Skeletal Radiology

, Volume 48, Issue 2, pp 195–207 | Cite as

Instability and impending instability in patients with vertebral metastatic disease

  • Antonio LeoneEmail author
  • Alessandro Cianfoni
  • Viola Zecchi
  • Maria Cristina Cortese
  • Nicolò Rumi
  • Cesare Colosimo
Review Article


Metastatic disease commonly involves the spine with an increasing incidence due to a worldwide rise of cancer incidence and a longer survival of patients with osseous metastases. Metastases compromise the mechanical integrity of the vertebra and make it susceptible to fracture. Patients with pathological vertebral fracture often become symptomatic, with mechanical pain generally due to intervertebral instability, and may develop spinal cord compression and neurological deficits. Advances in imaging, radiotherapy, as well as in spinal surgery techniques, have allowed the evolution from conventional palliative external beam radiotherapy to modern stereotactic radiosurgery and from traditional open surgery to less-invasive, and sometimes prophylactic stabilization surgical treatments. It is therefore clear that fracture risk prediction, and maintenance or restoration of intervertebral stability, are important objectives in the management of these patients. Correlation between imaging findings and clinical manifestations is crucial, and a common knowledge base for treatment team members rather than a compartmentalized view is very important. This article reviews the literature on the imaging and clinical diagnosis of intervertebral instability and impending instability in the setting of spine metastatic disease, including the spinal instability neoplastic score, which is a reliable tool for diagnosing unstable or potentially unstable metastatic spinal lesions, and on the different elements considered for treatment.


Spine Spine, instability Spine, metastases Spine, stabilization Spine imaging 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© ISS 2018

Authors and Affiliations

  • Antonio Leone
    • 1
    Email author
  • Alessandro Cianfoni
    • 2
    • 3
  • Viola Zecchi
    • 1
  • Maria Cristina Cortese
    • 1
  • Nicolò Rumi
    • 1
  • Cesare Colosimo
    • 1
  1. 1.Institute of Radiology, Catholic University, School of Medicine, Fondazione Policlinico Universitario A. GemelliRomeItaly
  2. 2.Department of NeuroradiologyNeurocenter of Southern SwitzerlandLuganoSwitzerland
  3. 3.Department of Neuroradiology, InselspitalBern University Hospital, University of BernBernSwitzerland

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