[Evolution and prospect of treatment decision-making systems for spinal metastases:from traditional frameworks to the era of precision medicine].

The treatment of spinal metastases is highly dependent on multidisciplinary collaboration. This study systematically reviews the evolution of clinical decision-making systems for spinal metastases, from traditional frameworks to the era of precision medicine. The neurologic, oncologic, mechanical, systemic(NOMS) framework, introduced in 2006, focused on surgical and radiotherapeutic interventions;however, it had notable deficiencies in its neurologic assessment grading and, in terms of oncologic management, largely overlooked the role of systemic therapy in achieving local control of bony metastatic lesions. The LMNOP (location, mechanical, neurologic, oncologic, patient) framework, proposed in 2011, attempted to explore individualized surgical approaches, but its accuracy in determining optimal strategies remained suboptimal, and it still fell short in adequately incorporating systemic therapeutic factors. In 2017, the International Spinal Oncology Consortium introduced the MNOP(mechanical, neurologic, oncologic, patient) system, which placed greater emphasis on patient survival assessment. In 2018, the Dutch guidelines standardized surgical timing and radiotherapy strategies, and in the same year, the MOSS (medical/mental, oncological, stenosis, stability) framework achieved innovations in systematic evaluation, non-surgical interventions, and the integration of psychological status. In 2021, the Department of Orthopedics at the Chinese PLA General Hospital proposed the SENO framework for spinal metastases, which encompasses four major elements:systemic conditions, effectiveness of systemic treatment of tumors, neurology, and oncology. Built upon the foundation of the ESCC Twelve-Point Grading System developed by the Chinese PLA General Hospital, the SENO framework has successfully established a novel precision comprehensive treatment model characterized by "minimally invasive intervention first, followed by systemic therapy". Clinical practice has demonstrated that the SENO framework offers significant advantages in therapeutic outcomes compared with traditional decision-making approaches. The continuous evolution of clinical decision-making systems for spinal metastases profoundly reflects the broader transformation of oncology from experience-based medicine to evidence-based medicine. Looking ahead, with the deep integration of artificial intelligence and multi-omics technologies, decision-making systems for spinal metastases are poised to advance toward a comprehensive, intelligent "prevention-intervention-rehabilitation" continuum, bringing new promise for improving patient prognosis.