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

Pennington, Zach; Ahmed, A. Karim; Molina, Camilo A.; Ehresman, Jeffrey; Laufer, Ilya; Sciubba, Daniel M.

doi:10.21037/atm.2018.01.28

Cited by 73 publications

(49 citation statements)

References 81 publications

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“…In this study, 460 (79.31%) patients received palliative surgery including 290 posterior laminectomy, 155 subtotal corpectomy, and 15 subtotal corpectomy combined with microwave ablation and vertebroplasty. Most of them presented severe pain and spinal instability but the general conditions were good with KPS score more than 60 and Frankel score in D and E. The revised Tokuhashi score have suggested that surgery only be considered in patients with a life expectancy of more than 6 months, meaning that patients, especially those with aggressive primary tumor metastasis, are ineligible for surgical symptom palliation. However, in this multicenter case series, lung cancer was the most common metastasis, as seen in 198 patients.…”

Section: Discussionmentioning

confidence: 84%

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Patient Characteristics Following Surgery for Spinal Metastases: A Multicenter Retrospective Study

Yang

Wang

Zhang

et al. 2019

Orthopaedic Surgery

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ObjectivesTo summarize the epidemiological characteristics of patients following surgery for spinal metastases retrospectively and make a univariate analysis to identify independent variables that could affect the operation decision making.MethodsThis was a multicenter retrospective review of patients with spinal metastasis who were treated with surgery from 1 January 2007 to 31 July 2019. Basic clinical data were analyzed retrospectively by univariate analysis to identify independent variables that could affect the decision of operation modalities, including gender, age, spinal metastatic site, Frankel score, Karnofsky performance score (KPS), spinal instability neoplastic score (SINS), visual analogue scale (VAS), Tokuhashi score, urinary and fecal incontinence, spinal pathological fracture, primary tumor, extraspinal metastasis, visceral metastasis, and bone lesion (osteolytic, osteoblastic or mixed).ResultsA total of 580 patients including 332 males and 248 females were enrolled in the study with an average age of 58.26 years old (range, 13–86 years old). The most common spinal metastatic level was the thoracic vertebra (190 [32.76%]), followed by the lumbar vertebra (146 [25.17%]), cervical vertebra (47 [8.10%]), and sacral vertebra (35 [6.03%]). Metastases involving more than two sites of the cervical, thoracic, lumbar, and sacral vertebrae arose in 162 (27.93%) patients. For primary tumor, there were 198 (34.14%) cases of lung cancer, 41 (7.07%) cases of kidney cancer, 39 (6.72%) cases of breast cancer, 38 (6.55%) cases of gastrointestinal cancer, 35 (6.03%) cases of lymphoma and myeloma, 25 (4.31%) cases of prostate cancer, 24 (4.14%) cases of liver cancer, 23 (3.97%) cases of mesenchymal tissue sarcoma, 20 (3.45%) cases of thyroid cancer, and 84 (14.48%) cases were tumor with unknown origin. Sixty‐three (10.86%) patients received minimally invasive surgery, 460 (79.31%) patients received palliative surgery, and the remaining 57 (9.83%) received tumor resection. According to the univariate analysis, the KPS score, SINS score, VAS score, Tokuhashi score, urinary and fecal incontinence, spinal pathological fracture, and bone lesion (osteolytic, osteoblastic or mixed) were independent and favorable factors affecting the surgery modalities.ConclusionsSurgical treatment for spinal metastases was mainly to relieve pain, rebuild spinal stability, improve nerve function, control local tumors, and improve the quality of life of patients. For middle‐aged and elderly patients with good general conditions, severe pain, spinal pathological fracture, spine instability and without urinary and fecal incontinence, early surgical treatment should be actively carried out.

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Section: Discussionmentioning

confidence: 84%

“…Unlike primary spinal tumors, the goal of surgery for spinal metastases is not cure but an overwhelming improvement of symptoms . That is to say, surgeons must consider the patients’ overall health, as well as the imaging examination of the vertebral metastases.…”

Section: Discussionmentioning

confidence: 99%

Patient Characteristics Following Surgery for Spinal Metastases: A Multicenter Retrospective Study

Yang

Wang

Zhang

et al. 2019

Orthopaedic Surgery

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“…Two recent systematic reviews have compared minimal access surgery with open surgery in patients suffering from MSCC (7,8). Lu et al included six cohort studies (three prospective and three retrospective) representing a total of 252 patients (19)(20)(21)(22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

Minimal Accessvs.Open Spine Surgery in Patients With Metastatic Spinal Cord Compression - A One–Center Randomized Controlled Trial

et al. 2020

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Background/Aim: We conducted a randomized controlled trial to investigate whether minimally access spine surgery (MASS) is less morbid than open surgery (OS) in patients with metastatic spinal cord compression (MSCC). Patients and Methods: A total of 49 MSCC patients were included in the trial. The outcome measures were bleeding (L), operation time (min), re-operations and prolonged wound healing. Results: The median age was 67 years (range=42-85 years) and 40% were men. The peri-operative blood loss in the MASS-group was significantly lower than that in the OS-group; 0.175L vs. 0.500L, (p=0.002). The median operation time for MASS was 142 min (range=72-203 min) vs. 103 (range=59-435 min) for OS (p=0.001). There was no significant difference between the two groups concerning revision surgery or delayed wound healing. Conclusion: The MASS technique in MSCC patients is associated with less blood loss, but a longer operation time when compared to the OS technique. In recent years, an increasing number of cancer patients develop symptomatic metastatic spinal cord compression (MSCC). This is most likely a result of the advancement in cancer treatment and prolonged survival among cancer patients in general (1, 2). The optimal treatment for MSCC patients is considered to be surgery in combination with radiation therapy (3, 4). However, the majority of patients are not recommended surgical treatment due to poor health and relatively short survival time, which means that they cannot withstand large surgical procedures (5, 6). Minimally access spine surgery (MASS) is considered less morbid than open surgery (OS), and results in fewer wound complications and less bleeding. The existing evidence for bleeding in minimal versus open surgery from observational studies is gathered in two recently published reviews by Pennington and colleagues and by Lu and colleagues. The conclusions were that "The overall quality of evidence currently available is low-all evidence is currently class III or IV" (7, 8). With this clinical trial we aimed to examine the perioperative bleeding, surgery time and number of revisions of MASS compared with conventional OS in the treatment of patients with MSCC. The hypothesis of the study was that MASS results in significantly less blood loss, shorter surgery time and fewer revisions when compared to open surgery. Patients and Methods Study population. The study includes MSCC patients admitted to Rigshospitalet, Denmark from January 1 st , 2014 to January 1 st , 2017. The hospital serves a population of 2.3 million people from the eastern part of Denmark. The MSCC diagnosis was based on magnetic resonance imaging (MRI) in combination with clinical symptoms such as back pain and/or neurological impairment. Patients with MSCC between T5 to L3 where included. Patients with Tokuhashi score ≤4, in need of sacral or iliosacral instrumentation, and patients who were candidates for a corpectomy were excluded. All patients were included in the study at referral and information regarding age, sex, primary oncolog...

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“…W ith the developments of the social economy and medical technology, the survival time of cancer patients is significantly prolonged 1 . The spine is the most common bone metastasis site in cancer patients 2 . In the United States, more than one million cancer patients suffer from spinal metastasis each year, of which approximately 70% are in the thoracic vertebrae, 20% are lumbar vertebrae, and 10% are cervical vertebrae 3,4 .…”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive Pedicle Screw Fixation Combined with Percutaneous Kyphoplasty Under O‐Arm Navigation for the Treatment of Metastatic Spinal Tumors with Posterior Wall Destruction

Zhou

Wang

Xiao

et al. 2020

Orthopaedic Surgery

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Objective To evaluate the safety and efficacy of O‐arm‐guided minimally invasive pedicle screw fixation combined with percutaneous kyphoplasty for metastatic spinal tumors with posterior wall destruction. Methods Patients who underwent minimally invasive pedicle screw fixation combined with percutaneous kyphoplasty for pathological vertebral fractures with posterior wall defects from January 2015 to December 2017 were followed up for 1 year. Visual analogue scale (VAS), SF‐36 scores, middle vertebral height, posterior vertebral height, and the accuracy of pedicle screws were assessed preoperatively, postoperatively, and 1 year after surgery. The operation time, time from operation to discharge, blood loss, volume of bone cement, and leakage of bone cement were recorded. Results Twenty‐three patients (13 females and 10 males) who met our criteria were followed up for 1 year. The operation time of these patients was 162.61 ± 33.47 min, the amount of bleeding was 230.87 ± 93.76 mL, the time from operation to discharge was 4.35 ± 2.42 days, and the volume of bone cement was 3.67 ± 0.63 mL. The VAS score decreased from 7.04 ± 1.07 to 2.65 ± 0.93 before surgery (P = 0.000) and remained at 2.57 ± 0.79 1 year after surgery. Compared with the preoperative SF‐36 scores for physical pain, physiological function, energy, and social function, the postoperative scores were significantly improved (P = 0.000). The height of the middle vertebral body increased from 14.47 ± 2.96 mm before surgery to 20.18 ± 2.94 mm (P = 0.000), and remained at 20.44 to 3.01 mm 1 year after surgery. The height of the posterior vertebral body increased from 16.56 ± 3.07 mm before operation to 22.79 ± 4.00 mm (P = 0.000), and 22.45 ± 3.88 mm 1 year after surgery. The 23 patients had a total of 92 pedicle screws; 85 screws were Grade A and 7 screws were Grade B. There was no leakage of bone cement after surgery. Conclusion In the short term, O‐arm‐guided minimally invasive pedicle screw fixation combined with kyphoplasty is safe and effective in the treatment of metastatic spinal tumors with posterior wall destruction.

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

Cited by 73 publications

References 81 publications

Patient Characteristics Following Surgery for Spinal Metastases: A Multicenter Retrospective Study

Patient Characteristics Following Surgery for Spinal Metastases: A Multicenter Retrospective Study

Minimal Accessvs.Open Spine Surgery in Patients With Metastatic Spinal Cord Compression - A One–Center Randomized Controlled Trial

Minimally Invasive Pedicle Screw Fixation Combined with Percutaneous Kyphoplasty Under O‐Arm Navigation for the Treatment of Metastatic Spinal Tumors with Posterior Wall Destruction

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