Very few studies provide clear long-term results after anterior decompression-stabilization for vertebral metastases. When they do, they fall into two groups: a first group, claiming about 80% of favorable and lasting neurological results, and a second group, which admits progressive deterioration, sometimes after an initial improvement. The present series belongs to the second group. It consists of 22 patients, 17 of whom underwent anterior surgery. Laminectomy was not performed (except one hemilaminectomy at C6). The reason for the divergent results is not immediately clear. A plea is made for a universal scoring system, to be used at regular intervals, which might provide a more objective look at the results. Last but not least, radiation therapy should always be considered first.