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Object Opinions vary widely as to the role of surgery (from none to wide margin excision) in the management of spinal metastases. In this study the authors set out to ascertain if surgery improves the quality of remaining life in patients with spinal metastatic and tumor-related systemic disease. Methods The authors included 223 patients in this study who were referred by oncologists and physicians over a 2-year period. All underwent surgery. Surgery was classified according to extent of excision ranging from en bloc excision or debulking to palliative surgery. All patients had a histologically confirmed diagnosis of epithelial spinal metastasis, and an oncology specialist undertook appropriately indicated adjuvant therapy in almost half of the patients. Results The mean patient age was 61 years. Excisional en bloc or debulking surgery was performed in 74%; the rest had (minimal) palliative decompression. All patients considered for surgery were included in the study. Patients presented with pain in 92% of cases, paraparesis in 24%, and abnormal urinary sphincter function in 22% (5% were incontinent). Breast, renal, lung, and prostate accounted for 65% of the cancers, and in 60% of patients there were widespread spinal metastases (Tomita Type 6 or 7). The incidence of perioperative death (within 30 days of surgery) was 5.8%. Postoperatively 71% of the entire group had improved pain control, 53% regained or maintained their independent mobility, and 39% regained urinary sphincter function. The median survival for the cohort was 352 days (11.7 months); those who underwent excision survived significantly longer than those in the palliative group (p = 0.003). As with survival results, functional improvement outcome was better in those who underwent excision. Conclusions Surgical treatment was effective in improving quality of life by providing better pain control, enabling patients to regain or maintain mobility, and offering improved sphincter control. Although not a treatment of the systemic cancer, surgery is feasible, has acceptably low mortality and morbidity rates, and for many will improve the quality of their remaining life.

Choosing the right operation for metastatic spinal tumours is often difficult, and depends on many factors, including life expectancy and the balance of the risk of surgery against the likelihood of improving quality of life. Several prognostic scores have been devised to help the clinician decide the most appropriate course of action, but there still remains controversy over how to choose the best option; more often the decision is influenced by habit, belief and subjective experience. The purpose of this article is to review the present systems available for classifying spinal metastases, how these classifications can be used to help surgical planning, discuss surgical outcomes, and make suggestions for future research. It is important for spinal surgeons to reach a consensus regarding the classification of spinal metastases and surgical strategies. The authors of this article constitute the Global Spine Tumour Study Group: an international group of spinal surgeons who are dedicated to studying the techniques and outcomes of surgery for spinal tumours, to build on the existing evidence base for the surgical treatment of spinal tumours.

IntroductionThe treatment of most spinal diseases is a difficult task because of the rate of immediate, mid-and long-term complications and failures [16]. Surgical planning and clinical follow up often rely on postural and/or dynamic X-ray exams, among other imaging options.Many authors investigated the radiological parameters liable to rule patient's evolution, such as postural and balance parameters [2,4,8,9,11,12,26]. These parameters might be classified in pelvic parameters, either morphologic (incidence) or positional (sacral slope [4,11,12], pelvic angle [8,9]), and spinal parameters (such as lordosis, kyphosis [4,11,12] or plumblines [8,9]). Their measurement is tedious and time consuming while the accuracy of the results may be highly variable depending on the method employed. Furthermore, when trying to compare the results between studies, a major difficulty comes from the differences in the definition, identification and measurement of parameters.Recent computer-based tools allowed for a rapid progress in quantitative measurements of a large range of parameters [9,17,19,20,23,26]. Moreover, these tools allow easy standardisation of X-ray films measurements, which is of paramount importance when comparing studies in multicentric analysis. However, validation of these tools is essential [3,17,18].In 1999, the team of LBM and LIO developed an Xray films analysis software (SpineView 1.0) allowing for the measurement of the main lumbar dynamic and sagittal postural parameters of the spine. The evaluation of this first software was achieved by comparison with direct measurements on plain X-ray films [17,18], and showed good reliability of the measurements. Abstract The objective of this study was to evaluate an X-ray films analysis software, i.e. to estimate the reliability and validity of clinical measurements by means of this software. The authors first performed tests of precision and reproducibility of measures. The precision for dynamic modules was estimated at ±2°for the lumbar analysis and ±3°for the cervical one. Mean reproducibility coefficients calculated for postural modules are about 4°for the angular parameters and 3 mm for the linear ones. We also evaluated clinical applicability of the software through its validity. Reference values calculated on a population of healthy subjects showed agreement with the literature. Then, when analysing postural X-ray films of severe scoliotic patients, we found that inter-observer reproducibility coefficients show a lower reliability of measurements; the main cause seems to be the low visibility of anatomic landmarks due to the quality of X-ray films and to the degree of deformity. This study allowed to better estimate the reliability and the usefulness of this tool, allowing for multicentric studies and exchanges.Keywords Spine AE X-ray AE Quantitative analysis AE Software AE Motion AE Balance Eur Spine J (2006) 15: 982-991