AO Spine Clinical Practice Recommendations: An Overview of the Current State of Fusion Surgery for Patients With Spinal Metastasis: Is Fusion Necessary?

Study Design: Literature review with clinical recommendations. Objective: Providing a clear and concise overview based on the of key literature and consensus expert opinion on spinal fusion following stabilization for spine metastases and offer actionable recommendations on when to fuse and not fuse in this patient population. Methods: Key articles from the published literature on spinal metastases treated with stabilization followed by fusion were reviewed, and clinical recommendations were formulated. The recommendations are categorized as either strong or conditional based on an assessment of methodological quality and expert opinion. This assessment considers factors such as experience, risks, burdens, costs, patient values, and circumstances. Results: Four articles were selected by practicing spinal oncology surgeons and each was evaluated for its methodological strength and its scientific evidence. Conclusion: Fusion rarely influences clinical outcomes in metastatic spine surgery. Treatment should prioritize mechanical stability, pain control, functional preservation, and timely continuation of oncologic therapy rather than pursuing bony arthrodesis. Fusion should be considered exclusively in select long-surviving patients, however routine attempts to enhance fusion or delay adjuvant therapy are not justified.