A Comparative Study Between Minimally Invasive Spine Surgery and Traditional Open Surgery for Patients with Spinal Metastasis.

STUDY DESIGN A retrospective study was conducted. OBJECTIVE This study aims to compare the perioperative outcomes of minimal invasive spine surgery (MISS) and traditional open surgery (TOS) for thoracolumbar spine metastasis. SUMMARY OF BACKGROUND DATA TOS for metastatic spinal tumors has many disadvantages, such as significant blood loss and high complication rate. MISS may change the treatment modality, but its safety and efficacy for spinal metastasis is lack. METHODS We retrospectively reviewed clinical data from 154 consecutive patients registered in our institute who underwent separation surgery for spinal metastases from January 2017 to December 2019. 49 patients received MISS and 105 patients had TOS. The demographic and perioperative data were collected and compared between two approaches. RESULTS There were no significant differences in baseline characteristics between the MISS and TOS group, except the gender (P = 0.04). The mean intraoperative blood loss in MISS group was lower than that in TOS group (748.57 vs. 950.48 mL, P = 0.039). The operative time was comparable between both groups (mean 213.45 vs. 221.03 mins, P = 0.78). The post-operative drainage before discharge in MISS group was remarkably less than that in TOS group (mean 494.02 vs. 1099.10 mL, P = 0.0004). As compared to TOS group, patients in MISS group had lower complication rate, although the difference is not significant (9.52% vs. 6.12%, P = 0.55). The infection rate of MISS group was two-fold lower than that in the TOS group, although the difference is not significant (P = 0.43). The mean hospital stay of MISS group is 7.35 days, which is significantly shorter than TOS group (9.94 days, P = 0.0007). Patients in both groups exhibited similar postoperative neurological outcomes. CONCLUSIONS MISS is a safe and effective technique that could be considered the optimal treatment for patients with spinal metastasis and myelopathy and thus is an excellent alternative in managing thoracolumbar spine metastasis. LEVEL OF EVIDENCE 3.