In summary, this report offers several recommendations for reasonable care in treating patients with neoplastic vertebral fractures. Medical management is appropriate to consider for all neoplastic vertebral fractures. Patients with neurological deficits, severe stenosis, instability, and high levels of mechanical pain should be considered for surgery. Radiation therapy should always be considered and is particularly appropriate for a radiosensitive tumor. Cement augmentation is considered most often in the absence of stenosis or neurologic changes, stable fractures with <80% height loss and intact posterior wall, and high VAS pain scores.

Additionally, in circumstances where reconstructive surgery may be preferred for structural reasons but contraindicated due to comorbidities, cement augmentation for pain relief can be considered with detailed attention to precision imaging and meticulous, controlled cement delivery. Finally, these criteria are developed as individual treatment ratings, though in practice, combination therapy is often preferred. Therefore, multidisciplinary discussions and planning are essential to promote the best clinical outcome for patients with metastatic neoplastic spine fractures.