Cancer spreading to the spine is a very serious and concerning problem. Over 95% of the time, the cancer starts
elsewhere and then spreads to the spine as it spreads all over the rest of the body (metastatic cancer,
metastasis). While seemingly uncommon, many patients are noted to have evidence of cancer spreading to the
spine of the time of death on autopsy. The question of whether or not this cancer spreading to the spine will
cause problems for the patient during his/her remaining time is difficult to determine. If the patient presents
to the spine surgeon with evidence and/or symptoms of cancer involving the bones of the spine, a difficult and
daunting decision-making process must be undertaken to determine the best course of treatment for this particular
patient. It is important for the surgeon to balance the quality of life with the quantity of remaining life the
patient may have.
The first question of the surgeon asks whenever confronted with a patient with metastatic disease to the spine
is, 'How much expected time does the patient has left?'. In other words, what is the patient's expected length
of survival with the cancerous illness? Since this is a cancer that has spread to the spine and presumably over
the body, these patients generally have a limited life span with a poor prognosis onn the order of weeks/months.
If the patient has less than 3 months remaining in his/her life by all reasonable predictions, then he/she will
likely not be able to recover from any significant spine surgical procedure and thus the management team usually
focuses on ensuring a high quality of life for the weeks/months the patient has left in his/her life.
The second question that face is a surgeon when encountering a patient with metastatic cancer to the spine is,
'What type of cancer is it'? Certain cancers are much more susceptible to chemotherapy and radiation than others.
For example, myeloma and lymphoma are much more sensitive to chemotherapy and radiation than other cancers and
this may not even require surgery even though there is extensive disease throughout the course of the spine. On
the other hand, there are certain cancers that are extremely resistant to chemotherapy and radiation therapy.
These cancers are thus more likely to require surgical treatment. In conjuction with a good oncology treatment
team and spine surgeon, the correct treatment decisions can be made by the patient prior to embarking on a
The third question at a surgeon asks prior to considering surgical intervention for a patient with metastatic
disease to the spine is, 'Does the patient have any serious neurological problems from compression of his/her
spinal cord/nerves'? If the patient has any neurological deficits / limitations as a result of the cancer in the
spine, such as trouble walking, bowel problems, or bladder problems, the surgeon and patient may be feel that the
patient's quality of life so poor that surgical intervention with high coplexity and prolonged recovery time may
be considered even with a limited remaining amount of time to live.
The decision making process behind how to treat a patient with metastatic disease to the spine is one of the most
difficult in medicine. It requires multiple physicians & teams working together to decide what is the best for the
patient and his/her family. Sometimes it is more important to maximize the quality of life the patient has remaining
rather than performing a large surgery to add a few more days/weeks to the patient's life span as these days / weeks
maybe of poor quality. However, sometimes patients prefer a higher quality of life rather than a longer length of
life, especially if that length of remaining life involves not being able to walk or control their bodily functions.
If there any specific situations or questions, please consult your fellowship trained board certified orthopedic
Mir H. Ali, MD,PhD
Director - Deerpath Spine Institute
Orthopedic Spine Surgeon - Rezin Orthopedics & Sports Medicine
Dr. Ali is a board certified orthopedic spine surgeon trained in the diagnosis as well as the treatment of
non-operative and operative spinal disorders. Dr. Ali practices in the far western and southwestern
suburbs of Chicago and utilizes surgery as a last resort when all other non-operative treatments have
failed to relieve pain and/or reduce risk of nerve damage/injury. All recommendations on this site are for
general situations and a particular situation requires evaluation before specific treatment recommendations
can be made.