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An increasing number of people are diagnosed with spinal metastases. This creates a need for care that is both more efficient and better tailored to each individual patient. This thesis explores several new techniques to improve treatment for these patients.

One key focus is predicting life expectancy. Twelve existing prediction models were tested in nearly a thousand patients. Four models performed reasonably well, but most underestimated how long patients would live. These models are outdated and need to be revised.

Another focus is pain relief through radiation therapy. Two types of radiation were compared. Both reduced pain equally well, but patients treated with the newer method (stereotactic radiation) were more likely to experience complete pain relief. More research is needed to find out which groups of patients benefit most from this approach.

The use of imaging during surgery was also studied. With 3D imaging, surgeons can better assess how spinal screws are placed. This can help detect mistakes but may also lead to unnecessary changes when the screws are already placed correctly. New surgical navigation systems also help surgeons place screws more precisely and use less invasive techniques. The systems tested in this thesis showed promise, but need further development before they can be used safely in real surgeries.

This thesis provides new insights that may help make care for patients with spinal metastases more personalized, safer, and more effective.