Objective: Intradural spinal metastases are considered rare. At present, limited information
is available on incidence, surgicalmanagement, and outcomes. Methods: We conducted a retrospective
patient chart review from 2002 to 2024, identifying all patients surgically treated for intradural spinal
metastases. Clinical, surgical and survival data were collected and compared to literature data for
patients surgically treated for extradural spinal metastases. Results: A total of 172 patients with
spinal metastases were identified with 13 patients meeting inclusion criteria (7.6%). The mean age
at diagnosis of intradural spinal metastases was 52 ± 22 years, with diverse primaries including
lung (n = 3), breast (n = 2), sarcoma (n = 2), and six unique entities. Intradural spinal metastasis
was diagnosed on average of 3.3 years after primary diagnosis. In total, we observed five (38%)
intradural-extramedullary and eight (62%) intramedullary metastases, located in the cervical (38.5%),
thoracic (46.1%) and lumbar spine (15.4%). The most common preoperative symptoms were pain,
sensory changes, and gait ataxia (each 76.9%). Gross total resection was achieved in 54%, and local
tumor control in 85%. Postoperatively, 92% exhibited clinical improvement or stability. Most frequent
adjuvant treatment was radio- and/or chemotherapy in 85%. The average survival after operation for
spinal intradural metastases was 5 months, ranging from 1 month to 120 months. The location of the
intradural metastasis in the cervical spine was associated with a significantly more favorable survival
outcome (compared to thoracic/lumbar location, p = 0.02). Conclusions: Intradural location of spinal
metastases is rare (7.6%). Even so, surgical resection is safe and effective for neurological improvement,
and survival appears lower compared to the reported survival of extradural spinal metastases.