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Review
. 2018 Mar;6(6):103.
doi: 10.21037/atm.2018.01.28.

Minimally invasive versus conventional spine surgery for vertebral metastases: a systematic review of the evidence

Zach Pennington  1 , A Karim Ahmed  1 , Camilo A Molina  1 , Jeffrey Ehresman  1 , Ilya Laufer  2   3 , Daniel M Sciubba  1
Affiliations
Review

Minimally invasive versus conventional spine surgery for vertebral metastases: a systematic review of the evidence

Zach Pennington et al. Ann Transl Med. 2018 Mar.

Abstract

One of the major determinants of surgical candidacy in patients with symptomatic spinal metastases is the ability of the patient to tolerate the procedure-associated morbidity. In other pathologies, minimally invasive (MIS) procedures have been suggested to have lower intra-operative morbidity while providing similar outcomes. We conducted a systematic review of the PubMed library searching for articles that directly compared the operative and post-operative outcomes of patients treated for symptomatic spinal metastases. Inclusion criteria were articles reporting two or more cases of patients >18 years old treated with MIS or open approaches for spinal metastases. Studies reporting results in spinal metastases patients that could not be disentangled from other pathologies were excluded. Our search returned 1,568 articles, of which 9 articles met the criteria for inclusion. All articles were level III evidence. Patients treated with MIS approaches tended to have lower intraoperative blood loss, shorter operative times, shorter inpatient stays, and fewer complications relative to patients undergoing surgeries with conventional approaches. Patients in the MIS and open groups had similar pain improvement, neurological improvement, and functional outcomes. Recent advances in MIS techniques may reduce surgical morbidity while providing similar symptomatic improvement in patients treated for spinal metastases. As a result, MIS techniques may expand the pool of patients with spinal metastases who are candidates for operative management.

Keywords: Minimally invasive (MIS) surgical procedures; neoplasm metastasis; neoplasms; spine.

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Conflict of interest statement

Conflicts of Interest: AK Ahmed: Neurosurgery Research & Education Foundation Medical Student Summer Research fellow; CA Molina: consultant for Augmedics; I Laufer: consulting fees from BrainLab, DePuy/Synthes, SpineWave, Medtronic, and Globus; DM Sciubba: consultant for DePuy-Synthes, Medtronic, K2M, Globus, and Orthofix. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
PRISMA statement summarizing collection of articles related to the primary research questions.
Figure 2
Figure 2
Pre-operative imaging in a 55-year-old breast cancer patient presenting with mechanical back pain demonstrating (A) greater than 50% collapse of the central vertebral body, (B) grade 1c epidural cord compression, and (C,D) bilateral pedicular involvement.
Figure 3
Figure 3
Post-operative results following treatment with T10 vertebroplasty and short-segment percutaneously-placed pedicle screw instrumentation. L, left.
See this image and copyright information in PMC

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