Surgical strategy for spinal metastases

Primary tumor

1 point: slow growth (e.g. breast, prostate, thyroid)

2 points: moderate growth (e.g. kidney, uterus)

4 points: rapid growth (e.g. lung, liver, stomach, colon, primary unknown)

Visceral metastases

0 points: no visceral metastases

2 points: treatable

4 points: untreatable

Bone metastases (including spine)

1 point: solitary / isolated

2 points: multipe

Note: scores for each group are derived from the hazard ratio by rounding off to the nearest integer. Treatment goal & Surgical strategy

2 - 3 points: long-term local control (mean survival 50 months) ⇒ wide or marginal excision

4 - 5 points: middle-term local control (mean survival 23,5 months) ⇒ marginal or intralesional excision

6 - 7 points: short-term palliation (mean survival 15 months) ⇒ palliative surgery

8 - 10 points: terminal care (mean survival 6 months) ⇒ supportive care, no surgery ¹⁾.