Are you routinely offering spine separation surgery followed by SBRT/SRS for spine oligometastatic lesions abutting the cord?  

I do not offer separation surgery. I view it as an extension of decompressive surgery by surgically creating a gap that may allow the radiosurgery to the epidural lesion. It sounds good but, in fact, this adds a significant surgical invasiveness with anesthesia in order to perform the non-invasive r...

We routinely offer SBRT to patients post separation surgery using the NOMS framework: radioresistant histologies (including local failure after prior RT) and favorable prognosis. We will offer post op SRS in the setting of no prior RT and minimal cord abutment, and hypofractionated SBRT in the case ...