**1. Introduction**

Spinal cord involvement due to vertebral metastases is a frequent complication in cancer patients and metastatic lesions of spine can significantly condition their quality of life, potentially producing untreatable pain, vertebral fractures, or even neurological deficit due to spinal cord or radicular involvement [1, 2]. Spinal metastases are likely to increase their incidence because patients with cancer today can live longer, due to early detection, as well as to improvements in cancer treatment and care [3]. These lesions should be considered and treated both medically or surgically to prevent undesired sequelae, and to preserve or, whenever possible, improve the quality of their residual life [4, 5].

The spine is the third most common site for cancer cells to metastasize, following the lungs and the liver. Almost 70% of cancer patients are expected to have spinal metastasis. In case of symptomatic lesions, the majority (60–70%) are found in the thoracic region, while of the remainder, 20% are found in the lumbar region, and 10% are found in the cervical spine. More than 50% of patients with spinal metastasis have more than one level involved [6, 7].

Surgery of spinal metastases cannot be curative, but only palliative, aimed to preserve or, whenever possible, improve quality of life for patients with short- or mid-term life expectan‐ cy. In such cases, surgery is indicated for the stabilization of involved segments, for spinal cord or root decompression, and for tissue diagnosis.

In the optic of reducing post-operative morbidity and accelerate the post-operative recovery, minimally invasive spine surgery (MISS) may represent the best option to achieve equiva‐ lent or superior outcomes to those of traditional open spine surgery, and to reduce the impact of surgery on critical patients with poor general and neurological conditions with short- or mid-term life expectancy.
