Advanced lung cancer: aggressive surgical therapy vertebral body involvement.

The NOMS considerations provide a dynamic decision framework to determine the optimal combination of systemic and radiation therapies and surgery. Generally, NSCLC metastases to the spine require SRS because cEBRT usually fails to provide consistent long-term local control. Patients with spinal cord compression secondary to NSCLC require surgical decompression to safely undergo SRS and to reduce the risk of radiation-induced spinal cord injury. Separation surgery allows spinal cord decompression and spinal stabilization using the posterior approach and, in combination with SRS, has been shown to provide reliable local control with low risk of wound complication or spinal hardware fracture.