Development of surgical methods and elaboration of approaches to the spine have made surgery feasible for most metastatic processes in the spine. However, delayed determination of the correct diagnosis and thus late initiation of adequate treatment remain the limiting factors for successful treatment. In our group of 69 patients, local back pain was the initial symptom in 81 % of patients and preceded the determination of diagnosis of metastatic spine disease on average by 11 weeks. The development of neurological deficit directly depends on the degree of spinal compression. At the time of diagnosis of metastatic spine disease, 70 % of patients had manifest neurological symptoms that had developed for an average of 15 days. The ability to walk at treatment onset is the most important prognostic factor in metastatic involvement of the spine. In the studied group at the time of diagnosis, 55 % of patients were confined to bed for a neurological deficit and had been unable to walk for an average of 5 days. Analysis of our group indicates that graphical determination of diagnosis of metastatic spine disease was often made late, even when symptoms of spinal compression had been clearly expressed for several days. The diagnosis must be based both on patient history of malignant neoplasm and on detailed clinical examination. Radiological imaging methods facilitate exact determination of the location and extent of metastatic disease in the spine. MRI is today considered the examination of choice when spinal metastasis is suspected. It is necessary to increase the awareness of physicians and right at suspicion of metastatic spine disease, expedite the use of diagnostic methods to determine the diagnosis. This represents the only way to satisfactory results and prevention of the devemetastaticlopment of irreversible neurological changes. In the presence of a severe preoperative neurological deficit, even surgical decompression of the spine often does not succeed in substantial improvement of motor deficit in the limbs.

        Key words: spinal metastases, spinal compression, late diagnosis