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With increase in the elderly population and improved survival among patients with malignancies, the rates of patients presenting with metastatic involvement of the spine is on the rise. Surgical management of spinal metastasis requires a multidisciplinary approach and surgery is a key component of multimodality management of metastatic spinal lesions. A PubMed search of relevant articles was performed and a narrative review of available pertinent literature in English language is presented.

The goal of treatment in patients with spinal metastasis is palliation, that is, to improve the quality of remaining life as judged by alleviation of pain, preservation or restoration of neurology, and improvement in function. Local control of the spinal metastasis not only influences the overall survival of a cancer patient but is vital to maintain treatment benefits for the duration of the patient`s survival. However, cancer therapy––both surgical and nonsurgical––carries a significant risk of complications, morbidity, and even mortality. Decision-making regarding the most appropriate treatment strategy is vital when treating terminally ill patients with spinal metastatic disease.

Degenerative spondylolisthesis is one of the commonest spinal pathologies encountered in the aging population. The clinical presentation of degenerative spondylolisthesis can be highly variable, and a large proportion of patients can be managed non-operatively. Operative treatment is reserved for patients with activity limiting disability. Decompression alone can be offered to patients with no radiological or clinical evidence of segmental instability. Fusion procedures have shown high rates of clinical success, although long-term effects such as adjacent segment degeneration have spurred the evolution of non-fusion technologies. These newer options have shown evidence of motion preservation, although long-term clinical benefits have yet to be confirmed.

Purpose: The purpose of the study was to determine the rate and predictors of return to work (RTW) after surgery for cervical spondylotic myelopathy (CSM). Overview of Literature: RTW is arguably the most important outcome following spine surgery from a patient’s perspective. But, to the best of our knowledge, there have been no reports in the English literature describing RTW among patients undergoing surgery for moderate-to-severe CSM. Materials and Methods: We included adult patients with CSM with Nurick grade ≥ 3 who underwent surgery. They were divided into two groups: those who returned to work within 6 months (group 1) and those who did not (group 2) and their outcomes were analyzed. Results: A total of 34 patients were included in the study. Baseline characteristics were comparable between the groups. Only 18 (52.9%) patients returned to work by 6 months. The nature of work had a statistically significant association with RTW by 6 months (P = 0.005) with failure to RTW specifically seen in manual laborers. Age, body mass index, symptom duration, pre-operative absenteeism, smoking, diabetes mellitus, number of levels operated, surgical approach, and post-operative complications did not have significant association with RTW. Better functional outcomes were seen in patients who returned to work as calculated using Nurick grade (P = 0.000) and modified Japanese Orthopedic Association score (P = 0.001). All the patients who returned to work and 75% of the patients who did not RTW were satisfied with the outcome of surgery (P = 0.039). Conclusion: In spite of functional improvement, CSM was associated with poor RTW with manual laborers being the most vulnerable group. This study will help surgeons modulate patient expectations as well as provide a platform for counseling them.