Strategies for Surgical Treatment and Outcomes in patients with Spinal Metastasis from Breast Cancer

At Complete Orthopedics, our team of spine surgeons and oncologic specialists provides comprehensive care for patients with spinal metastases. We focus on relieving pain, maintaining mobility, and improving quality of life through advanced surgical and non-surgical treatments.

Our clinics are located throughout New York City and Long Island, with affiliations at six leading hospitals that offer the most up-to-date imaging, surgical, and rehabilitation technologies.

How Common It Is and Who Gets It? (Epidemiology)

Breast cancer is the most common cancer in women and a leading cause of cancer-related death in North America and Europe. The spine is one of the most frequent sites where breast cancer spreads (metastasizes). Studies show that between 47% and 85% of women with metastatic breast cancer develop skeletal involvement, and nearly 70–80% have spinal metastases visible on imaging.

Roughly one-third of these cases produce symptoms such as pain, weakness, or loss of movement, requiring focused treatment—including, in some cases, surgery.

Why It Happens – Causes (Etiology and Pathophysiology)

Spinal metastasis occurs when breast cancer cells spread from the primary tumor to the bones of the spine. These cancer cells weaken bone structure and may compress nerves or the spinal cord, leading to pain and neurological problems.

The way these tumors grow depends on the type and sensitivity of the primary cancer. Some tumors respond well to radiation and chemotherapy, while others are more resistant and require surgical stabilization to prevent fractures or paralysis.

How the Body Part Normally Works? (Relevant Anatomy)

The spine is made up of 33 vertebrae, which protect the spinal cord and support body weight. The spinal cord carries signals between the brain and the body. Cancer cells that spread to the vertebrae can cause the bone to weaken and collapse, pressing on the spinal cord or nerves.

This can result in pain, loss of movement, and difficulty controlling bladder or bowel function. Surgery is often aimed at stabilizing the spine and relieving pressure on these critical structures.

What You Might Feel – Symptoms (Clinical Presentation)

Symptoms of spinal metastasis from breast cancer can vary depending on the location and extent of tumor involvement. Common symptoms include:

• Persistent back or neck pain that worsens with movement or at night
• Weakness or numbness in the arms or legs
• Loss of balance or difficulty walking
• Bladder or bowel changes
• Fatigue or unintentional weight loss

Any patient with a history of breast cancer who develops new or worsening back pain should seek prompt evaluation to rule out spinal involvement.

How Doctors Find the Problem? (Diagnosis and Imaging)

Diagnosis involves a combination of medical history, physical examination, and imaging tests. Common tools include:

• X-rays: May show bone destruction or collapse.
• MRI: Provides detailed images of soft tissues, nerves, and the spinal cord, showing tumor extent and compression.
• CT scans: Offer cross-sectional views of the bone to help plan surgery.
• Bone scans: Identify areas of increased bone activity caused by metastasis.
• Biopsy: A small sample of the lesion confirms the cancer type and guides treatment.

Classification

Spinal metastases can be classified based on the location, stability, and neurological involvement:

• Stable metastasis: Bone weakened but spine remains structurally intact.
• Unstable metastasis: Bone collapse or deformity threatens spinal cord function.
• Neurological compromise: Tumor compresses spinal cord or nerves, causing weakness or paralysis.

Doctors also consider the type of primary tumor, its response to treatments, and the overall health and life expectancy of the patient when classifying disease severity.

Other Problems That Can Feel Similar (Differential Diagnosis)

Conditions that may mimic spinal metastases include:

• Degenerative disc disease
• Spinal infections (osteomyelitis)
• Osteoporosis with compression fractures
• Benign bone tumors

Imaging and biopsy confirm whether the cause is cancer-related.

Treatment Options

Non-Surgical Care

Treatment for spinal metastasis from breast cancer typically begins with medical therapy and radiation.

• Medications: Pain relievers, steroids to reduce swelling, and bisphosphonates to strengthen bones and decrease pain.
• Chemotherapy or hormonal therapy: Used to control cancer growth systemically.
• Radiation therapy: Aimed at reducing tumor size and relieving pain.
• Stereotactic radiosurgery (SRS): A highly focused radiation technique that targets spinal metastases precisely while minimizing damage to nearby tissues.

Surgical Care

Surgery is considered when there is severe pain, spinal instability, or progressive neurological decline. The goal is not to cure the cancer but to preserve function and reduce pain.

Indications for surgery include:

• Worsening weakness or paralysis
• Severe, unrelenting pain not relieved by medications
• Structural instability or spinal deformity
• Tumors resistant to radiation or those that continue to grow despite therapy

Common surgical approaches:

• Decompression surgery: Removal of bone or tumor pressing on the spinal cord.
• Vertebrectomy and stabilization: Removing the affected vertebra and reconstructing the spine with rods, screws, or cages.
• Kyphoplasty or vertebroplasty: Minimally invasive procedures where bone cement is injected into the vertebra to stabilize fractures and relieve pain.

The choice of approach depends on tumor location, stability, and the patient’s overall health.

Recovery and What to Expect After Treatment

Recovery varies depending on the extent of disease and the surgical procedure performed.

In the hospital:

• Patients are monitored for neurological improvement, pain control, and wound healing.
• Physical and occupational therapy begin early to promote safe mobility.

At home:

• Rehabilitation continues to improve strength and function.
• Pain medication is adjusted as recovery progresses.
• Regular follow-up imaging ensures that the spine remains stable and no new lesions appear.

Possible Risks or Side Effects (Complications)

Potential surgical risks include:

• Infection or wound healing problems (especially in patients who had prior radiation)
• Bleeding during or after surgery
• Nerve injury or worsening neurological symptoms
• Hardware failure or need for revision surgery
• Blood clots, pneumonia, or other general surgical complications

Elderly patients or those with extensive disease may face higher complication risks, but careful planning helps minimize them.

Long-Term Outlook (Prognosis)

Outcomes depend on several factors, including tumor type, response to therapy, and overall health. Patients with breast cancer generally live longer than those with many other cancers, making aggressive treatment worthwhile in many cases.

Surgery, combined with radiation and systemic therapy, can provide lasting relief from pain and help preserve mobility and independence. Patients who undergo stabilization procedures often report a dramatic improvement in quality of life.

Out-of-Pocket Costs for Spinal Metastasis from Breast Cancer

Medicare

CPT Code 63307 – Decompression for spinal cord tumor (thoracic spine): $606.25
CPT Code 63085 – Vertebrectomy with decompression and reconstruction (thoracic spine): $472.59
CPT Code 22842 – Posterior instrumentation (3–6 segments): $185.26
CPT Code 22513 – Kyphoplasty (thoracic vertebra): $1,249.27
CPT Code 22514 – Kyphoplasty (lumbar vertebra): $1,243.52
CPT Code 22510 – Vertebroplasty (thoracic vertebra): $98.59
CPT Code 22511 – Vertebroplasty (lumbar vertebra): $400.74

For Medicare beneficiaries, the program generally covers 80% of approved surgical and hospital costs once the deductible has been satisfied. The patient is responsible for the remaining 20%. Supplemental insurance, such as Medigap, AARP, or Blue Cross Blue Shield, is designed to cover this coinsurance amount, significantly reducing or often eliminating any out-of-pocket expenses for approved procedures. These plans coordinate with Medicare so that patients are typically not billed beyond the deductible when coverage is in place.

If you have secondary insurance such as an Employer-Based Plan, TRICARE, or Veterans Health Administration (VHA), it serves as the secondary payer after Medicare processes the claim. After meeting the Medicare deductible, these plans can pay any remaining balance, including coinsurance or non-covered services. Secondary plans usually carry a small deductible ranging from $100 to $300, depending on the policy and whether the treating facility is within network.

Workers’ Compensation
If spinal metastasis treatment is required as part of a work-related cancer diagnosis or a condition that arose due to occupational exposure, Workers’ Compensation will pay for all surgical and medical costs related to decompression, reconstruction, vertebroplasty, or kyphoplasty. Patients will not have any out-of-pocket expenses when the condition is recognized as work-related.

No-Fault Insurance
If spinal metastasis care is needed following an automobile accident that exacerbated existing cancer-related spinal injury, No-Fault Insurance will cover all necessary diagnostic and surgical procedures. This includes decompression, vertebral reconstruction, or stabilization procedures. The only potential patient cost is a small deductible depending on the individual’s policy.

Example
Margaret, a 64-year-old patient with metastatic breast cancer, developed spinal cord compression in the thoracic region requiring decompression (CPT 63307) and stabilization with posterior instrumentation (CPT 22842). Her estimated Medicare out-of-pocket cost was $606.25 and $185.26 respectively. Because she had a supplemental Medigap policy, the remaining 20% coinsurance was fully covered, resulting in no out-of-pocket expenses for her spinal surgery.

Frequently Asked Questions (FAQ)

Q. Is spinal surgery for metastasis curative?
A. No. Surgery is palliative—it relieves symptoms and stabilizes the spine but does not cure the cancer.

Q. Can surgery help with pain?
A. Yes. Surgery can significantly reduce pain by stabilizing the spine and relieving nerve pressure.

Q. How long will recovery take?
A. Most patients stay in the hospital for a few days to a week. Full recovery and rehabilitation may take several weeks to months.

Q. Will I need more treatment after surgery?
A. Yes. Most patients continue systemic treatments such as chemotherapy, hormonal therapy, or radiation to control cancer.

Summary and Takeaway

Spinal metastasis from breast cancer is a serious but manageable condition. Treatment focuses on pain relief, preserving mobility, and improving quality of life. Surgery may be recommended when tumors cause spinal instability or neurological symptoms.

Through a multidisciplinary approach—including surgery, radiation, and systemic therapy—patients can achieve significant pain relief, better mobility, and improved daily function.

Clinical Insight & Recent Findings

A recent retrospective study analyzed 78 patients with spinal metastases from breast cancer who underwent surgery and multidisciplinary treatment to identify factors influencing survival outcomes. The average overall survival was 50 months, with one-, three-, and five-year survival rates of 92.3%, 69.4%, and 47%, respectively.

Surgery significantly improved pain and neurological function, and patients with better preoperative neurological status showed longer survival. Endocrine therapy emerged as an independent protective factor, particularly in hormone receptor–positive cases, while HER2 positivity and Ki-67 levels showed no significant survival impact. Total en-bloc spondylectomy did not improve survival compared with less invasive procedures but was associated with greater blood loss and surgical risk.

These findings highlight that limited but well-planned tumor excision, combined with endocrine therapy and radiotherapy, can optimize outcomes and preserve quality of life for breast cancer patients with spinal metastases. (Study on survival outcomes and surgical strategies for spinal metastases from breast cancer – See PubMed.)

Who Performs This Treatment? (Specialists and Team Involved)

Treatment involves a multidisciplinary team including orthopedic spine surgeons, neurosurgeons, oncologists, radiation therapists, and rehabilitation specialists. Each plays a vital role in ensuring safe surgery, effective pain relief, and optimal recovery.

When to See a Specialist?

You should see a spine specialist if you have a history of breast cancer and experience:

• Persistent or worsening back or neck pain
• Numbness, weakness, or balance problems
• Pain not responding to medication or radiation

Early evaluation helps prevent permanent spinal cord damage.

When to Go to the Emergency Room?

Seek emergency care if you develop:

• Sudden paralysis or inability to walk
• Loss of bladder or bowel control
• Severe, escalating back pain unrelieved by rest or medication

These symptoms may indicate spinal cord compression requiring immediate attention.

What Recovery Really Looks Like?

Most patients notice pain relief soon after surgery. Strength and mobility gradually return with physical therapy. Rehabilitation focuses on independence and maintaining strength for daily tasks. Emotional and psychological support is also an important part of long-term recovery.

What Happens If You Ignore It?

Untreated spinal metastasis can lead to severe pain, paralysis, and loss of independence. Spinal fractures and nerve compression can cause permanent disability. Early treatment prevents these complications and improves comfort and function.

How to Prevent It?

While spinal metastasis itself cannot be fully prevented, early detection of breast cancer and consistent follow-up care significantly reduce the risk of spread. Maintaining overall bone health through medication and exercise can also lower fracture risk.

Nutrition and Bone or Joint Health

A balanced diet rich in calcium, vitamin D, and protein helps maintain strong bones. Some patients benefit from bisphosphonates or denosumab, medications that help prevent bone loss from cancer. Staying hydrated and avoiding smoking and alcohol supports overall health.

Activity and Lifestyle Modifications

After treatment, gentle physical activity helps preserve mobility and strength. Low-impact exercises such as walking or swimming can improve endurance and quality of life. Avoiding heavy lifting and using proper posture reduces strain on the spine. Emotional well-being is also vital—support groups and counseling can be beneficial during recovery.