Contemporary management strategies for spinal metastases: diagnosis, multidisciplinary approaches, and outcomes – A narrative review

Background and Objective: Spinal metastases occur in 30-70% of cancer patients, with approximately 10-20% experiencing symptomatic manifestations including pain, instability, or neurological deficits. Nearly 20% of patients present with malignant spinal cord compression (MSCC) as their initial manifestation of malignancy. Our objectives were: To provide a comprehensive review of contemporary management strategies for spinal metastases, focusing on diagnostic approaches, multidisciplinary treatment frameworks, and surgical interventions that optimize patient functional outcomes and quality of life. Methods: SANRA-guided narrative review of PubMed, EMBASE, and Cochrane Library (2000-2025). Clinical trials, meta-analyses, consensus statements, and seminal papers were prioritised; purposive selection ensured broad thematic coverage. The analysis encompasses imaging techniques, surgical interventions, and decision-making frameworks including the NOMS (Neurologic, Oncologic, Mechanical, and Systemic) classification system. Results: Within the spinal column, metastases most commonly affect the thoracic region, followed by lumbar and cervical regions. Common primary tumors with high bone metastasis rates include breast (72%), prostate (84%), thyroid (50%), lung (31%), kidney (37%), and pancreas (33%), collectively accounting for more than 80% of spinal metastases cases. MRI demonstrates the advantage of detecting multilevel involvement without radiation exposure. Contemporary management employs a multidisciplinary approach incorporating chemotherapy, radiotherapy, and surgical interventions. Modern surgical approaches have evolved from historical laminectomy-only procedures to comprehensive decompression with stabilization techniques. Conclusions: Early recognition and prompt intervention remain critical for preventing irreversible neurological deficits and optimizing patient outcomes. Future improvements in molecular targeted therapies, imaging precision, and surgical techniques promise continued enhancement of treatment outcomes for patients with spinal metastases.