In spinal metastases, accurate classification and preoperative assessment are crucial for determining the most effective treatment approach. Various classification systems are available, each with a specific focus, such as tumor spread, spinal stability, or neurological involvement. For instance, anatomical classifications like the systems developed by Enneking and Boriani primarily categorize tumors based on their spinal location, aiding in the planning of surgical procedures. However, these systems have limitations, especially for cases requiring palliative care rather than curative surgery.

To address spinal instability in metastatic disease, systems like Harrington`s and the Spinal Instability Neoplastic Score (SINS) are commonly used. SINS evaluates factors such as lesion location and radiological features to provide a comprehensive instability assessment, guiding treatment decisions. Prognostic systems, such as Tokuhashi and Tomita, consider factors beyond local tumor characteristics, including the patient`s overall health and metastasis extent, to predict survival and guide therapeutic options.

Since spinal metastases vary greatly in presentation, a single, universal classification system is impractical. Therefore, a multidisciplinary approach, incorporating the advantages of each classification system, helps create individualized treatment plans, enhancing patient outcomes and accurately predicting survival.