Related Experiment Video
Updated: Mar 18, 2026
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
Metastatic Spine Tumor Surgery: A Comparative Study of Minimally Invasive Approach Using Percutaneous Pedicle Screws
Naresh Kumar1, Rishi Malhotra, Karthikeyan Maharajan
1Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore.
Study Design:
Prospective cohort study.
Summary Of Background Data:
Minimally invasive spinal surgery (MISS) has been gaining recognition in patients with metastatic spine disease (MSD). The advantages are reduction in blood loss, hospital stay, and postoperative morbidity. Most of the studies were case series with very few comparing the outcomes of MISS to open approaches.
Objective:
To evaluate and compare the clinical and perioperative outcomes of MISS versus open approach in patients with symptomatic MSD, who underwent posterior spinal stabilization and/or decompression.
Patients And Methods:
Our study included 45 MSD patients; 27 managed by MISS and 18 by open approach. All patients had MSD presenting with symptoms of neurological deficit, spinal instability, or both. Preoperative, intraoperative, and postoperative data were collected for comparison of the 2 approaches. All patients were followed up until the end of study period (maximum up to 4 years from time of surgery) or till their demise. The clinical outcome measures were pain control, neurological and functional status, whereas perioperative outcomes were blood loss, operative time, length of hospital stay, and time taken to initiate radiotherapy/chemotherapy after index surgery.
Results:
Majority of patients in both groups showed improvement in pain, neurological status, independent ambulation, and ECOG score in the postoperative period with no significant differences between the 2 groups. There was a significant reduction in intraoperative blood loss (621 mL less, P<0.001) in the MISS group. The average time to initiate radiotherapy after surgery was 13 days (range, 12-16 d) in MISS and 24 days (range, 16-40 d) in the open group. This difference was statistically significant (P<0.001). Operative time and duration of hospital stay were also favorable in the MISS group, although the differences were not significant.
Conclusions:
MISS is comparable with open approach demonstrating similar improvements in clinical outcomes, that is pain control, neurological and functional status. MISS approaches have also shown promising results due to lesser intraoperative blood loss and allowing earlier radiotherapy/chemotherapy.
Insights
Minimally invasive spinal surgery (MISS) offers similar clinical outcomes to open surgery for metastatic spine disease (MSD). MISS shows advantages in reduced blood loss and earlier initiation of radiotherapy/chemotherapy.
Area of Science:
- Spinal Surgery
- Oncology
- Neurosurgery
Background:
- Metastatic spine disease (MSD) is a growing concern.
- Minimally invasive spinal surgery (MISS) is increasingly recognized for potential benefits.
- Limited comparative studies exist between MISS and open approaches for MSD.
Purpose of the Study:
- To compare clinical and perioperative outcomes of MISS versus open surgery in MSD patients.
- To evaluate posterior spinal stabilization and/or decompression efficacy.
- To assess pain control, neurological function, and recovery metrics.
Main Methods:
- Prospective cohort study of 45 MSD patients.
- Comparison between 27 MISS patients and 18 open surgery patients.
- Data collection included preoperative, intraoperative, and postoperative parameters, with follow-up up to 4 years.
Main Results:
- Both MISS and open approaches yielded similar improvements in pain, neurological status, and functional scores.
- MISS demonstrated significantly less intraoperative blood loss (P<0.001).
- Radiotherapy/chemotherapy initiation was significantly earlier after MISS (13 days vs. 24 days, P<0.001).
Conclusions:
- MISS provides comparable clinical outcomes to open surgery for MSD.
- MISS is associated with reduced blood loss and facilitates earlier adjuvant cancer treatment.
- MISS represents a viable and potentially advantageous surgical option for MSD management.
