cooperative interaction between general mechanisms of bone growth and specific mechanisms of spinal metastases (SM) expansion. SM most commonly affects the thoracic spine, even though multiple segments may be affected concomitantly. The great majority of SM are extradural, while intradural-extramedullary and intramedullary metastases are less frequently seen. The management of patients with SM is particularly complex and challenging, with multiple factors—such as the spinal stability status, primary tumor radio and chemosensitivity, cancer biological burden, patient performance status and comorbidities, and patient’s oncological prognosis—influencing the clinical decision-making process. Different frameworks were developed in order to systematize and support this process. A multidisciplinary, personalized approach, enriched by the expertise of each involved specialty, is crucial. We reviewed the most recent evidence and proposed an updated algorithmic approach to patients with MSD according to the clinical scenario of each patient. A flowchart-based approach offers an evidence-based management of MSD, providing a valuable clinical decision tool in a context of high uncertainty and quick-acting need.