This 2009 JBJS current concepts review by Bickels et al. synthesizes the evaluation, indications, and operative techniques for surgical management of metastatic bone disease across long bones, acetabulum, and spine — asking when to operate, how to select patients, and what reconstruction strategy best matches the anatomical site and prognosis.
When evaluating a long-bone metastasis, apply the Mirels score immediately: a peritrochanteric, lytic lesion involving >2/3 of cortical width with functional pain scores 9+ points and warrants prophylactic nailing before fracture occurs.
For any patient with spinal metastasis and neurological deficit, the Patchell data support direct decompressive surgery plus radiation over radiation alone — provided performance status and life expectancy (≥3 months) allow it.
This 2009 JBJS current concepts review by Bickels et al. synthesizes the evaluation, indications, and operative techniques for surgical management of metastatic bone disease across long bones, acetabulum, and spine — asking when to operate, how to select patients, and what reconstruction strategy best matches the anatomical site and prognosis.
When evaluating a long-bone metastasis, apply the Mirels score immediately: a peritrochanteric, lytic lesion involving >2/3 of cortical width with functional pain scores 9+ points and warrants prophylactic nailing before fracture occurs.
For any patient with spinal metastasis and neurological deficit, the Patchell data support direct decompressive surgery plus radiation over radiation alone — provided performance status and life expectancy (≥3 months) allow it.