From Primary to Spine: A Collaborative Surgical Framework for Breast Cancer with Spinal Metastases

Abstract: Background: Breast cancer is the most common malignancy in women worldwide, and the spine is the most frequent site of skeletal metastasis, occurring in up to 70% of patients with metastatic disease. The clinical presentation is often insidious — patients may present first to a neurosurgeon with axial back pain, radiculopathy, or frank myelopathy, without any prior breast cancer diagnosis. This bidirectional clinical reality necessitates a structured collaborative framework between the breast oncosurgeon and neurosurgeon. Objective: This review defines the complementary and interdependent roles of the breast oncosurgeon and neurosurgeon in the detection, evaluation, surgical planning, and postoperative management of breast cancer spinal metastases. We propose an evidence-based collaborative surgical framework applicable in multidisciplinary oncology settings. Methods: A narrative review of peer-reviewed literature published between 2000 and 2024 was conducted using PubMed, Scopus, and Web of Science databases. Search terms included "breast cancer spinal metastases," "neurosurgery breast oncology collaboration," "separation surgery," "NOMS framework," "SINS score," and "multidisciplinary spine oncology." Fifty-five relevant articles were identified and synthesized. Results: Breast cancer spinal metastases exhibit molecularly driven heterogeneity. The Spinal Instability Neoplastic Score (SINS) and the Neurological-Oncological-Mechanical-Systemic (NOMS) framework provide evidence-based surgical thresholds. Surgical indications encompass epidural spinal cord compression, spinal instability, radioresistant disease, intractable pain, and diagnostic uncertainty. A collaborative surgical framework — incorporating structured referral criteria, multidisciplinary tumor board (MDT) protocols, systemic therapy integration, and radiation sequencing — improves time-to-surgery and neurological outcomes. Conclusion: Breast cancer reaches beyond the breast. An integrated, protocol-driven collaboration between the breast oncosurgeon and neurosurgeon optimizes patient outcomes across all phases of metastatic spinal disease. Standardized referral pathways, shared MDT platforms, and surgical sequencing algorithms are essential to this collaboration. Keywords: Breast cancer; spinal metastases; collaborative framework ; multidisciplinary team; NOMS; SINS; epidural spinal cord compression. Title: From Primary to Spine: A Collaborative Surgical Framework for Breast Cancer with Spinal Metastases Author: Dr. Richa Rani, Dr. Saurabh Patel International Journal of Healthcare Sciences ISSN 2348-5728 (Online) Vol. 14, Issue 1, April 2026 - September 2026 Page No: 360-371 Research Publish Journals Website: www.researchpublish.com Published Date: 27-June-2026 DOI: https://doi.org/10.5281/zenodo.20958997 Paper Download Link (Source) https://www.researchpublish.com/papers/from-primary-to-spine-a-collaborative-surgical-framework-for-breast-cancer-with-spinal-metastases