3.1.1. Palliative Surgery (Stabilization with or without Partial Tumor Resection)

Osteolytic BMs from DTC easily cause SREs, especially in the spine and lower limb bones, which require weight bearing in daily activities [12]. Palliative surgery is mainly indicated in the presence of pathological or impending fracture risk and spinal cord compression with or without vertebral fracture [2]. In palliative surgery, reconstruction or fixation of the diseased lesion is the main procedure, and spinal cord decompression with partial resection of the tumor is also applied to the spinal lesion.

To aid clinicians in the diagnosis of neoplastic instability, an 18-point Spinal Instability Neoplastic Score (SINS) [39] for spinal lesions and a 12-point Mirels score [40] for upper and lower extremity lesions have recently been the most widely-used systems. The SINS system for the spine includes six parameters: location, pain, alignment, osteolysis, vertebral body collapse, and posterior element involvement. A high score, from 13 to 18, indicates the need for surgical stabilization to restore spinal stability from the affected lesion. The Mirels system for the extremities includes four parameters: location, pain, osteolysis, and tumor size. A high score, from 9 to 12, indicates the need for surgical intervention. These criteria have been shown to be valid, reliable, and reproducible [41,42].
