Do you take any special precautions when treating cervical spine metastases?

For each spine met case, it's important to determine whether it's a surgical or radiotherapy case. Spinal instability neoplastic score (SINS) and Bilsky grade (epidural cord compression) are two important parameters to consider. If SINS is 6 or below and if Bilsky grade is 1c or below, surgical intervention is usually not needed, and primary RT or SBRT is appropriate regardless of the region of the spine (C vs T vs LS) though the location of the metastasis affects the SINS. If SBRT is offered to a cervical spine lesion, the brachial plexus dose has to be constrained. Whenever there is any indication that there is mechanical instability (increased pain with flexion/extension of the spine) or neuro deficits, a spinal surgical consult is neede...