Separation Surgery Followed by Stereotactic Ablative Body Radiotherapy (SABR) Versus SABR Alone for Spinal Metastases

Inclusion Criteria: * Diagnosis of a solid malignant tumour (preferentially histologically proven;alternatively obtained by spinal surgical procedure) * Age 18 years or older * Histological, radiological or scintigraphical evidence of spinal metastasis (no limitation in the number of sites of metastases) * Spinal instability neoplastic score (SINS) \<13 (i.e. no need for stabilisation of the spine) (see Appendix 6) * Spinal metastasis with MESCC: ESCC grade 1c, 2 and 3 (see Appendix 7) * Ambulatory: being able to walk 10m without aid or with aid (cane, rollator, one persons help). * Life expectancy estimated to be at least 3 months. * World Health Organization (WHO) Performance Status of 0-2 (some help) (see Appendix 3) * Patient has given written informed consent. Exclusion Criteria: * Contra indication for MRI scan (e.g. pacemaker) * Previous RT or surgery at the level of the affected vertebrae * Non-solid primary tumours (e.g. lymphoma, multiple myeloma, germ cell tumours) * Non ambulatory at presentation * More than 3 affected vertebrae in one target site * More than 2 treatment sites * SINS ≥ 13 (unstable spine)