I have carefully read the comments of Kehayov et al. Of course, I would like to add some comments and clarifications.

Among patients with vertebral metastases, lung cancer is considered as one of the most unfavourable, with a higher complication rate, due to an often-altered general condition and associated comorbidities [1, 2]. As a result, a selective analysis appeared to us to be necessary.

We adopted a pragmatic analysis to assess the benefit of surgery for lung cancer patients with symptomatic vertebral metastasis. Half of the operated patients had «really» benefited from the surgery, i.e. by fulfilling the four proposed criteria: absence of major complication, restoration of mechanical stability, improvement in pain and preservation (or restoration) of ambulatory status. The interpretation of these results (more detailed in the article) is of course up to the interpretation of each team. However, we must not forget that surgery induces side effects, and delays the initiation of anti-cancer treatments, especially when a complication occurs.

Of course, we continue to surgically treat vertebral metastases in patients with lung cancer. Our indications are stricter, retained during a multidisciplinary evaluation and guided by the opinion of the referring oncologist [3].

Note that this study, published in 2016, included patients operated from January 2005 to December 2011.

As stated by Kehayov et al., more recent minimally invasive procedures allowed to decrease procedure-related complications and to reduce the soft tissues healing time, in order to not delay excessively oncologic treatments. We also published some papers on that topic [4].

The prognosis of lung cancer (like others) has progressed in recent years, since the discovery of new genetic mutations, making it possible to propose new targeted therapies.

These medical and surgical improvements encourage us to reassess the place of surgery, but keeping a "pragmatic" analysis of the real functional benefit.