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Objectives and questions: The study aims to evaluate the efficacy of stereotactic radiosurgery in the management of spinal metastases in terms of local tumor control, patient survival, and quality of life, identifying both advantages and limitations of SRS.

Material and methods: A systematic literature search was performed in PubMed with cross-referencing according to the recommendations of PRISMA. Relevant full-text-available articles published in English or German between 2012 and 2022 were included. The search string used was “metastatic spine diseases AND SRS OR stereotactic radiosurgery”.

Results: There is growing evidence that SRS is a precise and effective treatment. It has demonstrated an efficacy of 90% for pain control and 72–90% for local tumor control. SRS offers palliative benefits and may influence survival outcomes in selected cases. SRS delivers high doses of radiation while minimizing exposure to critical neural structures, providing benefits such as pain relief, limited tumor growth, and a low complication rate, even for tumors resistant to traditional radiation therapies. SRS can be a primary treatment for certain metastatic cases, particularly those without spinal cord compression. However, it is not appropriate for patients with multiple spinal levels involved, spinal instability and reirradiation. Factors that influence potential complications, such as radiation-induced myelopathy, vertebral compression fractures and radiation-induced toxicity, include tumor size, location, radiation dose, and overall patient health.

Discussion and conclusions: This study highlights SRS as a highly effective modality for the treatment of pain caused by spinal metastases, achieving high rates of pain control with rapid onset. Local control rates vary depending on factors such as prior radiotherapy and tumor histology, emphasizing the need for individualized treatment planning. SRS appears to be a preferred option for oligometastasic and radioresistant lesions in the absence of contraindications. Key challenges include dose optimization, radiation-related-toxicity and post-treatment vertebral fractures. Further research is needed to refine treatment protocols, determine optimal radiation dose and fractionation schemes, and assess the long-term effects of SRS on neural structures.