Global trends in the utilisation of NOMS framework for spinal metastasis management: A systematic review

Introduction: Traditional risk stratification systems based on the clinicopathological criteria have limitations and may not accurately predict outcomes for all patients. The neurologic, oncologic, mechanical, and systemic (NOMS) framework aims to optimise treatment outcomes and improve patient care. Here, we aimed to provide a comprehensive overview of the NOMS framework within the context of spinal metastasis. Materials and Methods: The study rigorously followed the guidelines set by PRISMA. We conducted an extensive search and be as transparent as possible across well-regarded databases such as PubMed and Euro PMC. The primary outcome measure focused on examining the feasibility of implementing the NOMS framework for patients with spinal metastasis in real-world clinical settings, and this measure was predefined and justified. Results: This systematic review included three studies involving 300 participants with spinal metastases at the cervicothoracic junction. The studies examined surgical interventions like decompression, fusion and corpectomy within the NOMS framework. Across the studies, the NOMS approach is consistently associated with adverse outcomes, including complication rates, surgical revisions, hardware complications, deformities, tumour recurrence and variable survival rates. It is also linked to hospital stays, ICU durations and specific discharge statuses. Another study focused on spinal metastasis patients undergoing endoscopic surgery, highlighting the NOMS framework's connection to recurrence rates, performance metrics, neurological status, pain management, functional recovery and quality of life. In addition, other studies explored navigated instrumentation, with a primary focus on screw placement accuracy. All three studies demonstrated methodological rigor by reporting adequate allocation concealment. Conclusion: NOMS framework consistently associates with adverse spinal metastasis surgery outcomes.