SPINE METASTASES (NYC)

Multidisciplinary Spine Oncology • Surgical Decompression • Stabilization • Precision Planning

Overview

Spine metastases occur when cancer spreads to the bones of the spine or the epidural space surrounding the spinal cord. They are the most common malignant lesions of the spine and can cause severe pain, spinal instability, neurological compromise, and spinal cord compression.

As a neurosurgical oncologist at Lenox Hill Hospital and Director of Northwell Health’s Brain & Spine Metastasis Program, Dr. Randy S. D’Amico provides advanced evaluation and surgical management of metastatic spinal disease. He specializes in treating patients with progressive neurological symptoms, unstable spinal segments, refractory pain, and metastatic epidural spinal cord compression (MESCC).

Dr. D’Amico works closely with medical oncology, radiation oncology, and interventional pain specialists to deliver coordinated, rapid, and individualized care for patients across New York City and the tri-state area.

When Surgery Helps

Surgery for spine metastases is typically considered when:

  • There is significant spinal cord compression

  • Neurological symptoms are progressing (weakness, numbness, loss of coordination)

  • There is spinal instability or vertebral collapse

  • A patient has severe mechanical pain not relieved by radiation

  • A tissue diagnosis is needed and biopsy is not feasible

  • Tumors are resistant to radiation or systemic therapy

  • There is failure of prior radiation (“post-radiation progression”)

  • Rapid intervention is needed to preserve mobility or neurologic function

Many patients who are told “nothing more can be done” actually benefit from decompression and stabilization, especially when treated by a team experienced in metastatic spine disease.

Symptoms of Spine Metastases

Symptoms vary depending on the level and extent of disease:

  • Severe or worsening back pain

  • Pain that radiates to arms or legs

  • Pain worse at night or when lying flat

  • Weakness or difficulty walking

  • Numbness or tingling

  • Loss of balance or coordination

  • Difficulty controlling bladder or bowel function (urgent evaluation)

Any sign of spinal cord compression requires immediate assessment.

Diagnosis & Evaluation

Evaluation typically includes:

  • MRI of the spine (thoracic, lumbar, cervical as needed)

  • CT imaging for bone detail

  • Whole-body staging (PET/CT)

  • Assessment of mechanical stability

  • Tumor histology and molecular profile

  • Coordination with oncology for systemic treatment options

Tools like the SINS score (Spinal Instability Neoplastic Score) guide decisions regarding the need for stabilization.

Surgical Approach

Decompression of the Spinal Cord

Surgery removes tumor burden from the spinal canal to relieve pressure on the nerves or spinal cord. This is critical when patients have weakness or symptoms of MESCC.

Stabilization & Reconstruction

If the tumor has weakened the spine, instrumentation may be needed, including:

  • Screws and rods

  • Vertebral body replacement or cement augmentation

  • Minimally invasive stabilization techniques

The goal is to restore alignment, prevent further collapse, and reduce pain.

Minimally Invasive Options

Depending on tumor location and stability, minimally invasive approaches can reduce recovery time:

  • Percutaneous screw fixation

  • Minimally invasive decompression

  • Kyphoplasty/vertebroplasty

Coordination with Radiation Therapy

Surgery is often followed by stereotactic body radiotherapy (SBRT) to control residual tumor.
Close collaboration ensures optimal timing and sequencing.

Integrated Care for Complex Cases

Spine metastases require collaboration with multiple specialists. Dr. D’Amico works closely with:

  • Medical oncology

  • Radiation oncology (SBRT, IMRT)

  • Interventional radiology

  • Palliative care / symptom management teams

  • Neuro-rehabilitation

This multidisciplinary model ensures each patient receives the right combination of surgery, radiation, and systemic therapy.

Second Opinions

Dr. D’Amico frequently evaluates patients for:

  • Tumors causing spinal cord compression

  • Pain not improving after radiation

  • Imaging uncertainty (fracture vs tumor)

  • Progressive or recurrent metastatic disease

  • Clarification of whether surgery, radiation, or both are beneficial

  • Prior statements that “surgery is not an option”

Second opinions are often available quickly, especially when neurological symptoms are worsening.

Serving New York City & the Tri-State Area

Patients with spine metastases are cared for at Lenox Hill Hospital on the Upper East Side (100 E 77th St, New York, NY 10075), with access for individuals from:

  • Manhattan

  • Brooklyn

  • Queens

  • The Bronx

  • Long Island

  • Westchester

  • Northern New Jersey

Urgent appointments are available for patients with new or progressive neurological symptoms.

Next Steps

If you or a loved one has been diagnosed with spine metastases:

  • Request a Consultation

  • Seek a Second Opinion

  • Refer a Patient

  • Return to Conditions Treated for additional information