Commentary: A new era in the management of spinal metastasis

Introduction In spinal tumor metastases the gold standard treatment is surgery, followed by chemo and radioterpy (1). Surgery remains the fulcrum of the therapy, especially in cases with spine instability and spinal cord involvement. In literature, the debate regarding the feasibility of the decompressive treatment and its optimal timing for surgery is still open and it is very difficult to determine the optimal surgical timing in patients with vertebral metastases starting with a neurological deficit (2). We strongly believe that surgery timing is an important prognostic factor for the clinical outcome in patients treated for spinal metastases with acute neurological deficit. As reported in our study regarding the cervical spinal cord injury (3) the surgical timing is relevant also for the spinal compression in vertebral metastases. In our previous study we considered 81 patients with traumatic cervical spinal cord injury operated before and after 12 hours. Forty seven of 81 (58%) patients exhibited improved neurological function and 72.% of them was treated <12 hours after the injury. This ultra-early surgical timing in this type of patients was also associated with significantly greater neurological improvemen