Types of surgery

• Vertebroplasty: Vertebroplasty involves injecting so-called "bone cement" into compressed vertebrae, which can increase the weight-bearing capacity of the vertebrae and the hardness of the bone. Spinal metastases often accompany pathological fractures that cause pain and are suitable for cases where physicians assess no spinal cord compression or when patients are not suitable for anesthesia or surgery due to physiological conditions.

• Palliative Surgery: Palliative surgery is divided into two parts: laminectomy and pedicle screw fixation. In the case of tumor metastasis, spinal cord compression mostly originates from the anterior vertebral bodies. By removing the posterior lamina, space can be created within the spinal canal, and stability can be restored with pedicle screw fixation. This surgical approach is less invasive for patients. However, since the tumor occupying the vertebral bodies is not removed, it is suitable for patients for whom other treatment modalities (such as chemotherapy or radiation therapy) are effective.

• Debulking Surgery: Intralesional corpectomy or debulking surgery involves removing portions of the vertebral body occupied by the tumor in addition to removing the pedicles and fixation with screws. The advantage of this surgery is that it significantly improves the local control rate of tumor metastasis. However, the disadvantage is that the surgery typically involves higher blood loss, especially when dealing with highly vascularized tumors such as papillary thyroid carcinoma, renal cell carcinoma, or hepatocellular carcinoma. Embolization therapy may be recommended before surgery to reduce intraoperative blood loss.

• Total Vertebrectomy: Total vertebrectomy involves the complete removal of the vertebral body and lamina, often involving adjacent intervertebral discs. This is a more aggressive surgical approach with higher relative risks but is considered the most ideal procedure for tumor control. In terms of post-vertebrectomy reconstruction, metal artificial vertebral bodies are used to support the spine, and in some cases, allograft bone implants may be added to achieve better fusion outcomes.