In most clinical situations the tumor can be addressed either by the anterior or the posterior approach.
The use of a 360 approach is reserved for a limited amount of cases. Uncritical use of a 360 approach may unnecessarily increase the risk of complications.
The choice of where to start (anterior or posterior) will depend on the individual case.
When resection of anterior and posterior columns is required in the surgical management of metastatic spine disease, bilateral posterior pedicle screw fixation above and below the anterior construct should be used.
The anterior surgery provides direct access to release pressure and to reconstruct the anterior column.
However, some surgeons may prefer to start posteriorly as it is possible to perform a multilevel fixation. When the spine is stabilized, the anterior decompression will be easier.
For details on the procedures, please refer to the anterior and posterior procedures separately.