Targeted therapy has greatly improved the outlook for patients with spinal metastatic cancers. Scoring systems like the Tokuhashi or Tomita scores are commonly used to predict prognosis and inform surgical decisions, but they are outdated and fail to consider recent advancements. We aimed to investigate the current state of the literature and treatment options pertaining to advancements in targeted therapy compared to other forms of medical management for metastatic spinal tumors. This study represents the first comprehensive systematic review that encompasses the most common primary cancers that metastasize to the spine and evaluates the median overall survival (mOS) across five different medical treatment modalities as well as surgical intervention. Additionally, our study analyzes the tumor receptor status in conjunction with these treatments. A PubMed search was conducted, and according to the PRISMA guidelines, 28 articles out of 1834 met the inclusion criteria. The pooled data analysis highlighted the superior efficacy of targeted therapy, evidenced by a significant improvement in the mOS and lower hazard ratios in patients with lung and breast cancers who received targeted therapy compared to those who did not. Our study provides valuable insights into the recent advancements in the medical management of metastatic spinal tumors. Future indications include incorporating this literature into personalized treatment approaches for metastatic spinal tumors.

Chronic lateral knee pain after uneventful total knee arthroplasty can be challenging to manage. We present 3 cases where the pain transiently resolved with injections of local anesthetic. Diagnostic arthroscopy revealed cement protrusion at the lateral femoral bone-prosthesis interface. Passive full knee extension during the curing phase is routine to ensure cement pressurization and optimal bonding. This may enable cement extrusion at the lateral femoral interface and result in persistent pain. Therefore, prevention measures should include thorough visualization of the implant after cementing. Arthroscopic cement excision en bloc is a minimally invasive procedure to treat these patients.